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Sage — Ophthalmology

Topics in this chapter

• Eye: Organ Dysfunction (Ocular Archetype)
• AMD: compensatory debris clearance and perfusion restoration
• Diabetic retinopathy: ischemic compensation and neurovascular failure
• Glaucoma
• Hypertension and glaucoma
• A Metabolic Hypothesis of Ocular Surface Disease
• Dry eye and cataract as glandular and lenticular energy failures
• Retinitis pigmentosa, retinoblastoma, and inherited retinal disease
• Fuchs’ dystrophy: the corneal endothelial pump as bioenergetic failure
• Retinal artery and vein occlusions and NAION: one failure, two scars

Related pointers: Hypertension · Diabetes · Warburg and Crabtree · Blue Eyes · Kit: AREDS3 · HydroEye · Astaxanthin

Conventional ophthalmology: powerful local tools, incomplete upstream story

Ophthalmology textbooks and clinical paradigms emphasize anatomical classification (AREDS categories for AMD, ETDRS levels for DR, optic-nerve-head and visual-field staging for glaucoma), local pathophysiology (drusen and complement for AMD; capillary dropout and VEGF for DR; trabecular meshwork resistance and RGC apoptosis for glaucoma; meibomian dysfunction and ocular-surface inflammation for dry eye; crystallin oxidation for cataract), and targeted interventions (anti-VEGF, laser, surgery, IOP-lowering drops, artificial tears, phacoemulsification). These yield often dramatic symptomatic and structural stabilization in subsets of patients — anti-VEGF transformed wet AMD and diabetic macular edema prognosis — but they treat disease once it appears rather than prevent it, and the number of people living with these conditions keeps rising with aging populations and metabolic disease. In this view, they manage downstream manifestations without routinely asking why the cellular engines in RPE, photoreceptors, retinal vasculature, trabecular meshwork, lens epithelium, or ocular-surface glands may remain energetically compromised.

References

Conventional ophthalmology: powerful local tools, incomplete upstream story

1. Rosenfeld PJ, Brown DM, Heier JS, et al., 2006. Ranibizumab for neovascular age-related macular degeneration. New England Journal of Medicine 355(14):1419-1431. doi:10.1056/NEJMoa054481
2. Mitchell P, Liew G, Gopinath B, et al., 2018. Age-related macular degeneration. The Lancet 392(10153):1147-1159. doi:10.1016/S0140-6736(18)31550-2
3. Wong WL, Su X, Li X, et al., 2014. Global prevalence of age-related macular degeneration and disease burden projection for 2020 and 2040: a systematic review and meta-analysis. The Lancet Global Health 2(2):e106-e116. doi:10.1016/S2214-109X(13)70145-1
4. Tham YC, Li X, Wong TY, et al., 2014. Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis. Ophthalmology 121(11):2081-2090. doi:10.1016/j.ophtha.2014.05.013
5. Teo ZL, Tham YC, Yu M, et al., 2021. Global Prevalence of Diabetic Retinopathy and Projection of Burden through 2045: Systematic Review and Meta-analysis. Ophthalmology 128(11):1580-1591. doi:10.1016/j.ophtha.2021.04.027

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