When vision deteriorates, many people first think of presbyopia. However, decreased vision is not simply a sign of aging; it may be a warning that retinal diseases, which can lead to blindness, are quietly progressing. Major retinal diseases such as age-related macular degeneration and diabetic retinopathy have almost no early subjective symptoms, and once the retinal nerves are damaged, recovery is extremely difficult. The Korea Economic Daily met with Professor Yoon Young-hee of the Department of Ophthalmology at Asan Medical Center, who has been at the forefront of treating retinal and vitreous diseases in Korea, to discuss the risks of retinal diseases, the core of treatment, and essential eye health management that patients must know.

―What led you to choose retinal diseases as your lifelong clinical specialty?

“In the early 1980s, when training as a resident, the clinical environment for retinal diseases in Korea was very poor. It was common to see patients with retinal detachment or vitreous hemorrhage lose their vision because they did not receive appropriate treatment. At that time, globally, treatments such as retinal laser therapy and vitrectomy were just beginning to develop, and it would take time for such technologies to be introduced domestically. Seeing patients on the verge of blindness, it became clear that this was a field where there was much to be done and that someone had to take responsibility and devote themselves to it.”

―You have long treated conditions that can lead to blindness, such as macular degeneration and diabetic retinopathy. What is the most important principle in the treatment of retinal diseases?

“Early diagnosis and regular check-ups. Retinal nerve cells, like brain nerves, are almost impossible to regenerate once damaged. Macular degeneration usually progresses slowly in one eye first in older adults, so even when they notice visual changes, many people dismiss them as presbyopia and do not visit a hospital. Treatment opportunities are often missed on the grounds that daily life is still possible with the other eye. In the case of diabetic retinopathy as well, many postpone screening because they have no symptoms, and only come to the hospital after vitreous hemorrhage or macular edema occurs. By that time, irreversible damage has often already progressed.”

―The number of young diabetic patients is also increasing. From the perspective of retinal disease, what should be particularly watched for?

“Young diabetic patients are increasingly common in clinical practice. The younger the patient, the longer the potential duration of the disease, and busy lives often lead to poor blood sugar control. When obesity, hyperlipidemia, and smoking are present together, the risk increases further. There are not a few cases in which patients visit due to sudden visual deterioration, only to find that proliferative diabetic retinopathy has already progressed to vitreous hemorrhage or retinal detachment. Retinal disease is not something to respond to after symptoms appear; it is a disease that must be managed before any symptoms arise.”

―Many people delay visiting a hospital, saying their vision has only slightly worsened. What early symptoms should never be ignored?

“A sudden worsening of floaters or a sensation that the field of vision is blocked as if a curtain has come down may be an early symptom of retinal detachment. Metamorphopsia, in which straight lines appear distorted or the center appears blurred, and central scotoma are common in macular diseases. A feeling that part or all of the visual field has become dark may occur in diabetic retinopathy or retinal vascular occlusion. If such symptoms are present, examination should not be postponed and must be performed immediately.”

―You have also led the introduction of new treatment techniques such as sutureless, micro-incision vitrectomy and artificial retina implantation. What do these changes mean for patients?

“The retinal field has made remarkable progress over the past few decades. Sutureless, micro-incision vitrectomy has greatly reduced surgical invasiveness, accelerated recovery, and lowered pain and the risk of complications. It is now the standard treatment, but there was significant resistance when it was first introduced. Artificial retina implantation has currently been suspended due to economic and technological limitations, but it was highly meaningful in that it offered possibilities to patients who previously had no treatment options. Such technological advances bring about real changes in patients’ quality of life.”

―Retinal disease treatment technologies are said to have advanced significantly in recent years. Compared to the past, what is the biggest change patients can feel?

“Recent advances in the treatment of retinal diseases began with groundbreaking improvements in diagnostic technology rather than treatment techniques. In the past, pupil dilation was required for fundus photography or optical coherence tomography (OCT), which made examinations burdensome, but now most detailed examinations can be performed without dilation. For fluorescein angiography as well, intravenous injection was previously essential, but recently, technologies that enable the test without injections have been introduced, greatly reducing patient burden. Another major change patients experience is that examination results are transmitted to the consultation room immediately after imaging, enabling faster and more accurate diagnosis. On the treatment side, the development of anti-vascular endothelial growth factor (anti-VEGF) agents has been the most significant turning point. Vision can now be preserved to a considerable extent in patients with macular degeneration or macular edema who would previously have gone blind, and for diabetic retinopathy, treatment options have expanded from being laser-centered to including pharmacologic therapy. Recently, treatment methods that insert special micro-implants into the eye to reduce the number of injections have also been introduced, further reducing patients’ treatment burden. Changes in the surgical field have also been substantial. With the introduction of sutureless, micro-incision vitrectomy, surgery has become possible under local anesthesia without general anesthesia, hospital stays have become shorter, and same-day surgery with rapid return to daily life has become feasible. In addition, vitrectoretinal surgery and cataract surgery, which were previously performed stepwise, can now be carried out simultaneously, significantly shortening the overall treatment period.”

―Is there any message you particularly wish to convey to patients and potential patients who feel anxious about retinal diseases?

“Not all retinal diseases lead to blindness. The course varies greatly depending on the type and stage of the disease. What is important is not to miss the window for accurate diagnosis and appropriate treatment. Rather than relying on online information or unverified therapies, patients should thoroughly consult with a retinal specialist. Retinal diseases are conditions in which vision can be preserved if detected early and managed consistently. Any change in vision, however slight, should not be taken lightly.”

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