Seeing is Believing: Cutting-Edge Technologies Transforming Ophthalmology

Miguel Angel Ariza-Gracia ^1* Vijayavenkataraman Sanjairaj ² Philippe Büchler ¹

• ¹ ARTORG Center for Biomedical Engineering Research, Faculty of Medicine, University of Bern, Bern, Switzerland
• ² New York University Abu Dhabi, Abu Dhabi, United Arab Emirates

The introduction of corneal cross-linking (CXL) for treating keratoconus has already proved revolutionary, with potential applications extending to non-invasive treatment of other refractive conditions such as myopia and hyperopia. However, as demonstrated in the study by Frigelli et Coherence Elastography) [1], the full potential of this therapy is only beginning to be realized.Utilizing optical coherence elastography (OCE), the study offers new insights into the biomechanical changes in the cornea during treatment and how the refractive changes are related to the biomechanical stiffening of the cornea.The ability of OCE to measure axial elongation and stiffness in treated corneal regions marks a significant step toward personalized medicine. The study highlights that tailoring the energy delivery during CXL and modifying irradiation patterns can enable patient-specific refractive corrections. For example, it was found that CXL treatment with high energy delivery can lead to a 2.4-fold increase in refractive correction compared to standard treatments. These findings open up the possibility of optimizing therapies for individual patients based on their unique corneal structures and needs.Beyond immediate clinical applications, this study raises broader questions about corneal therapy. As our understanding of the interplay between corneal biomechanics and optics deepens, we can envision non-invasive, highly targeted solutions that not only halt the progression of keratoconus but also improve the optical performance of the cornea. However, challenges persist in achieving widespread clinical adoption, standardizing treatment protocols, and refining patient selection criteria. This shift towards personalized refractive correction represents a paradigm shift in ophthalmology, placing the patient at the heart of innovation. The study underscores the benefits of 3D systems in enhancing surgical precision and efficiency. By providing high-resolution stereoscopic views and better spatial orientation, 3D systems reduce surgical time and improve outcomes, as demonstrated by the shorter membrane removal time in the 3D systems group. Additionally, these systems alleviate surgeon fatigue through ergonomic improvements, making complex procedures less taxing and increasing the sustainability of high-volume surgical workloads.The implications of 3D systems extend beyond Proliferative Diabetic Retinopathy (PDR) surgeries. As adoption grows, their potential to improve outcomes in cataract surgery, macular hole repair, and other vitreoretinal procedures are expected to become increasingly apparent. Furthermore, these systems hold immense potential as surgical training tools, offering trainees unparalleled clarity and detail compared to traditional systems. Despite these advantages, challenges such as high cost of implementation and the learning curve for surgeons associated with transitioning from traditional microscopy remain. Nonetheless, the integration of 3D technology marks a significant leap forward in modernizing ophthalmic surgery and improving patient outcomes. The study shows that low-energy femtosecond lasers, such as the FEMTO LDV, produce smoother cut surfaces and cause less disruption to collagen morphology than high-energy systems. These findings are significant because smoother surfaces directly correlate with faster visual recovery and reduced post-operative complications. Additionally, the use of electronbeam irradiated corneas, which can be stored at room temperature for extended periods, addresses longstanding logistical challenges in corneal storage and transplantation.The implications for stromal keratophakia and refractive surgery are profound. By ensuring better tissue quality and minimizing surgical trauma, these advances could lead to more predictable outcomes and broaden access to vision-restoring procedures. However, further evaluation of scalability and cost-effectiveness is necessary to facilitate widespread clinical adoption.Early detection and treatment of amblyopia and its risk factors, such as strabismus and refractive error, are crucial to prevent long-term vision loss. However, conventional methods, including stereovision tests, often fall short in terms of sensitivity and scalability. The work of Comparison with Four Classic Stereovision Tests) [4] introduces an AI-based solution that not only addresses these challenges but also sets a new standard for vision screening.Their AI-based model integrates several non-stereoacuity-based tests, achieving higher sensitivity and specificity compared to classical stereovision tests such as Lang II and TNO.Particularly noteworthy is the study's use of an AI algorithm to synthesize test results, leveraging the strengths of individual assessments while compensating for their limitations.An AI-driven, cost-effective screening tool could make early vision screening accessible even in resource-constrained environments. By reducing dependence on highly trained specialists, such solutions democratize healthcare and ensure that more children receive timely diagnoses and interventions. However, concerns about algorithm transparency, data privacy, and regulatory approval must be addressed to facilitate widespread adoption. As AI technology continues to evolve, its applications in detecting other ophthalmic conditions, from glaucoma to diabetic retinopathy, are likely to expand, solidifying its place as an indispensable tool in modern ophthalmology.The studies presented in this issue exemplify the transformative potential of technology in ophthalmology. They illustrate a field where innovation is not an end but a means to improve patient care. From the precision of optical coherence elastography in corneal cross-linking to the immersive clarity offered by 3D surgical systems, and from the meticulous craftsmanship of femtosecond lasers to the diagnostic prowess of artificial intelligence, each advancement represents a significant step toward a future where visual disorders are not merely managed but anticipated and resolved with unparalleled precision.