Meeting the Editorial Board Member of AES: Dr. Peter Wiedemann

Posted On 2024-09-26 10:59:12


Peter Wiedemann1, Jin Ye Yeo2

1Past Chief and Chair Department of Ophthalmology, Leipzig University and University Hospital Leipzig, Germany; 2AES Editorial Office, AME Publishing Company

Correspondence to: Jin Ye Yeo. AES Editorial Office, AME Publishing Company. Email: aes@amegroups.com.

Expert introduction

Dr. Peter Wiedemann (Figure 1) is a Professor of Ophthalmology at Leipzig University. He is a vitreoretinal specialist whose expertise includes complex vitreoretinal surgery and the care of conditions such as age-related macular degeneration, diabetic retinopathy, ocular trauma, retinal detachment, retinal vascular diseases, and uveitis.

Dr. Wiedemann earned his medical degree at Erlangen University, Germany. He started ophthalmic research at the Doheny Eye Institute, Los Angeles, with Dr. Stephen Ryan and completed a residency and fellowship in ophthalmology at Cologne University with Prof. Klaus Heimann. Dr. Wiedemann studies clinical diseases such as proliferative vitreoretinopathy (PVR) and macular holes, and Müller cells' pathophysiology in his research. He has authored over 600 peer-reviewed publications in ophthalmology and is Co-editor of the textbook Ryan´s Retina. He is a member of the German National Academy of Sciences Leopoldina, the German Ophthalmological Society, and the Club Jules Gonin. He is also a Fellow of the Academia Ophthalmologica Internationalis (AOI) and the immediate Past President of the International Council of Ophthalmology (ICO).

Figure 1 Dr. Peter Wiedemann


Interview

AES: What inspired you to specialize in ophthalmology, particularly in vitreoretinal surgery?

Dr. Wiedemann: After medical school, I worked in pharmacology and cell biology, first in Munich and then in Tucson, Arizona. I always wanted to do something with vision and light. In those years, pharmacological knowledge was low in ophthalmology. I applied at the USC Doheny Eye Institute. I started my career in ophthalmology as a research associate with Dr. S.J. Ryan, who was looking for someone to research adjuvant therapy for proliferative vitreoretinopathy. I was lucky to work in this department with this enthusiastic chairman and many international research fellows – some of them have stayed friends until now – and I am proud to be a Doheny scholar. When it came to my residency, Steve Ryan told me, “You don't want just to do lenses.” Therefore, vitreoretinal surgery was the only option. The one Vitreoretinal University Department in Germany at the time was Prof. Klaus Heimann's in Cologne, where I spent my specialist training and time as a senior consultant. Joining the team of the Cologne Eye Hospital was another excellent decision.

AES: Given your contributions to understanding age-related macular degeneration and diabetic retinopathy, what are the most promising advancements in these fields?

Dr. Wiedemann: I see the most remarkable progress in multimodal imaging, possibly the analysis of images with artificial intelligence and worldwide access to telemedical evaluation of these images. This technological progress is a prerequisite for continuously improving the diagnosis and pharmacological therapy of retinal and macular diseases.

AES: Could you briefly overview current publications on rhegmatogenous retinal detachment (RRD)? Are there any articles that stand out to you?

Dr. Wiedemann: Since Jules Gonin's outstanding work, we believe that we have understood RRD. However, despite advances in understanding retinal biology, microsurgical techniques, and instrumentation, RRD remains a condition that results in the loss of visual function in most affected eyes. Two recent papers summarize the most cited articles on RRD (1, 2).

I have always liked to learn new aspects of the incidence of RRD. There is evidence of an increasing trend in RRD incidence over time, possibly doubling the current incidence rate within the next two decades (3). The ratio of male to female patients with RRD varied between the age groups. The proportion of pseudophakic RRD cases increased within 15 years. The male predominance in RRD is stronger in pseudophakic eyes than in phakic eyes (4). Interestingly, RRD within 90 days of macular surgery was higher for macular hole surgery than for epiretinal membrane surgery (5).

A review of RRD has recently been published (6). Kuhn and Aylward treat the essential steps of pathophysiology and treatment well and stress the importance of the vitreous. Thus, the primary goal of RRD surgery is to weaken (pneumatic retinopexy, scleral buckle) or eliminate (vitrectomy) the dynamic traction (7).

Although surgical techniques for RRD have improved, the subjective nature of surgery makes objective assessment difficult. There often are several reasonable options for managing a surgical dilemma. As a clinician, I appreciate learning from cohort studies, registries, and randomized clinical trials to improve surgery. Two recent studies have dealt with long-term controversies.

a) In a current analysis, low-certainty evidence from randomized controlled trials (RCTs) did not demonstrate the benefit of placing supplemental scleral buckles during vitrectomy to manage RRD. Additional high-quality trials are needed to provide more precise estimates of these effects (8). Nevertheless, I believe in the impact of a scleral buckle.

b) Scleral buckle, pneumatic retinopexy, pars plana vitrectomy (PPV) with silicone oil, and immediate face-down positioning are likely associated with less retinal displacement, essential for postoperative vision (9).

In the future, preoperative OCT should be included to improve the results of RRD surgeries. A novel staging system describes sequential morphological changes in RRD (10). Finally, I am interested in the timing of retinal surgery and in PVR treatment. I have listed relevant papers in these editorials (11, 12).

AES: Your work on retinal vascular diseases and ocular trauma has influenced treatment approaches. What recent developments in vitreoretinal surgery are you most excited about, and how do they impact patient care?

Dr. Wiedemann: Endophthalmitis is one of the most severe ocular emergencies worldwide. Without prompt treatment, significant vision loss is inevitable (13). Sympathetic ophthalmia after intraocular surgery is rare and may not have changed over the past five decades (14). However, it should be realized that it is also a complication of vitrectomy.

In recent years, macular foveoschisis has become a prevalent complication in individuals with high myopia. This is primarily due to inward traction by vitreoretinal adhesions and outward traction exerted by the posterior scleral staphyloma on the retina (15).

Uncomplicated phacoemulsification accelerates the physiological process of posterior vitreous detachment (PVD) development. In patients without a preexisting PVD, preoperative evaluation of the vitreoretinal interface should be performed with careful postoperative follow-up (16). I think this is very important for general ophthalmologists.

A study provides low-certificate evidence that facedown positioning (FDP) modestly improves macular hole surgery's anatomical and visual outcomes and indicates that the effect may be more substantial for macular holes exceeding 400 μm. These findings support the recommendation of FDP for patients with macular holes exceeding 400 μm (17).

AES: With your involvement in organizations such as the German National Academy of Sciences Leopoldina and the International Council of Ophthalmology, how do you see the future of ophthalmology evolving?

Dr. Wiedemann: Ophthalmology is at the forefront of breakthrough technologies. I believe in the potential of artificial intelligence, teleophthalmology, and robot-assisted surgery to revolutionize ophthalmology. Compared with manual surgery, robot-assisted vitreoretinal surgery will improve precision and limit tissue damage. Of course, challenges and limitations are associated with their adoption. Home monitoring and telemedicine can improve patient outcomes. However, ophthalmology is a part of medicine, not a technical specialty. Societal interventions to ensure that all patients receive appropriate care are necessary. For this, well-trained and passionate ophthalmologists are most important. Collaboration, teamwork, and standardization are essential to overcome these challenges.

AES: Given the rapid advancements in ophthalmic research, what areas are pivotal for future exploration and development?

Dr. Wiedemann: Over 2.2 billion people worldwide have vision impairment or blindness, with 1 billion having conditions that could be treated or prevented. Ninety percent of sight loss can be avoided with early detection and treatment, and eye care solutions are among the most cost-effective health interventions worldwide. The WHO launched a Global Eye Health Research Agenda to guide future research priorities to achieve Integrated People-Centered Eye Care. The 2023 baseline report on adequate eye care coverage highlights the need for the global eye health sector to work collectively to ensure quality and equitable service.

Sustainable eye care delivery systems are essential for addressing the global burden of vision impairment and blindness, particularly in low-income and middle-income countries. Workforce shortage and technological development present opportunities to scale up eye care services in new ways to meet the goals of universal eye health coverage. Innovative approaches such as artificial intelligence can potentially have a significant impact. The 2030 In Sight strategy ensures that no one experiences unnecessary or preventable sight loss: Eye care and rehabilitation services are accessible and affordable for everyone, and people understand the importance of caring for their eye health.

AES: What advice would you offer young ophthalmologists and researchers aspiring to significantly contribute to vitreoretinal surgery?

Dr. Wiedemann: I like a quote from Maria Montessori for a young surgeon: “(The child gives us a beautiful lesson—that) to form and maintain our intelligence, we must use our hands.” Do as much surgery as you can. A recent publication has more suggestions (18).

For research, I like two statements by Albert Szent-Gyorgyi.

“Research is four things: brains with which to think, eyes with which to see, machines with which to measure, and money”, and “Research aims to see what everybody else has seen and to think about what nobody else has thought”. Both quotes state that we must see and think with our own eyes.

AES: As an Editorial Board Member, what are your expectations and goals for AES?

Dr. Wiedemann: To publish high-quality, innovative, and reliable research that advances the field, rigorous, fair, and constructive peer review and editorial standards must be ensured. Feedback that helps authors improve their research presentation is essential.

We can promote articles through social media, conferences, and academic networks to increase the journal's reach and citation impact. Diversity in authorship, editorial board membership, and peer reviewers broadens our reach. Special issues that bridge different fields and encourage collaboration can provide new insights.


References

  1. Asahi MG, Pakhchanian H, Doepker C, Raiker R, Gallemore RP. A Bibliometric Analysis of the Top 100 Cited Papers in Retinal Detachment. J Vitreoretin Dis 2021;5(6):467-478.
  2. Grzybowski A, Shtayer C, Schwartz SG, Moisseiev E. The 100 most cited papers on retinal detachment: a bibliographic perspective. Br J Ophthalmol 2022;106(3):305-311.
  3. Ge JY, Teo ZL, Chee ML, et al. International incidence and temporal trends for rhegmatogenous retinal detachment: A systematic review and meta-analysis. Surv Ophthalmol 2024;69(3):330-336.
  4. Radeck V, Helbig H, Maerker D, et al. Rhegmatogenous retinal detachment repair-does age, sex, and lens status make a difference?. Graefes Arch Clin Exp Ophthalmol 2022;260(10):3197-3204.
  5. Ben Ghezala I, Mariet AS, Benzenine E, et al. Incidence of Rhegmatogenous Retinal Detachment Following Macular Surgery in France Between 2006 and 2016. Am J Ophthalmol 2022;243:91-97.
  6. Lin JB, Narayanan R, Philippakis E, Yonekawa Y, Apte RS. Retinal detachment. Nat Rev Dis Primers 2024;10(1):18. 
  7. Kuhn F, Aylward B. Rhegmatogenous retinal detachment: a reappraisal of its pathophysiology and treatment. Ophthalmic Res 2014;51(1):15-31.
  8. Rosenberg DM, Ghayur HS, Deonarain DM, et al. Supplemental Scleral Buckle for the Management of Rhegmatogenous Retinal Detachment by Pars Plana Vitrectomy: A Meta-Analysis of Randomized Controlled Trials. Ophthalmologica 2022;245(2):101-110.
  9. Mason RH, Minaker SA, Marafon SB, et al. Retinal displacement following rhegmatogenous retinal detachment: A systematic review and meta-analysis. Surv Ophthalmol 2022;67(4):950-964.
  10. Martins Melo I, Bansal A, Naidu S, et al. Morphologic Stages of Rhegmatogenous Retinal Detachment Assessed Using Swept-Source OCT. Ophthalmol Retina 2023;7(5):398-405.
  11. Wiedemann P. When to repair a retinal detachment?. Int J Ophthalmol 2024;17(4):607-609.
  12. Wiedemann P, Hui YN. PVR update: pathophysiology and clinical management. Int J Ophthalmol 2024;17(9):1577-1580.
  13. Ramachandran A, Das T, Pathengay A, Pappuru RR, Dave VP. Surgical approach to endophthalmitis: an overview. Eye (Lond) 2024;38(13):2516-2521.
  14. Bondok MS, He B, Ka-Lok Tao B, et al. Incidence of Sympathetic Ophthalmia after Intraocular Surgery: A Systematic Review and Meta-analysis. Ophthalmology 2024;131(7):836-844.
  15. Chen H, Liu X, Zhou X, Fu J, Wang L. Advancements in Myopic Macular Foveoschisis Research. Ophthalmic Res 2024;67(1):424-434.
  16. Hurley DJ, Murtagh P, Guerin M. Posterior vitreous detachment rates post-uncomplicated phacoemulsification surgery: a systematic review. Int Ophthalmol 2024;44(1):155.
  17. Raimondi R, Tzoumas N, Toh S, et al. Facedown Positioning in Macular Hole Surgery: A Systematic Review and Individual Participant Data Meta-Analysis. Ophthalmology 2024.
  18. Wiedemann P. How to become a good surgeon. Adv Ophthalmol Pract Res 2023;3(2):63-66.