Sebag J, Sadun Alfredo A, Pierce Eric A
Dr. Sebag: VMR Institute for Vitreous Macula Retina, Huntington Beach, CA; Dr. Sadun: Doheny Eye Institute/UCLA, Los Angeles, CA; Dr. Pierce: Ocular Genomics Institute, Massachusetts Eye and Ear Infirmary, Harvard Medical School.
Trans Am Ophthalmol Soc. 2016 Aug;114:WP1.
Future advances in ophthalmology will see a paradigm shift in diagnostics from a focus on dysfunction and disease to better measures of psychophysical function and health. Practical methods to define genotypes will be increasingly important and non-invasive nanotechnologies are needed to detect molecular changes that predate histopathology.
This is not a review nor meant to be comprehensive. Specific topics have been selected to illustrate the principles of important paradigm shifts that will influence the future of ophthalmic diagnostics. It is our impression that future evaluation of vision will go beyond visual acuity to assess ocular health in terms of psychophysical function. The definition of disease will incorporate genotype into what has historically been a phenotype-centric discipline. Non-invasive nanotechnologies will enable a paradigm shift from disease detection on a cellular level to a sub-cellular molecular level.
Vision can be evaluated beyond visual acuity by measuring contrast sensitivity, color vision, and macular function, as these provide better insights into the impact of aging and disease. Distortions can be quantified and the psychophysical basis of vision can be better evaluated than in the past by designing tests that assess particular macular cell function(s). Advances in our understanding of the genetic basis of eye diseases will enable better characterization of ocular health and disease. Non-invasive nanotechnologies can assess molecular changes in the lens, vitreous, and macula that predate visible pathology. Oxygen metabolism and circulatory physiology are measurable indices of ocular health that can detect variations of physiology and early disease.
This overview of paradigm shifts in ophthalmology suggests that the future will see significant improvements in ophthalmic diagnostics. The selected topics illustrate the principles of these paradigm shifts and should serve as a guide to further research and development. Indeed, successful implementation of these paradigm shifts in ophthalmology may provide useful guidance for similar developments in all of healthcare.
眼科未来的进展将见证诊断领域的范式转变，从关注功能障碍和疾病转向更好地衡量心理物理功能和健康状况。定义基因型的实用方法将变得越来越重要，并且需要非侵入性纳米技术来检测早于组织病理学的分子变化。
本文并非综述，也无意求全。我们选择了特定主题来说明将影响眼科诊断未来的重要范式转变的原则。我们的印象是，未来对视力的评估将超越视力，从心理物理功能方面评估眼部健康。疾病的定义将把基因型纳入这个历来以表型为中心的学科。非侵入性纳米技术将促成从细胞水平的疾病检测到亚细胞分子水平的范式转变。
通过测量对比敏感度、色觉和黄斑功能，可以超越视力来评估视力，因为这些能更好地洞察衰老和疾病的影响。通过设计评估特定黄斑细胞功能的测试，可以比过去更准确地量化视觉扭曲并更好地评估视觉的心理物理基础。我们对眼病遗传基础理解的进展将有助于更好地描述眼部健康和疾病状况。非侵入性纳米技术可以评估晶状体、玻璃体和黄斑中早于可见病变的分子变化。氧代谢和循环生理学是可测量的眼部健康指标，能够检测生理变化和早期疾病。
对眼科范式转变的概述表明，未来眼科诊断将有显著改善。所选主题说明了这些范式转变的原则，应作为进一步研发的指南。事实上，在眼科成功实施这些范式转变可能为整个医疗保健领域的类似发展提供有益指导。
