EURETINA 2025: Rethinking Risk and Revisiting What Works
Sheba Global Ophthalmology
Sheba Global Ophthalmology (SGO) was established to advance equity in eye care worldwide, focusing on regions where access to specialists and treatment remains limited.
Through its four pillars—humanitarian outreach, education and training, global collaboration, and research and innovation—SGO works to make eye care universally accessible and sustainable.
Events like EURETINA 2025 bring together leading experts from around the world to exchange knowledge, build collaborative networks, and discuss advances that shape the future of ophthalmic care.
These opportunities help SGO and other organizations bridge the gap between innovation and implementation, supporting long-term progress in expanding access to quality eye care globally.
Insights from Sheba’s GRT Study
At the conference, Dr. Yael Lustig-Barzelay presented findings from a study conducted at Sheba Medical Center under the supervision of Dr. Avner Hostovsky, retina specialist at the Goldschleger Eye Institute. The research analyzed a cohort of 78 patients treated for non-traumatic, non-syndromic giant retinal tears (GRT) who were followed for over 5 years on average.
A key finding revealed that one third (33%) of patients developed retinal detachment in the contralateral (fellow) eye, despite close follow-up. Prophylactic laser treatment did not appear to reduce this risk. Additionally, no clinical risk factors—including age, axial length, or refractive error—were significantly associated with contralateral detachment.
These results highlight the ongoing challenge of managing the fellow eye in GRT patients and underscore the need for improved risk stratification and more effective preventive strategies. Until such advances are achieved, long-term, careful follow-up remains essential for this patient population.
Looking Back Before Moving Forward
Among the scientific sessions, one keynote particularly stood out: “Throwing Away Wisdom: How We Abandon What Works.” Dr. María H. Berrocal, a leading vitreoretinal specialist and past president of the Pan-American Vitreoretinal Society, argued that proven interventions are being abandoned for newer but not necessarily superior alternatives: segmental scleral buckling for primary rhegmatogenous retinal detachment and panretinal photocoagulation (PRP) for proliferative diabetic retinopathy.
The Decline of Scleral Buckling
One example was scleral buckling for phakic retinal detachments, which has declined from 41% to 23% in the U.S. despite superior outcomes. Buckling achieves 93–97.2% single-surgery success versus 83–85% for vitrectomy, with faster recovery (2.5 weeks vs. 7.6 weeks), dramatically lower cataract rates (under 5% vs. over 50%), and better early vision—61% of buckled eyes achieved better than 20/70 vision at one month compared to only 10% after vitrectomy.
The Durability of Panretinal Photocoagulation (PRP)
Dr. Berrocal also addressed panretinal photocoagulation (PRP) for proliferative diabetic retinopathy, highlighting its unmatched long-term durability. Landmark trials and real-world data show that 70–80% of PRP-treated eyes remain stable for over 10 years without further intervention. In contrast, anti-VEGF monotherapy requires an average of 19 injections over five years with 43 clinic visits—twice the frequency of PRP. Despite this intensive regimen, vitreous hemorrhage still occurred in nearly 50% of anti-VEGF-treated eyes, and cardiovascular mortality was 3.5-fold higher compared to the PRP group.
The risks increase when follow-up is lost—a common reality in clinical practice. In these cases, 33% of anti-VEGF eyes develop tractional retinal detachment compared to only 2% of PRP-treated eyes. The economic difference is also substantial: treating all U.S. PDR patients with anti-VEGF would require over 4 million injections annually at an estimated cost of $3 billion per year, compared to a one-time PRP cost of approximately $700 per eye.
Global Health Implications
These findings extend beyond clinical outcomes. Dr. Berrocal emphasized that durable, low-maintenance treatments hold enormous global health value. In regions with limited specialist access or where patients travel long distances, lifelong injections are not feasible. PRP provides lasting regression after one to three sessions, while scleral buckling requires only minimal equipment—cryotherapy, indirect ophthalmoscopy, and basic surgical tools—making both viable in resource-limited settings.
These traditional techniques reduce repeated interventions, travel, and costs while lowering the carbon footprint of frequent visits. Most importantly, they preserve equity of access, ensuring patients receive sight-saving care regardless of geography or income.
The message resonated strongly: effective ophthalmic care must balance innovation with sustainability, evidence with accessibility, and progress with perspective.
Bridging Innovation and Access
The discussions at EURETINA 2025—from findings on contralateral risk in giant retinal tears to Dr. Berrocal’s call to preserve proven, accessible treatments—illuminate two sides of the same challenge. For Sheba Global Ophthalmology, advancing clinical knowledge and supporting sustainable, equitable solutions are inseparable goals. SGO works through research, education, and global collaboration to ensure that progress in eye care translates into tangible outcomes for patients everywhere—particularly in regions where access remains limited. Innovation must not only push boundaries; it must also build bridges.
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