Medical Hypothesis, Discovery & Innovation (MEHDI) Journals

Glaucoma is a leading cause of blindness worldwide, characterised by specific visual field defects due to the degeneration of retinal ganglion cells and damage to the optic nerve head (ONH). Elevated intraocular pressure (IOP) is the most important risk factor for glaucoma development. One of the clinical hallmarks of glaucomatous optic neuropathy is the excavation of the ONH, which consists of a progressive posterior displacement of the ONH surface and excavation of the pre-laminar tissues beneath the anterior-most aspect of the scleral canal, known as the anterior scleral ring. Radial optic neurotomy (RON) is a surgical technique that has been proposed for treating central retinal vein occlusion. While the original rationale of RON was the relief of increased tissue pressure within the optic nerve that results from occlusion of the central retinal vein, recent results are discussed here which suggest that by relaxing of the scleral ring of the prelaminar and laminar regions of the ONH, RON may alleviate the IOP-related connective tissue stress, and in turn, prevent the onset and reduce the progression of glaucomatous neuropathy

E. Rosenstein, Ruth

Belforte, Nicolás

English

Radial Optic Neurotomy: A New Surgical Approach for  Glaucoma Treatment?

Heidary, Fatemeh

Gharebaghi, Reza

 
 
MEHDI Ophthalmology Journal 2012; Vol. 1, No 4  
 
 
 
Editorial 
  Medical Hypothesis, Discovery & I  nnovation 
Ophthalmology Journal 
   
 
 
Surgical Innovation, a Niche and a Need 
 
Fatemeh Heidary¹ MD FICO; Reza Gharebaghi² MD  
 
¹ Shahid Beheshti University of Medical Sciences, ²Editorial Office, Medical Hypothesis, Discovery & Innovation Ophthalmology Journal 
 
Key Words: Ophthalmology; Hypotheses; Surgical innovation; techniques; Idea 
 
Correspondence to: 
Reza Gharebaghi, MD, Editorial Office, Medical Hypothesis, Discovery & Innovation Ophthalmology Journal, Email: info@meptic.com
 
Surgical Innovation in the current   
The life sciences in the 21st century are evolving from a 
descriptive or phenomenological discipline to extrapolative 
one. Rapid development has transpired dramatically in 
biological studies in the last few years, much of which 
encompasses concepts more familiar to engineers and 
physicists rather than physicians [1].  
Innovation has vast morphological meanings but is simply 
defined as the act of announcing something new or the use of a 
novel idea or technique. In some cases, it is practiced as 
replacement to invention, though innovation is further 
accurately outlined as something thought up or mentally 
fabricated. Although innovation in surgery has a less than 
perfect tradition, the field and research of surgical innovation 
are new [2]. In surgery, those new ideas could be a new surgical 
method, a new instrument or a procedure. However, if a new 
surgical process or instrument is introduced and used, many 
steps should be taken.  
Application of formal processes to include innovative surgical 
procedures into hospitals or health services has long been 
integrated into the healthcare system, while protecting the 
interests of patients, physicians and the organization [3]. Most 
countries have specific guidelines for assessing and introducing 
new surgical methods in hospitals and medical centers which 
are more or less similar to each other. The milestone of these 
standards hinges on the importance of the patient’s safety. Any 
new method should constitute no risk to patient’s health. 
Sometimes introducing new methods or developing new 
instruments, especially in the field of ocular surgery, might be 
hazardous to the patient can be potentially blinding procedure 
unless its safety has been already proven.  
Frequently the assessment as to whether a new surgical 
method should be introduced is between the desire to enhance 
knowledge and increase surgical experience against the 
potential risks of novel procedures. As a matter of fact, a 
substantial amount of sensory data is filtered through the eyes, 
they are our actually windows to the world hence the aim is to 
protect the visual system healthy against any risky procedure.  
Furthermore, the present and future costs of the new 
techniques and procedures should be estimated as precisely as 
possible. New methods must prove to be lower in cost than the 
older methods and both the morbidity and mortality rates 
should be demonstrably lower. 
 
Scope of the journal in surgical techniques 
Our journal intends to introduce new methods and instruments 
or convey the idea of creating them. A major difference 
between this journal and fiction is that the ideas should be 
evidence-based and must have been written based on scientific 
principles and logical procedures.  
Although the authors bear the responsibility for any datum they 
publish, we do not recommend using an idea or hypothesis in 
clinical setting only because they have been published in this 
journal. This journal is merely a pathway to more studies. It is 
absolutely necessary to run more laboratory and clinical studies 
and other research to show the reliability and feasibility of 
those findings.  We recommend that researchers who are 
 
 
MEHDI Ophthalmology Journal 2012; Vol. 1, No 3  
 
66 IDEAS TO HELP THE UNDERPRIVILEGED DISPOSSESSED INDIVIDUALS 
willing to publish new surgical methods or instruments point 
out the advantages and disadvantages of the discussed 
methods in a special section in their manuscript. 
Another issue is training. That is, how to assess the amount of 
time needed for learning a new method, and if learning that 
method will be time-saving. The authors should clearly answer 
the questions that address the scope of training required for 
the instrument or new surgical techniques (e.g., how much 
content, what level of complexity)? Who is the audience of the 
new technique or an instrument (e.g., their experience, job 
requirements)? What resources are available (e.g., trainers, 
facilities, quick-reference guidelines)? Has the method been 
evaluated before? And how wide-ranging or complicated is the 
procedure?  
The other important subject is the ethical issues. It is important 
that a new method be evaluated for its ethical principles and 
whether there are any conflicts of interest. If a company has 
already started investing in a specific product, it should disclose 
its material interest to the journal. Researchers should also 
disclose how many patients the new ideas or devices have been 
tested upon and, more importantly, whether the animal studies 
had been performed beforehand. Furthermore, the researcher 
should declare his/her informed consent and obtain the ethics 
committee’s confirmation for a new technique or device. It is 
the patient’s right to choose and select his surgical methods 
based on their safety. The journal might ask for original 
confirmation of ethics committee. If a new method is 
introduced, the author should provide an explanation of which 
group of surgeons and with what level of surgical skills could 
use that method, and whether trainees would be able to 
perform them. If the author describes monitoring and the long 
term follow-up of the new technique, the manuscript would 
have a much greater chance of being published.  
 
Spiritual ownership 
Spiritual ownership starts from the development of an idea. 
The registration of a new idea requires some tests that are both 
time-consuming and costly. Registry of the idea or technique in 
a journal such as ours gives the idea developer the opportunity 
to have his idea patented. As well, if he does not have the 
facilities to perform the necessary confirmations, the idea’s 
presence in the journal will allow others to do so. 
The journal would publish papers even if the author does not 
have the opportunity to perform clinical researches. Since the 
researcher has generated the first spark for the idea, by 
publishing it, he can patent the idea or technique for himself. 
Having said that, we do declare that in legal terms, as patenting 
ideas and hypotheses has not become operational in many 
countries, we are unable to undertake the legal responsibility of 
the patent registration. The researcher should arrange for 
registering the patent for his idea, thought, instrument or 
medication by him/herself solely or with the collaboration of 
the university and scientific centers in his/her own country. 
 
Future directions 
In future issues we will continue to focus on original research 
and would also report important, timely information about 
innovation and ideas in ophthalmology and possible standards. 
However, ophthalmology and visual sciences manuscripts from 
perspectives such as ethics, ocular healthcare reform, and 
interactive comments from round table features are most 
welcome. 
The scientific societies strongly oppose traditional methods and 
seek changes. Changes must be directed towards progress and 
address at least one of the problems facing humanity today. 
We thank those who make up this community: numerous 
individuals, authors and peer reviewers who have worked 
through the start-up process to ensure that our peer-review 
system is rigorous and sound.  
Finally, thanks to the editorial board members for their 
continuous guidance, trust, and support.  
We should endeavor to work together in order to create ideas 
to form a healthier and safer world for everybody! 
 
DISCLOSURE 
The authors report no conflicts of interest in this work. 
 
REFERENCES 
1. O'Shea P. Future medicine shaped by an interdisciplinary new 
biology. Lancet. 2012 Apr 21;379(9825):1544-50. PMID: 22516560. 
2. Riskin DJ, Longaker MT, Gertner M, Krummel TM. Innovation in 
surgery: a historical perspective. Ann Surg. 2006 Nov;244(5):686-93. 
PMID: 17060760.  
3. In: NSW GOVERNMENT HEALTH website: Clinical Practice - Model 
Policy for Safe Introduction of New Interventional Procedures[online]. 
73 Miller Street North Sydney NSW 2060 Locked Mail Bag 961 North 
Sydney NSW 2059. Available from: 
www.health.nsw.gov.au/policies/PD/2005/pdf/PD2005_333.pdf[Access
ed:26/10/2012]. 
 
 


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Radial Optic Neurotomy: A New Surgical Approach for Glaucoma Treatment?

Surgical Innovation, a Niche and a Need

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