Department of Ophthalmology and Optometry – Medical University of Vienna

University Clinic for Ophthalmology and Optometry, Medical University of Vienna
Int. Director: Prof. Stefan Sacu / Contact: Sophie Frank-Publig
 

Founding and early years (1812–1850s)
The Vienna University Eye Clinic was founded in 1812 by Georg Joseph Beer and is considered the oldest university eye clinic in the world.

Expansion of the ‘Vienna School’ (mid-19th century)
Vienna as an internationally leading centre for teaching and research in ophthalmology: important figures shaped surgical and diagnostic techniques.

Breakthroughs and technology (late 19th century)
Important medical advances emerged from the Viennese setting: Karl (Carl) Koller demonstrated the use of cocaine as a local anaesthetic for eye surgery in 1884. Later, several ‘eye clinics’ (first and second university eye clinics) with their own professorships were established in Vienna.

‘Vienna School’: Ernst Fuchs and its heyday around 1900   
Ernst Fuchs' (head of the Second University Eye Clinic) work (textbook, pathological descriptions) had a worldwide influence and shaped the ‘Vienna School’.

First successful corneal transplant (1905)
A group of Viennese students/colleagues also pioneered technical achievements: Eduard Konrad Zirm performed the first successful human corneal transplant in 1905 — a milestone in transplant medicine / transplantology and ophthalmology.

Interwar period, Nazi era and post-war period
Careers, staffing structures and research suffered as a result of politics (emigration, discontinuities). After 1945, the clinic's operations, training and research were rebuilt. Viennese ophthalmology regained its former international reputation.

Modernisation and site development (late 20th century – present day)
Several modernisations, technical upgrades and, ultimately, organisational adjustments followed. Today, the clinic is one of the largest and most technologically advanced eye clinics in Europe.

Research, teaching and international networking
The Vienna Eye Clinic remains an active centre for clinical research, teaching and international cooperation; numerous techniques and textbooks from Vienna have left their mark on the professional world.

Significance of the Eye Clinic
Over the last ~200 years, the Vienna Eye Clinic has contributed significantly to the establishment of ophthalmology as a scientific discipline and has been an international centre of excellence from its foundation to the present day.
 

An overview of the timeline: 

• 1812 – Eye Clinic founded by Georg Joseph Beer
• 1830–1850 – ‘Vienna School’
• 1884 – Karl Koller discovers cocaine as a local anaesthetic
• 1905 – First successful corneal transplant
• 1991 – First commercially used optical coherence tomography
• 2004 – Integration into the Medical University of Vienna
   

Did you know?
--> Cocaine is used as a local anaesthetic in eye surgery – a revolutionary discovery from Vienna!

Figure 1: Portrait of Georg Joseph Beer and his drawings

Figure 2: Ernst Fuchs and colleagues at the Second University Clinic

Figure 3: Isidor Schnabel with colleagues during rounds

Sources: Gröger and Schmidt-Wyklicky, The founding of the world's first university eye clinic in Vienna in 1812 and its elevation to a professorship in 1818, Spektrum der Augenheilkunde 06/2012
History of Ophthalmology in Vienna – wog-wien.at/eyekeyvienna Accessed on 02.10.2025
 

Texts and information by Sophie Frank-Publig, Ruth Donner, Jan Lammer, Daniel Schartmüller, Gerhart Schmiedinger; Outpatient Clinic for Corneal Diseases and Special Implant Surgery; University Clinic for Ophthalmology and Optometry, Medical University of Vienna; Int. Director: Prof. Stefan Sacu

The cornea is the clear, transparent layer at the front of the eye. 
It acts as a ‘window’ through which light enters the eye and plays a crucial role in sharp vision. 

History

• Until the 19th century: Early days

In ancient times and the Middle Ages, doctors could only describe corneal diseases externally. 
Inflammation was treated with herbs or ointments, often without knowing exactly how the eye worked. 
It was not until better microscopes were developed in the 18th and 19th centuries that the structure of the cornea became clear.

• 19th–20th century: The beginning of the modern era

It was recognised that injuries or scars on the cornea severely impair vision. 
The first operations attempted to remove or replace cloudy areas of the cornea, which was achieved for the first time in 1905 (Dr. Zirm).

• 20th century

From the 1950s onwards, doctors began to set up corneal banks for donor corneas.

See Figure 1: Dr Zirm in the operating theatre
 

Corneal transplants today
Thanks to modern laser technology, microsurgery and artificial corneas, many corneal diseases can be treated. Cell therapies and biotechnological procedures can also regenerate damaged corneas without having to replace them.

• Classic corneal transplantation (perforating keratoplasty):
Here In this case, the entire cornea is replaced with donor tissue. It is and remains an important procedure!

• Lamellar keratoplasty:
Instead of transplanting the entire cornea, it is now possible to replace only the diseased layers. 
This preserves healthy tissue and leads to faster recovery. Lasers can help to cut the layers precisely.

• Artificial corneal implants:
New, artificial inner corneal layers made of high-tech material (e.g. EndoArt®) replace damaged endothelial cells – without donor tissue. This shortens the healing time and reduces the risk of rejection.

Corneal cross-linking:
Cross-linking with UVA light and vitamin B2 (riboflavin) is a treatment for corneal deformities such as keratoconus. It helps to stop the condition from progressing, often making a transplant unnecessary!

Figure 2: Corneal Cross-Linking

Future

Limbal stem cell transplantation:
If the corneal surface is destroyed by disease or injury, stem cells can be transferred from the edge of the cornea (limbus). They renew the corneal tissue and restore a clear surface.

Precise Vision Endothelial Keratoplasty (PVEK):
A new method has recently been introduced – a combination of cell biotechnology and 3D printing: 
The cells are printed onto a collagen scaffold and used in surgery! The shortage of donor corneas (there is 1 cornea for every 70 needed worldwide) can be alleviated by this new method. It significantly improves care and optimises outcomes for patients with corneal diseases.

Initial trials on rabbit eyes: After 4 weeks, the control rabbit developed a thickened and scarred cornea. 
In comparison, two PVEK rabbits showed a clear and thin cornea after 4 weeks. 

Figure 3: Test rabbits PVEK rabbits

Did you know?
--> In amniotic membrane coverage, a thin layer of the amniotic sac is placed on the cornea like a natural plaster – it protects, alleviates inflammation and promotes healing!
 

Sources: 
Images: https://www.drzirm.org/ (accessed on 06.10.2025), 
https://www.neuhann.de/patienteninformation/hornhauttransplantation-keratoplastik (accessed on 06.10.2025), https://www.klinikum.uni-heidelberg.de/verfahren/crosslinking-201154 (accessed on 06.04.2025)
Lamis Baydoun, Isabel Dapena & Gerrit Melles MD, PhD, Current Treatment Options for Fuchs Endothelial Dystrophy, 2016
Tabibian et al. PACK-CXL: Corneal cross-linking in infectious keratitis. Eye Vis (Lond). 19 April 2016
Mimouni, M. (2024). 3D-Printed Ex Vivo-Expanded Endothelial Keratoplasty. Corneal Physician, Vol. 28, November 2024
 

Aleksandra Sedova, Julia Aschauer, Stefan Pieh / Specialist outpatient clinic for refractive surgery
University Clinic for Ophthalmology and Optometry, Medical University of Vienna / Head: Prof. Stefan Sacu

The beginnings: first optical aids in the Middle Ages
In monasteries, monks used cut rock crystals/beryl as ‘reading stones’, which were placed directly on the text and compensated for presbyopia. The word ‘berille’ (beryl) is the origin of the word “brille” (glasses) – first a single lens (‘Brill’), later two mounted lenses.

Methods of determining refraction
In the past: Trial glasses and eye charts, the strength was determined subjectively (‘better with A or B?’); 
accuracy depended heavily on experience and cooperation.

Today: autorefractometers measure refractive power objectively in seconds; wavefront analysis also detects fine imaging errors; topography/tomography measures the cornea, anterior chamber and, if necessary, the lens – essential for refractive surgery and contact lens fitting. 
Subjective fine adjustment remains the final step to achieving the best corrected visual acuity.
 

The development of spectacles through the centuries

1290 – Riveted spectacles
Two lenses riveted to the bridge of the nose – heavy, but the first wearable spectacles.

Figure 1: Riveted spectacles
 

1751 – Spectacles with arms / ear spectacles
Arms behind the ears → significantly better hold.

Figure 2: Spectacles with arms / ear spectacles


1784 – Bifocal spectacles
One lens with a distance and a near section.

Figure 3: Bifocal spectacles


1940s – Plastic lenses
Glasses become lighter; 1980s – Titanium frames increase comfort.

Figure 4: Plastic lenses


1959 – Progressive Varifocal glasses
Continuous vision without a visible dividing line.

Figure 5: Progressive Varifocal glasses

Glasses in the past

• Heavy, round lenses
• Metal or horn frames
• No customisation, one-size-fits-all
• Often uncomfortable and unattractive

Glasses today

• Lightweight titanium or plastic frames
• Thin, high-refractive lenses
• Special coatings (anti-reflective, blue light filter, scratch protection)
• Tailor-made for visual impairments, comfort and design

Revolutionary development: The contact lens

In 1888, Fick introduced the first glass lenses: effective, but heavy and only wearable for short periods. 
PMMA followed in 1936 – lighter, but hardly oxygen-permeable. In 1961, soft hydrogel lenses revolutionised comfort; today, there are dimensionally stable, highly oxygen-permeable lenses, modern soft lenses (including toric/multifocal) and special lenses such as ortho-k or scleral lenses (e.g. for myopia control or irregular corneas).

The move to laser surgery
In the 1970s and 1980s, radial keratotomy attempted to flatten the cornea and reduce myopia by making fine incisions. In 1983, the excimer laser was introduced: it removes corneal tissue with extreme precision (~0.25 µm per pulse). LASIK (flap + excimer laser) was developed in 1990 and became the standard; today, SMILE (lenticule extraction) and phakic intraocular lenses complement the range of individually tailored corrections.

The precision of the excimer laser is in the range of approximately 0.25 µm per pulse – which corresponds to 1/400 of the thickness of a human hair!

Figure 6: Precision of the excimer laser

Did you know?
--> Initially, only long-sightedness could be corrected with glasses?

Glasses, contact lenses, lasers and implants
Julia Aschauer, Aleksandra Sedova, Stefan Pieh / Specialist outpatient clinic for refractive surgery
University Clinic for Ophthalmology and Optometry, Medical University of Vienna / Head: Prof. Stefan Sacu

Glasses
Frames: ultra-lightweight titanium or plastic, comfortable fit.
Lenses: individually thin, anti-reflective, with UV or blue light filter (optional).
Myopia prevention (‘myopic defocus’): centre = sharp for everyday vision, edge = targeted slight blurring
→ can slow down the progression of myopia in children.
 

Contact lenses 

• Soft lenses
  • very comfortable, wide selection
  • for high corneal curvature
  • less precise
  • slightly higher risk of infection than with glasses
     
• Rigid lenses
  • small, hard lenses
  • provide a very sharp image even with irregular corneas
  • requires adjustment acclimatisation necessary
     
• Scleral lenses
  • larger, rest on the sclera
  • ideal for severely deformed corneas
  • more complicated to handle

Caution: Risk of infection: higher with all lenses than with glasses!

Ortho-K (orthokeratology, night lenses):

• Shapes the cornea overnight → sharp vision during the day without glasses/lenses.
• Slows down myopia (eye length growth).
• Disadvantage: increased risk of infection → strict hygiene required.

Figure 1: Ortho-K, night lenses
 

Myopic defocus lenses

• Like defocus glasses: control zones alternate with correction zones.
• Result: good vision + slowing of length growth → effective for myopia control.

Figure 2: Myopic defocus lenses

Laser procedures (corneal surgery)

Excimer (193 nm, UV)

• Removes corneal tissue in ~0.25 μm increments.
• PRK/TransPRK: Removes surface (TransPRK = ‘no-touch’); good for thin corneas. • PTK: For scars/superficial diseases.
• Custom (topography/wavefront): For irregular corneas (e.g. keratoconus consequences). • Caution: Minimum thickness & safety distance mandatory.

Femtosecond (IR)

• Cuts tissue with ultra-precision.
• Femto-LASIK: Femto creates flap, excimer underneath.
• SMILE®: Mini-incision, remove lenticule → tissue-sparing/stable.

Figure 3 - Laser procedures
 

Implants (phakic IOL/ICL)
Additional lens in front of/behind the iris – natural lens remains. Advantage: suitable for very high myopia/cornea that is too thin, very good vision quality, reversible. Disadvantage: surgery necessary, lifelong check-ups.
 

Conclusion
Glasses/contact lenses: safe & proven; special designs (myopic defocus, Ortho-K) can slow down childhood myopia. Laser procedures: very precise, can be planned individually – note limitations (especially corneal thickness).
Implants: option for high refractive errors.→ Choice always individual depending on the eye, refractive error and safety.

Did you know that...
--> glasses can slow down the progression of myopia?

From cataract extraction to high-tech surgery
Lisy Marcus, Victor Danzinger, Nikolaus Mahnert, Daniel Schartmüller & Christina Leydolt – Vienna IOL Study Group / University Clinic for Ophthalmology and Optometry, Medical University of Vienna
Head: Prof. Stefan Sacu
 

Introduction
Cataract surgery has a history stretching back thousands of years. From painful early methods, it has developed into one of the safest and most common procedures in modern medicine.

Cataract extraction – ancient times to the 19th century
The first treatment was known as cataract extraction:

• Performed without anaesthesia and very painful
• The clouded lens was pushed into the vitreous body with a needle
• High risk of inflammation, infection and blindness → despite the dangers, it remained the only treatment for centuries.
   

Harold Ridley & the first artificial lens
British ophthalmologist Sir Harold Ridley (1906–2001) is considered the father of modern cataract surgery. During the Second World War, he observed that Plexiglas splinters were well tolerated in pilots' eyes. He recognised the potential of the material (PMMA) for an artificial lens and implanted the first intraocular lens (IOL) in London in 1949. His idea was initially met with criticism, but it prevailed and today forms the basis for millions of successful cataract operations worldwide.

Figure 1: Harold Ridley
 

The history of biometry
After Ridley's first artificial lens, the question arose: what is the correct lens power? From the 1950s onwards, the first measurements were taken on the eye – length, corneal curvature and anterior chamber depth. The early calculation formulas were inaccurate, but with ultrasound biometry (from 1980) and later optical biometry (from 1990), precise calculations became possible.→ Today, biometry enables an exact prediction of visual acuity – many patients no longer need glasses after surgery.

Figure 2: History of biometry

The development of modern phacoemulsification
In 1967, Charles Kelman introduced phacoemulsification – inspired by a dental drill. Ultrasonic vibrations were used to break the lens into tiny particles, which were then suctioned out. The procedure could now be performed through tiny incisions – healing was faster and complications were less common. In combination with foldable artificial lenses, the method became the global standard.→ Over 20 million operations per year – an example of how innovation can revolutionise medicine.

Did you know?
--> Cataracts are the most common cause of blindness worldwide – but also the most successful operation in modern medicine. Today, over 20 million cataract operations are performed annually, with a success rate of over 95%.

Sources: https://www.srf.ch/wissen/gesundheit/behandlung-grauer-star-vom-riskanten-starstich-zur-routineoperation
https://ridleyeyefoundation.org/our-history/

Victor Danzinger, Lisy Marcus, Nikolaus Mahnert, Daniel Schartmüller & Christina Leydolt – Vienna IOL Study Group / University Clinic for Ophthalmology and Optometry, Medical University of Vienna
Int. Director: Prof. Stefan Sacu

What is presbyopia?
Presbyopia is a natural ageing process of the lens that usually occurs from the age of 40 onwards. Due to the loss of elasticity, the lens can no longer deform sufficiently – close objects appear blurred. Reading glasses or varifocal glasses typically compensate for this.
 

Presbyopia correction during cataract surgery
Modern intraocular lenses (IOLs) can also correct presbyopia and significantly reduce dependence on glasses.

Multifocal lenses (trifocal IOLs): multiple focal points for distance, intermediate and near vision → high independence from glasses, but possible halos and glare.
EDOF lenses (extended depth of focus): Extended depth of focus with fewer side effects during cataract surgery → more natural vision, reading glasses may be required for close work.
 

Research: perfect presbyopia correction
Current research is aimed at improving vision quality and reducing optical side effects:

Multifocal designs: AI-supported spiral optics for smoother transitions and better contrast. EDOF lenses: Maximised depth of focus with low sensitivity to glare.
Mix & match: Combination of different lens types for individual vision needs. Accommodating IOLs: Future lenses that mimic the natural focusing of the young lens – currently still in development.
 

Vienna IOL Study Group
Founded in 1996 at the Medical University of Vienna, the Vienna IOL Study Group is dedicated to the further development of cataract surgery. Its goal is to improve quality, safety and comfort through clinical studies on new surgical methods, devices and intraocular lenses – always in accordance with the highest scientific standards.

Figure 1: Multifocal intraocular lens
Trifocal design with three focal points for near (≈40 cm), intermediate (≈60–80 cm) and distance vision.

Figure 2: Nuclear opacity and cortical opacity on the left and diffractive multifocal intraocular lens on the right
Concentric ring segments enable sharp vision at close range, intermediate range and distance after cataract surgery.

Figure 3: EDOF (Extended Depth of Focus) intraocular lens
Special design for extended depth of focus – enables sharp, continuous vision from distance to intermediate range.

Figure 4: Vienna IOL Study Group
(from left): Assoc. Prof. Christina Leydolt, Marcus Lisy, Victor Danzinger, Daniel Schartmüller, Nikolaus Mahnert, Leonie Barth BSc.

Did you know?
--> Special innovative lenses enable the correction of presbyopia during cataract surgery, allowing for glasses-free vision.
 

Sources/images:
Rampat R, Gatinel D. Multifocal and Extended Depth-of-Focus Intraocular Lenses in 2020. Ophthalmology. 2021
zeiss.com/meditec/en/products/iols/trifocal-iols/at-lisa-tri-family
iol.meduniwien.ac.at/clinical-trials
bvimedical.com/products/isopure

Stefan Steiner, Sophie Riedl, Stephan Szegedi, Barbara Kiss, Clemens Vass / Specialist Outpatient Clinic for Glaucoma / University Clinic for Ophthalmology and Optometry, Medical University of Vienna
Head: Prof. Stefan Sacu

Drug therapy
Eye drops are usually the first choice in glaucoma treatment. They lower intraocular pressure by improving the drainage of aqueous humour or reducing its production. Several groups of active substances are available, including prostaglandin analogues, beta blockers, alpha-2 agonists, carbonic anhydrase inhibitors and rho kinase inhibitors. Combinations are often used to enhance the effect. → Effective and well tolerated, and therapy depends on the reliability and tolerability of the patient.

Laser therapy
An option if drops are insufficiently effective or intolerable. 

Laser trabeculoplasty: improves drainage via the trabecular meshwork.
Laser iridotomy: small opening in the iris, especially in narrow-angle glaucoma.
Cyclophotocoagulation: reduces aqueous humour production via the ciliary body tissue.
→ The aim is to reduce pressure without surgical intervention.

Surgical therapy
The University Clinic for Ophthalmology and Optometry at Vienna General Hospital offers a wide range of modern surgical procedures for the treatment of glaucoma.
 

Minimally invasive glaucoma surgery
Suitable for mild to moderate glaucoma or in combination with cataract surgery. Enables moderate pressure reduction with lower risk and faster recovery. → Not suitable for very advanced stages.

Figure 1 - Example of a minimally invasive procedure in the chamber angle
Example of a minimally invasive procedure in the chamber angle: Excision of the trabecular meshwork using a special instrument (Kahook Dualblade) to reduce the outflow resistance in the trabecular meshwork.

Trabeculectomy and drainage implants 
Used when medication and laser treatment are no longer sufficient. The aim is to reduce pressure more significantly in order to stop the progression of optic nerve damage. → Complex procedure with risks such as infection or scarring, but often the last option for preserving vision.

Figure 2: Example of a Preserflo MicroShunt
Example of a Preserflo MicroShunt that drains aqueous humour into a previously inserted drainage pad.

Did you know?
--> In addition to drug therapy for glaucoma, there is also the option of treatment using laser or surgical procedures.

 

Sources:
1) Steiner S, Vass C. Praxis der nichtfiltrierenden minimalinvasiven Glaukomchirurgie [Insights into the practice of minimally invasive glaucoma surgery]. Klin Monbl Augenheilkd. 2025 May;242(5):585-604. German. doi: 10.1055/a-2217-6851. Epub 2025 Jan 14. PMID: 39809442.
2) Sadruddin O, Pinchuk L, Angeles R, Palmberg P. Ab externo implantation of the MicroShunt, a poly (styrene-block-isobutylene-block-styrene) surgical device for the treatment of primary open-angle glaucoma: a review. Eye Vis (Lond). 2019 Nov 15;6:36.

Ioanna Dimakopoulou, Markus Ritter, Georgios Mylonas, Michael Georgopoulos, Prof. Stefan Sacu – Special Outpatient Clinic for Vitreoretinal Surgery / University Clinic for Ophthalmology and Optometry, Medical University of Vienna / Head: Prof. Stefan Sacu

The period before Gonin (before 1920)
First descriptions in the 19th century (Ware, Wardrop, Panizza). Retinal tears were first detected using the ophthalmoscope (Helmholtz, 1850). Despite many attempts, the disease remained incurable – until Jules Gonin discovered the connection between tears and detachment around 1920.

What is retinal detachment?
The retina detaches from its base and loses its supply – if left untreated, it can lead to blindness. The main cause is a tear through which fluid penetrates. 
Types:

• Rhegmatogenous (tear)
• Tractional (tensile forces, e.g. in diabetes)
• Exudative (fluid) Warning signs: flashes of light, black spots (‘soot rain’), ‘curtain’ in the field of vision.

Figure 1 - Retinal detachment

Modern retinal surgery - from as of 1920 
Jules Gonin recognised that tears in the retina were the cause and initially sealed them with heat. In 1938, it became possible to reattach the retina using an air bubble in the eye. Later, the ‘plomb’ and ‘cerclage’ techniques were developed, in which a band is placed around the eye. From 1965 onwards, extreme cold (cryopexy) was used, which was gentler on the tissue and made the procedures safer.

Figures 2–4: Historical surgical methods in retinal surgery – ignipuncture according to Gonin, coagulation according to Larsson and introduction of the intraocular air bubble by Rosengren.
 

Breakthrough in retinal surgery: vitrectomy and laser since 1973
Pars-plana-vitrectomy made it possible to remove the vitreous body and eliminate traction forces and bleeding. The laser could be used to seal tears precisely. → Today, over 90% of all retinal detachments can be treated successfully.

MedUni Vienna: pioneering work in retinal detachment since 1972
In 1972, the First University Eye Clinic in Vienna established a special outpatient clinic for retinal detachment. Early aftercare and research made Vienna an international centre for retinal surgery.

Chronological development

• Before 1920: Blindness almost certain (success rate 0%)
• 1929: Ignipuncture: First cures
• 1938: Air bubble as internal tamponade
• 1953: Plombage: Indentation of the sclera
• 1957: Cerclage: Ring-shaped stabilisation
• 1965: Cryopexy: Cold instead of heat
• 1973: Vitrectomy & laser coagulation – modern standard methods (success rate > 90%)

Did you know?
--> For centuries, retinal detachment was considered incurable. It was not until the 20th century that courageous pioneers made decisive advances that continue to save the vision of millions of people to this day.

Sources:
Kreissig, Ingrid. (2016). Primary retinal detachment: A review of the development of techniques
for repair in the past 80 years. Taiwan Journal of Ophthalmology. 
6. 10.1016/j.tjo.2016.04.006. 

Jakob Kraiger, Sam Hedo, Markus Ritter, Georgios Mylonas, Michael Georgopoulos, Prof. Stefan Sacu, Special Outpatient Clinic for Vitreoretinal Surgery / University Clinic for Ophthalmology and Optometry, Medical University of Vienna / Head: Prof. Stefan Sacu
 

What can go wrong with the retina?

• Retinal detachment

Fluid enters under the retina through a hole, causing it to lift up (‘the wallpaper comes off’) and separate from the choroid. This results in shadow vision, visual field defects and, if left untreated, blindness.

Figure 1: Retinal detachment

• Macular hole / epiretinal membrane

A small central hole in the macula, often age-related due to traction of the vitreous body on the retina, leads to significant visual impairment.

Figure 2: Macular hole

• Consequence of diabetes or vascular diseases

Elevated blood sugar damages the fine retinal vessels. This leads to leaky vessels – blood and fluids leak into the retina. Similar damage, such as bleeding or insufficient blood supply, occurs in retinal vein or artery occlusions.
 

How does retinal surgery help today?

• Minimally invasive surgery

The vitreous body is removed through tiny incisions and the retina is reattached (vitrectomy).

• Reattaching the retina with gas or oil

After sealing the hole with laser or cold, the eyeball is filled with air, gas or oil to reattach the retina from the inside.

• Laser treatments

Lasers seal retinal holes and stop the growth of new, harmful vessels.

Figure 3: Laser treatments
 

Opportunities for patients
Thanks to modern retinal surgery, many diseases can now be treated effectively. Retinal detachments can be successfully operated on in around approximately 90% of all cases. New surgical techniques enable a quick recovery – often in just a few days or weeks.
Even if full vision is not always restored, eyesight can usually be preserved or improved.
 

Current innovations

• Microsurgery with high-resolution cameras 

High-resolution 3D cameras enable more precise procedures without the need for a microscope.

Figure 4: Microsurgery with high-resolution cameras

• Robotic assistance for maximum precision

Robotic arms perform the most delicate movements without vibration – for maximum accuracy.

• Intraoperative OCT at MedUni Vienna

Our microscopes have integrated OCT – this allows the retina to be assessed in real time during surgery.

Figure 5: Example of intraoperative OCT

Did you know?
--> The retina is the inner layer of the eye – it converts light stimuli into electrical nerve impulses, which the brain processes into images. Just like film in a camera!

Sources:
Leica Microsystems
Kanski's Clinical Ophthalmology. A Systematic Approach, 8th edition, Brad Bowling, page 526
Kashani et al. Surgical Method for Implantation of a Biosynthetic Retinal Pigment Epithelium Monolayer for Geographic Atrophy: Experience from a Phase 1/2a Study. Ophthalmol Retina. 2020 Mar;4(3):264-273. doi: 10.1016/j.oret.2019.09.017. 
 

Sam Hedo, Jakob Kraiger, Gregor Reiter, Bilal Haj Najeeb, Günther Weigert, Wolf Bühl, Prof. Stefan Sacu
Outpatient clinic for the diagnosis and treatment of macular diseases / University Clinic for Ophthalmology and Optometry, Medical University of Vienna / Head: Prof. Stefan Sacu

How AMD changes lives 
AMD leads to a loss of central vision, making everyday activities such as reading, getting dressed and driving difficult. This often leads to loneliness, social withdrawal, anxiety and depression. Patients are at high risk of falling, which often results in hospitalisation due to fractures or other dangerous injuries. 

Figure 1 – Left: normal vision. Right: vision with advanced AMD 
Source: Augenmedizin.at – Clinical pictures. Available at: https://augenmedizin.at/krankheitsbilder (accessed on 29 September 2025).

Laser photocoagulation: First treatment method for AMD

• First tested in the late 1970s.
• Principle: A high-energy laser beam is directed at the diseased region of the retina. The laser generates heat (“coagulation”), which destroys abnormal new blood vessels.
• Problems:
  • Healthy retinal tissue is also damaged. 
  • Especially in the centre (macula), the treatment often led to an immediate deterioration in visual acuity.
• Long-term results: 
  • Short-term vision loss after treatment. 
  • After 2 years: Patients who underwent laser therapy had better visual performance than those who did not receive treatment.

Figure 2 - Laser photocoagulation
 

Photodynamic therapy (PDT)

• Introduced in the late 1990s 
• Procedure:
  • A light-sensitive agent (verteporfin) is administered via a vein and accumulates in diseased vessels in the retina.
  • Activation by weak laser light → vessels are selectively closed.
• Advantage: Healthy tissue remains largely intact.
• BUT: The progression of AMD is only slowed down, not stopped.

Figure 3: Schematic representation of photodynamic laser therapy (PDT)
Source: (Yoo, Kim et al. 2022)
 

Anti-VEGF therapy – preserving vision through targeted treatment

• In wet AMD, abnormal, leaky blood vessels grow on the retina, leading to fluid accumulation and bleeding that impair sharp vision. 
• It has been discovered that a messenger substance called VEGF drives this vascular growth. 
• The solution:
  • Special medications – known as anti-VEGF agents – block this messenger substance.
  • The medications are injected directly into the eye.
  • The growth of new vessels stops and fluid and bleeding recede.
• The result: Many patients can see better again!

Figure 4 – Anti-VEGF therapy 
 

Chronological development

• 1852: The first descriptions of AMD, albeit under a different name.
• 1855: The first description of drusen by Dutch ophthalmologist F.C. Donders.
• 1910: Viennese ophthalmologist Ernst Fuchs described the disease in detail for the first time.
• 1970s: Emergence of the term “AMD”, early experiments with radiation therapy and surgical trials.
• 1970-1980: Laser photocoagulation: First therapy, very destructive.
• 1999: Photodynamic therapy: Less destructive.
• 2005: Anti-VEGF therapy: Revolution in routine treatment.

Did you know?
--> Just 50 years ago, there was no effective treatment! 
Today, we can preserve or even improve vision in many people!

Sources:
Argon Laser Photocoagulation for Neovascular Maculopathy: Five-Year Results From Randomised Clinical Trials. Arch Ophthalmol. 1991;109(8):1109–1114. doi:10.1001/archopht.1991.01080080069030
Photodynamic therapy of subfoveal choroidal neovascularisation in age-related macular degeneration with verteporfin: one-year results of 2 randomised clinical trials—TAP report. Treatment of age-related macular degeneration with photodynamic therapy (TAP) Study 
Group. Arch Ophthalmol. 1999 Oct;117(10):1329-45. Erratum in: Arch Ophthalmol 2000 Apr;118(4):488. PMID: 10532441.
(Rosenfeld, Brown et al. 2006) DeepPDT-Net: predicting the outcome of photodynamic therapy for chronic central serous chorioretinopathy using two-stage multimodal transfer learning. Sci Rep. 2022 Nov 4;12(1):18689. (Yoo, Kim et al. 2022)

Sophie Frank-Publig, Gregor Reiter, Klaudia Birner, Julia Mai, Sophie Riedl, Prof. Stefan Sacu
Vienna Clinical Trial Centre Ophthalmology, Optima – Ophthalmic Image Analysis, Christian Doppler Research Association / Int. director: Prof. Stefan Sacu
 

Why is age-related macular degeneration still so important?
Age-related macular degeneration is important because it is the most common cause of severe vision loss in older people in industrialised countries. More than 200 million people worldwide are already affected today – and this number is rising due to the ageing population!

Research into causes
Scientists are discovering more and more genes and inflammatory processes associated with AMD. This may lead to more targeted therapies in the future. Lifestyle: Dietary supplements (AREDS2), a healthy diet (Mediterranean cuisine) or a special diabetes medication can reduce the risk of progression.

New developments in therapy

• Complement system inhibitors

For a long time, there was no treatment for geographic atrophy. Now there are drugs that can slow down its progression. New drugs such as pegcetacoplan and avacincaptad pegol were approved for therapy in the USA in 2023.

• Improved therapies for wet AMD 

Existing eye injections are being further developed. Some new drugs only need to be administered every few months instead of every few weeks!
 

Automatic measurement of fluid

Figure 1 – Automatic measurement of fluid
Here, an algorithm developed by us automatically evaluated three forms of fluid accumulation in AMD on optical coherence tomography images.
 

Forms of the disease on new devices
The disease begins with the formation of druses. These are waste product deposits. 
Later, geographic atrophy develops, where the cells of the retina die, or the wet form, where leaking vessels secrete fluid and even bleeding and scarring can occur.
We now know that all forms go hand in hand: druses, fluid and atrophy can occur simultaneously!

Figure 2: Forms of the disease
 

Research focus at the MUW Eye Clinic: Artificial intelligence
We are developing computer models that automatically analyse eye images and help to better understand the disease. AI also helps doctors with treatment! But what is it used for?

• 1. Early detection and diagnosis

Changes in eye images can be detected automatically, so AMD is now often diagnosed earlier!

• 2. Prediction – Can AI see into the future?

Yes! Accurate risk assessment is used to predict how the disease will develop in an individual. This allows treatment to be planned on a more individual basis! 

• 3. Support during therapy

Risk assessment and fluid measurements can reduce the burden on those affected. But in the end, the decision always remains with the doctors!

• 4. Research and new findings

AI is also used to discover new correlations – for example, small changes in tissue that can also be detected in images.
 

Did you know?
--> Artificial intelligence can now detect small changes in the eye better than experienced specialists!

 

Sources: Mai et al. Comparison of Fundus Autofluorescence Versus Optical Coherence Tomography-based Evaluation of the Therapeutic Response to Pegcetacoplan in Geographic Atrophy. Am J Ophthalmol. 2022 Dec;244:175-182.
Schlegl et al. Fully Automated Detection and Quantification of Macular Fluid in OCT Using Deep Learning. Ophthalmology. 2018 Apr;125(4):549-558.
Frank-Publig & Birner et al. Artificial intelligence in assessing progression of age-related macular degeneration. Eye (Lond). 2025 Feb;39(2):262-273.
Spaide et al. Consensus Nomenclature for Reporting Neovascular Age-Related Macular Degeneration Data: Consensus on Neovascular Age-Related Macular
Degeneration Nomenclature Study Group. Ophthalmology. 2020
 

Heiko Stino, Kim Lien Huber, Paul Widmann-Sedlnitzy, Laura Kunze, Andreas Pollreisz / University Clinic for Ophthalmology and Optometry, Medical University of Vienna / Int. Director: Prof. Stefan Sacu

Background

Fluorescein angiography (FLA) is the gold standard for assessing retinal vessels: a dye is injected intravenously and its distribution is photographed over a period of ~10 minutes. This allows reliable imaging of new vessel formation, leaks and areas without blood flow, even in the periphery. Disadvantages include invasiveness, time consumption and rare side effects.

Optical coherence tomography angiography

OCT angiography (OCTA) measures blood flow without dye by scanning the same area multiple times and detecting movement in the vascular lumen. It is fast, non-invasive and layers the retina into plexuses. Limitations: smaller field of view than FLA and possible artefacts during long scans or eye movements.

Figure 1: Patient with proliferative DR, multiple proliferations & hypoperfusion

Achievements of the University Clinic for Ophthalmology & Optometry Vienna

A widefield OCTA prototype was developed in collaboration with MedUni Vienna (≈15 s exposure, image diameter ~18 mm). This system allows rapid, high-quality, non-invasive vascular imaging of the entire retina, including the periphery. Based on this, several clinical projects have been successfully implemented.

Figure 2: Patient with proliferative DR, OCTA (A) with B-scan (b) and FLA (C)

Detection of proliferations

The detection of neovascularisation is crucial for the diagnosis of proliferative diabetic retinopathy. With widefield OCTA, the correct diagnosis was made in 95% of cases; small vascular anomalies can often be shown in greater detail than with FLA. This makes the method particularly suitable for screening and follow-up.

Figure 3: Non-perfused areas (yellow) in increasing stages of DR (from left to right)

Combination with fundus photography

The combination of colour fundus images with widefield OCTA allows for a multi-layered analysis: structure (photo) and perfusion (OCTA) are assessed in a congruent manner. This facilitates the mapping of lesions, monitoring during therapy and communication with patients.

Non-perfused areas

As the disease progresses, non-perfusion zones increase and threaten the retinal supply. Widefield OCTA makes these areas visible and quantifiable at all stages. This allows for more targeted risk assessments and therapy adjustments (e.g. panretinal laser treatment).

Figure 4: Colour photograph (left) & OCTA (right) of the same patient

Did you know?
--> With OCTA, the movement of red blood cells can be used to visualise the vessels of the retina!

Sources:

1. Stino H, Niederleithner M, Iby J, Sedova A, Schlegl T, Steiner I, Sacu S, Drexler W, Schmoll T, Leitgeb R, Schmidt-Erfurth UM, Pollreisz A. Detection of diabetic neovascularisation using single-capture 65°-widefield optical coherence tomography angiography. Br J Ophthalmol. 18 December 2023;108(1):91-97. 

2. Stino H, Huber KL, Niederleithner M, Mahnert N, Sedova A, Schlegl T, Steiner I, Sacu S, Drexler W, Schmoll T, Leitgeb R, Schmidt-Erfurth U, Pollreisz A. Association of Diabetic Lesions and Retinal Nonperfusion Using Widefield Multimodal 

Imaging. Ophthalmol Retina. 2023 Dec;7(12):1042-1050.

Philipp Fuchs, Adrian Reumüller, Reinhard Told, Birgit Lackner, Roman Dunavölgyi
Specialist Outpatient Clinic for Ophthalmic Oncology and Oculoplastics / University Clinic for Ophthalmology and Optometry, Medical University of Vienna / Head: Prof. Stefan Sacu

Introduction
Our eyelids protect the cornea, distribute tear fluid and shape our appearance. Eyelid surgery has developed from simple procedures to high-precision oculoplastics.

What is oculoplastics?
Oculoplastics (or oculoplastic surgery) deals with operations on the structures surrounding the eye – eyelids, tear ducts and eye socket. It encompasses functional, reconstructive and aesthetic procedures and aims to preserve or restore the function, protection and natural appearance of the eye.

In the past: traditional approaches
In the 19th century, procedures were often radical and reconstructions rare. Malpositions such as entropion or ectropion led to pain, corneal damage and loss of vision. Cosmetic aspects played hardly any role – the survival of the eye was crucial.

Today: modern oculoplastics
Today, function and aesthetics are given equal consideration. Tumours are gently removed, eyelids are precisely reconstructed and malpositions are corrected. Minimally invasive techniques, lasers and biocompatible materials enable natural and functional results.

When the eye must be removed
In cases of severe injury, infection or tumours, enucleation is sometimes necessary. This involves removing the eyeball while preserving the muscles and eyelids. An implant enables movement and a natural-looking prosthesis – important for quality of life and self-image.

Figure 1: Eye prosthesis – artificial eye
 

Tear ducts & surgery
The tear ducts drain fluid into the nose. If they become narrowed, probing with a silicone tube helps to keep them open during healing.

Figure 2: Drainage of tear fluid via the punctum, canaliculi and lacrimal sac into the nose
 

Research & innovation at MedUni Vienna

• Development of new surgical techniques
• Research into biomaterials for gentle reconstruction.
• International pioneering role through collaboration (oncology, plastic surgery, radiology)
   

Chronological development

• 1812: Vienna: First university eye clinic
• 1859: Arlt (Vienna): Controlled enucleation
• 1874: Arlt (Vienna): Eyelash transplantation
• 1882: Ernst Fuchs (Vienna): Enucleation as standard therapy for intraocular melanoma
• 1884: Knapp (Vienna): Classic enucleation technique under local anaesthesia
• 2025: State-of-the-art oculoplastics and evidence-based clinical research

Did you know?
--> Malpositions such as entropion (eyelid turned inwards) can lead to blindness if left untreated.
--> Modern eyelid surgery combines function and aesthetics – with minimal scarring and rapid healing.

Sources: 
•Arlt CF. Transplantation of the ciliary base. In: Graefe A, Saemisch T (eds.). Handbook of Complete Ophthalmology. Vol. 3(1). Leipzig: Wilhelm Engelmann; 1874. pp. 447–451.
•Jelcic I, Zoranovic U, Karaman K, et al. Carl Ferdinand von Arlt, Ritter von Bergschmidt (1812–1887): A Pioneer in Ophthalmology. Acta Medica Academica. 2019;48(3):332-336. doi:10.5644/ama2006-124.276.
•Fuchs E. Das Sarcom des Uvealtractus. Vienna: Wilhelm Braumüller; 1882. (Bibliographic reference)
•https://www.medizin.uni-tuebingen.de/cache/images/c/8/2/7/e/c827ed54d99fd1f669a29c2267fa4e05f2c50177.jpeg

Wassermann L., Rezar-Dreindl S., Neumayer T., Schwarzenbacher L., and Stifter E. Special Outpatient Clinic for Strabismus, Pediatric Ophthalmology, and Pediatric Ophthalmic Surgery / University Department of Ophthalmology and Optometry, Medical University of Vienna / Head: Prof. Stefan Sacu
 

The Introduction of the Mother-Child Health Handbook
With the introduction of the Mother-Child Health Handbook in 1974 and the accompanying preventive care program, infant and maternal mortality in Austria was significantly reduced within just a few years. The program also includes several eye examinations:

• On the first birthday, the pediatrician checks the outer segment of the eye, mobility, and parallel position of the eyes (Brückner test).
• On the child's second birthday, a comprehensive eye examination is performed, including a visual acuity test, orthoptic status, and refraction (cycloplegic) to detect visual impairments such as myopia, hyperopia, or anisometropia early.

The goal of these examinations is to detect eye diseases early and treat them promptly to ensure visual development and prevent amblyopia.

Figure 1: Introduction of the Mother-Child Health Handbook
 

What does amblyopia actually mean, and what are the risk factors/causes?
Amblyopia is a type of weak vision that is not caused by an organic disease. The eye itself is healthy, but the brain is not adequately trained to see. It can occur unilaterally or bilaterally and affects approximately 0.2–5% of the population worldwide. Risk factors include premature birth, developmental delay, family history, and visual defects such as strabismus or ametropia. Causes can include opacities (e.g., cataracts), severe refractive errors (myopia, hyperopia, astigmatism, anisometropia), or ptosis. If the affected eye is not used properly for a long time, it remains functionally weak.

Figure 2: Amblyopia and risk factors
 

Treatment of amblyopia
Treatment aims to support the weaker eye:
Occlusion therapy: The better-seeing eye is covered with a patch for a few hours to train the weaker eye.
Correction of causes: Refractive errors are treated with glasses or contact lenses, and ptosis or strabismus are operated on early if necessary.
The duration of treatment depends on age and severity (usually 1–6 hours daily until age 10). Regular check-ups are crucial to avoid overloading the healthy eye.

Figure 3: Amblyopia Treatment
 

Trend in the prevalence of amblyopia among Austrian conscripts born between 1965 and 2003
An analysis of 1.7 million Austrian conscripts (born between 1965 and 2003) showed a significant decline in the prevalence of amblyopia after the introduction of the Mother-Child Health Handbook: from approximately 4% to only 1.5% by 2001. This development underscores the great success of the Austrian screening program and the importance of early ophthalmological checkups in childhood.

Figure 4: Trend in the prevalence of amblyopia among Austrian conscripts born between 1965 and 2003
The graph shows a clear decline in unilateral and bilateral visual impairment after the introduction of the screening program (the entire group and then the individual groups with different visual acuity limits).

Did you know?
--> In 2024, the Mother-Child Health Handbook celebrated its 50th anniversary; it was introduced in 1974 by Health Minister Ingrid Leodolter.

Sources:
1. (https://www.medmedia.at/gyn-aktiv/eine-einzige-erfolgsgeschichte/)
2. BUI QUOC et al. - Amblyopia: A review of unmet needs, current treatment options, and emerging therapies
j.survophthal.2023.01.001. Epub 2023 Jan 18.
3. Fu et al., Global prevalence of amblyopia and disease burden projections through 2040: a systematic review and meta-analysis 2019 Br J Ophthalmol 2020 Aug;104(8):1164-1170.
4. Holmes et al- A randomized trial of prescribed patching regimens for treatment of severe amblyopia in childhood ophthalmology 2003 Nov;110(11):2075-87. doi: 10.1016/j.ophtha.2003.08.001.
5. The Pediatric Eye Disease Inbestigator Group - A randomized trial of patching regimens for treatment of moderate amblyopia in children Arch Ophthalmol. 2003;121:603-611
6. Wassermann et al - Trend of prevalence of amblyopia in Austrian conscripts born between 1965 and 2003 – a descriptive study – 09/2025 submitted
 

Retinopathy of Prematurity – Past, Present, and Future
Rezar-Dreindl S., Neumayer T., Wassermann L., Schwarzenbacher L., and Stifter E.
Specialized Outpatient Clinic for Strabismus, Pediatric Ophthalmology, and Pediatric Ophthalmic Surgery with Premature Infants / University Department of Ophthalmology and Optometry, Medical University of Vienna
Int. Line: Prof. Stefan Sacu
 

Childhood Eye Diseases 
Around 19 million children worldwide are affected by visual impairment or blindness (WHO). The most common cause is retinopathy of prematurity. Other causes include lens opacities, corneal and optic nerve diseases, and hereditary retinal diseases.

Figure 1: Schematic representation of the eye
 

Retinopathy of Prematurity – What is it?
Retinopathy of Prematurity (RPM) affects the retina of premature infants. Since retinal vessels do not fully develop until birth, premature birth can lead to abnormal vascular growth and retinal damage. Factors that play a role in the development of RPM include low birth weight and gestational age at birth, as well as artificial respiration with increased oxygen levels. The incidence of RPM varies by country/region, access to the healthcare system, and access to appropriate screening methods. The incidence depends largely on the standard of care and screening.
 

Past
First described in 1942 ("retrolental fibroplasia"). Due to advances in neonatal care, an increasing number of children were born with lower birth weight and gestational age. This increased the number of premature babies with PRM, making it the most common cause of visual impairment and blindness in childhood worldwide.
Today, the lower the birth weight, the higher the risk. In 1986, cryotherapy was the first treatment to be established – it significantly reduced the rate of blindness.
 

Present
Laser therapy has been used since the 1990s, and since 2019, VEGF-inhibiting drugs injected into the vitreous have been used.

Figure 2: Application of drugs into the vitreous space (intravitreal injection)

Early diagnosis remains crucial: All children born <32 weeks of gestation or with a birth weight of <1500 g are regularly screened. Thanks to modern methods, ROP is now easily treatable, and severe vision impairment is rare.
 

Figure 3: Examples of RPM in premature infants - images taken with a fundus camera. 
Left: typical image of RPM requiring treatment, Right: after laser treatment of the peripheral retina
 

Future and Research
Research at the Medical University of Vienna shows: Of 352 premature infants, 41% developed RPM, and 5% required treatment. Each additional gram of birth weight reduced the risk by 0.4%. With new techniques such as OCT angiography (OCTA), retinal vessels can be visualized non-invasively and precisely. → Goal: Earlier detection, better treatment, long-term preservation of vision.

Figure 4: Left: The OCTA image shows the central retinal vessels of a full-term infant
right: a premature infant born at 27 weeks of gestation with a birth weight of 950 g. 
Clear differences in vascular architecture are evident.
 

Did you know?
--> Globally, retinopathy of prematurity is the most common preventable cause of blindness in childhood.

Sources:
1. Terry TL. Retrolental fibroplasia. J Pediatr. 1946;29(6):770-773.
2. Gilbert C. Retinopathy of prematurity: a global perspective of the epidemics, population of babies at risk and implications for control. Early Hum Dev. 2008;84(2):77-82.
3. Kong, L. et al. An update on progress and the changing epidemiology of causes of childhood blindness worldwide. J.Am. Assoc. Pediatrics Ophthalmol. Strabismus JAAPOS 2012
4. Wood, S, et al. 80 Years of vision: Preventing blindness from retinopathy of prematurity. J. Perinatol. 2021
5. Sabri, K. et al. Retinopathy of Prematurity: A Global Perspective and Recent Developments. Pediatrics 2022
6. Blazon MN, Rezar-Dreindl S, Wassermann L., Neumayer T, Berger A, Stifter E. Retinopathy of Prematurity: Incidence, Risk Factors, and Treatment Outcomes in a Tertiary. Care Center. JCM 2024
7. Rezar-Dreindl S, Eibenberger K, Told R, Neumayer T, Steiner I, Sacu S, Schmidt-Erfurth U, Stifter E. Retinal vessel architecture in retinopathy of prematurity and healthy controls using swept-source optical coherence tomography angiography. Acta Ophthalmol.2021 Mar; 99(2).
 

Sophie Frank-Publig / Department of Ophthalmology and Optometry, Medical University of Vienna
Head: Prof. Stefan Sacu
 

Myth 1: All babies are born with blue eyes
At birth, some eyes appear blue because the pigment melanin is not yet fully developed. Within the first year of life, the eye color can darken as more melanin is deposited.

Myth 2: Babies already have fully grown eyes at birth
Newborn eyes are about two-thirds the size of adult eyes. They grow primarily in the first years of life and again during puberty. This also changes the refractive power. Vision usually stabilizes during adolescence or early adulthood (around 18–21 years) – until age-related farsightedness (presbyopia) sets in in the mid-40s.

Myth 3: Two brown-eyed parents can't have a blue-eyed child
Eye color depends not on just one or two genes, but on up to 16. Therefore, a child can have a completely different eye color than both parents.

Myth 4: Carrots improve eyesight
Carrots contain vitamin A, which is important for healthy vision. But: Even small amounts are enough! Vitamin A is also found in spinach, kale, dairy products, and fish. So more carrots won't improve your eyesight, and glasses won't replace the vegetables. Important: Vitamin A is better absorbed when eaten with fat.

Myth 5: Eye exercises improve your eyesight
Exercises neither change visual acuity nor prevent the need for glasses. Exercises can only help with certain problems, such as when both eyes aren't working well together.

Myth 6: Staring at the sun is healthy
On the contrary: Just a few seconds can cause permanent damage to the retina or even lead to blindness. Regular sunglasses don't provide protection – special filters that meet an ISO standard are required.

Myth 7: If you cross your eyes, they will stay that way
The eye muscles can move freely –being cross-eyed is caused by disease, incorrect vision correction, or nerve/muscle damage, not by intentionally crossing your eyes.

Myth 8: Only boys can be color blind
Although women are less commonly affected, they can also be color blind.

Myth 9: Color blind people only see black and white
Most people see colors – but incorrectly or with limitations; for example, red and green tones are difficult to distinguish. Complete "grayscale vision" is rare.

Myth 10: Sitting too close to the TV is harmful to your eyes
It's tiring and can cause headaches, but it doesn't damage your eyes. Children often sit closer because they can focus better at close range. However, people who sit very close for a long time could be nearsighted.

Myth 11: Reading in poor light damages your eyes
No – it just makes them more strained. With good lighting, your eyes tire more slowly.

Myth 12: Computer work ruins your eyes
Screens don't directly harm you, but they can cause dry or tired eyes. Tip: Look into the distance every 20 minutes, blink regularly, and use artificial tears!

Myth 13: Fine print or a lot of close work damages your eyes
It doesn't wear your eyes out, but it does make them tired. Breaks help.

Myth 14: Wearing glasses or contact lenses is becoming addicted
Glasses don't impair your vision; they relieve eye strain.

Myth 15: The wrong prescription damages your eyes
This doesn't cause permanent damage, but it can cause headaches or blurred vision – which disappears as soon as you take them off.

Myth 16: Learning difficulties are caused by vision problems
The cause is a processing disorder in the brain, not the eyes. However, poor eyesight can be interpreted as a learning disability – so get your eyes checked if your child is having trouble at school.

Myth 17: Vision deterioration is a part of aging
Not necessarily: Many problems like presbyopia or cataracts are treatable. Regular checkups are important for early detection of diseases like glaucoma or macular degeneration.

Myth 18: A cataract must be "mature" before surgery
Today, the clouded lens can be removed as soon as it interferes with vision.

Myth 19: Eye transplants are possible
That's not possible – the eye is connected to the brain via the optic nerve. This nerve consists of over a million fibers that cannot be reconnected. However, the cornea (the clear part at the front) can be transplanted.

Myth 20: All eye exams are the same

• Ophthalmologists: Medically qualified professionals with up to 12 years of training, authorized to prescribe medications and perform surgeries
• Orthoptists: Three-year university of applied sciences degrees, their expertise lies in the detection, treatment, and prevention of vision disorders, strabismus, or eye movement disorders.
• Opticians: make and fit glasses or contact lenses based on prescriptions from other professionals. They have also completed specialised training or an apprenticeship.

Sophie Riedl, Stefan Steiner, Stephan Szegedi, Barbara Kiss, Clemens Vass / Specialist Outpatient Clinic for Glaucoma / University Clinic for Ophthalmology and Optometry, Medical University of Vienna
Head: Prof. Stefan Sacu

Is it glaucoma?

In ancient Greece, Hippocrates used the term glaucosis to describe “sea-green eyes” without distinguishing between different causes such as lens opacity (cataract). In 1622, Richard Banister first described the ‘hard eyeball’. In 1722, Michel Brisseau distinguished between glaucoma and lens disorders. However, the exact causes of these different diseases remained unknown until the 19th century.

Location: Optic nerve

Glaucoma is a group of diseases that damage the optic nerve. This nerve transmits information from the photoreceptor cells to the brain, where the image is formed. Damage to the optic nerve causes visual field defects, which can lead to blindness if left untreated.

Figure 1: Progression of visual field loss: Initially, the visual field is normal, with a small blind spot. Over time, arc-shaped losses spread and can eventually affect almost the entire visual field.

Treatment

Damage to the optic nerve that has already occurred cannot be reversed. 

• The aim of treatment is to slow down the progression of glaucoma.
• Eye drops are usually used to lower the pressure in the eye. These must be used regularly and should not be discontinued without consulting a doctor.
• Laser treatment or, if necessary, surgery are also options.
• New procedures and medications designed to protect the optic nerve are currently being researched.
   

Risk: Intraocular pressure

In most cases, increased intraocular pressure damages the optic nerve. However, glaucoma can also occur at normal pressure – presumably due to impaired blood flow to the optic nerve.

Figure 2: Aqueous humour: It flows in the anterior chamber of the eye. If production and drainage are not in balance, intraocular pressure rises.
 

What can I do?

The disease often goes undetected for a long time!
Glaucoma often goes unnoticed for a long time because the defects are initially located at the edge of the visual field and the brain compensates for them. In Western Europe, it is the second leading cause of blindness – that's why prevention is important!

That's why prevention is important!
From the age of 40, painless examinations are recommended: measurement of intraocular pressure, ophthalmoscopy, visual field test and OCT to assess the optic nerve.

Consultation regarding medication
Inform your ophthalmologist about any medication you are taking, such as cortisone or medication for irritable bladder, as these can increase eye pressure.

Did you know?
--> Early detection saves your eyesight! Glaucoma is usually painless and can therefore go unnoticed!

Kim Lien Huber, Paul Widmann-Sedlnitzky, Laura Kunze, Heiko Stino, Bianca Gerendas, Katharina Kriechbaum, Andreas Pollreisz / Specialist Outpatient Clinic for Diabetic Retinopathy / University Clinic for Ophthalmology and Optometry, Medical University of Vienna / Int. Line: Prof. Stefan Sacu
 
 
What is diabetic retinopathy?
Diabetic retinopathy (DRP) is a complication of diabetes mellitus in which high blood sugar levels damage the small blood vessels in the retina. It is classified into the following stages:

• Mild DRP: Small bulges in the blood vessels (microaneurysms)
• Moderate DRP: More damaged vessels, minor bleeding
• Severe DRP: Many vessels are damaged → the retina receives too little oxygen
• Proliferative DRP: Due to oxygen deficiency, the eye forms new, very unstable vessels. These can bleed into the eye or detach the retina 
risk of permanent vision loss.

Diabetic macular oedema can occur at any stage!
No noticeable symptoms for a long time! Only when complications such as macular oedema, vitreous haemorrhage or retinal detachment occur, does blurred vision, distorted lines or spots in the field of vision occur.
 

Figure 1: Normal findings (top) and macular oedema (bottom)
Optical coherence tomography (OCT) of diabetic macular oedema: This complication of diabetic retinopathy is caused by fluid leakage and leads to swelling (oedema) of the centre of vision (macula).
 

Treatment

• Laser coagulation
• Surgical removal of the vitreous body
• Injection therapy into the eye: 
  • Inhibition of the growth factor VEGF: 
    • Ranibizumab (Lucentis®)
    • Aflibercept (Eylea®)
  • Faricimab (Vabysmo®Cortisone preparations:
    • Triamcinolone
    • Dexamethasone implant (Ozurdex®)

 
Rapid increase in diabetes cases worldwide
Figure 2: Rapid increase in diabetes cases worldwide
 

Figure 3: Fluorescein angiography (left) and fundus photography (right) of an eye
Fluorescein angiography (left) and fundus photography (right) of an eye with proliferative diabetic retinopathy: Numerous haemorrhages, wildly growing new vessels (neovascularisation) and areas with insufficient blood supply (ischaemia) can be seen.

 
What can I do about it?

• Careful control of blood sugar!
• Regular eye examinations by a registered ophthalmologist
• No to mild diabetic changes in the eye: once a year
• Moderate changes: every 6 months
• Severe changes: every 3 months
• Proliferative changes: close monitoring 
• Regularly check blood pressure and blood lipids 
• Healthy lifestyle: exercise, no smoking, healthy diet

 
Emergency – when to go to the eye clinic immediately?

• Sudden loss of vision or deterioration of vision
• Flashes of light in the eye or black spots “soot rain”
• Veil or “curtain” in the field of vision

 
Did you know?
--> The dangerous thing about diabetic retinopathy is that there are no noticeable symptoms for a long time -> risk of blindness!
 

Sources:
Pollreisz, Andreas et al. “Diagnostik, Therapie und Verlaufskontrolle der diabetischen Augenerkrankung (Update 2023)”. Wiener klinische Wochenschrift vol. 135,Suppl 1 (2023): 195-200. doi:10.1007/s00508-022-02119-7IDF Diabetes Atlas;, 9te Edition 2019 https://www.diabetesatlas.org/upload/resources/material/20200302_133351_IDFATLAS9e-final-web.pdf
 

Judith Kreminger, Adrian Reumüller, Reinhard Told, Birgit Lackner, Roman Dunavölgyi / Specialist outpatient clinic for ophthalmic oncology and oculoplastics / University Clinic for Ophthalmology and Optometry, Medical University of Vienna / Int. Line: Prof. Stefan Sacu
 

From harmless moles to life-threatening melanomas
Benign or malignant tumours can develop on the eye.
Malignant tumours, such as choroidal melanoma, can form metastases and must be treated. Benign tumours are usually harmless, but can impair vision.
Modern therapies often make it possible to preserve the eye and vision.

Historical development 

Previous standard - Enucleation: removal of the eye
In the past, malignant eye tumours often required the removal of the entire eye – this saved lives, but vision was lost. Even today, this operation is sometimes necessary. However, a prosthesis can be inserted afterwards, which makes the eye look almost natural on the outside.

Early 20th century - Irradiation with plates: 
Doctors sutured small radioactive plates onto the eye to irradiate the tumour in a targeted manner. This allowed the eye to be preserved and significantly improved quality of life.

Today - Teletherapy: 
Modern radiation therapy: Today, radiation can be directed into the eye from outside the body. This allows even larger or difficult-to-reach tumours to be treated effectively. Over the last 100 years, therapy has changed dramatically – from removal of the eye to precise proton radiation. Today, gentle and highly accurate treatments are possible.
 

State of the art
Modern imaging – looking into the eye like never before
OCT allows doctors to look deep into the eye – almost as if looking into a layer of tissue. This enables tumours to be detected accurately and their structure to be assessed precisely.

Our research project – DREAM OCTA
With this new technology, benign vascular tumours can be examined quickly and without contact – similar to taking a photograph. The aim is to avoid lengthy and unpleasant examinations.

Figure 1: Modern imaging

Figures 2 and 3: The tumour is marked with red circles in the images.

Did you know?
--> Choroidal melanomas are the most common tumours in adults.
--> Many eye tumours can now be treated without removing the eye.
--> Since 2024, proton radiation therapy for eye tumours has been available in Austria for the first time, exclusively at the Vienna General Hospital.
 

Markus Ritter, Bianca Gerendas, Joanna Dimakopoulo, Sabine Motschiunig, Prof. Stefan Sacu
Outpatient clinic for hereditary retinal diseases – electrophysiology
University Clinic for Ophthalmology and Optometry, Medical University of Vienna

Introduction
Hereditary retinal diseases are caused by changes in genetic material. They affect the light-sensitive retina and can gradually impair vision.
 

What are hereditary retinal diseases?
The retina consists of sensory cells – rods and cones. Genetic changes can disrupt their function. The disease often begins early and progresses slowly.
Common forms: 

• Retinitis pigmentosa – night blindness and later tunnel vision. 
• Stargardt's disease – loss of central vision as early as adolescence. 

Figure 1: Hereditary retinal diseases
 

Diagnosis
The diagnosis is made in specialised outpatient clinics. Eye examinations and imaging (e.g. OCT or fundus photography) reveal typical changes. The electroretinogram (ERG) measures retinal activity. Eye tests check visual acuity, colours and visual field. Genetic tests identify the mutation and assist with counselling and studies.

Fundus photography
Special cameras can be used to take precise images of the retina. This makes changes visible and allows the course of the disease to be well documented. 
Ultra-wide-angle imaging: This modern retinal photography shows up to 80% of the retina – usually without pupil dilation. This allows even the outermost areas to be detected, which are otherwise easily overlooked.

Figure 2: Fundus photography
 

Electroretinogram (ERG)
The ERG measures the electrical activity of the retina – similar to an ECG for the heart. After dilating the pupil, fine electrodes are placed on the eye and light stimuli are applied. The ERG shows whether the rods (for night vision) or cones (for colour vision) are damaged.

Figure 3: Electroretinogram
 

Gene therapy – a glimpse into the future
Gene therapy involves introducing a healthy gene into the retinal cells to replace defective genetic information. 
Harmless viruses are used as a “means of transport” for this purpose. The treatment is carried out by means of a single injection under the retina.
In 2017, Luxturna® became the first gene therapy for the RPE65 gene to be approved – a major step forward. The first treatment in Austria was carried out in Vienna. 
New studies and techniques such as CRISPR/Cas offer hope for further targeted therapies.
    
Figure 4: Administration and mode of action of voretigene neparvovec
Image source: ABCA4, ATP-binding cassette family A transporter member 4; LRAT, lecithin retinol acyltransferase; RDH, retinol dehydrogenase; RPE, retinal pigment epithelium. LUXTURNA [package insert]. Philadelphia, PA: Spark Therapeutics, Inc., 2017.

Figure 5: Progressive vision loss from the patient's perspective in RPE65-associated retinal dystrophy
 

Did you know?
--> Over 270 genes can cause retinal diseases.
--> More than 2 million people worldwide are affected by retinitis pigmentosa.
--> The first gene therapies have been approved in Europe – a milestone for those affected.