In the military, fighter pilots are taught the concept of their airplane’s “envelope,” or the combination of speed and stress that a plane can handle. This combination is often expressed as a graph of a line with a certain slope. As long as the pilot keeps the plane within the area demarcated by the line—the envelope—he’s relatively safe. But if he goes beyond the limits of the line, such as when he’s being pursued by an enemy plane intent on shooting him down, he’s said to be “pushing the envelope,” or entering a region of speed and stress that could bring him crashing to earth.

Certain corners of ophthalmology have always been known to push the envelope. Whether it’s the black-box excimer lasers ophthalmologists invented in the ‘90s to enable them to perform refractive surgery on their own, or retina specialists compounding the anti-vascular endothelial growth factor drug Avastin for use in age-related macular degeneration, this discipline doesn’t shy away from new frontiers. I was reminded of this as I read through the articles in this month’s issue.

Irregular astigmatism, such as that induced by a decentered excimer laser ablation, has long been a tough nut to crack for corneal surgeons. As this month’s cover story (“Topo-guided Ablation and Irregular Astigmatism,” by Senior Editor Christopher Kent, p. 20) demonstrates, however the latest topography-guided excimer laser systems, though not approved for irregular astigmatism in the United States, are being used creatively by surgeons outside the country to treat these patients. These surgeons are helping these patients see better than they were ever able to before.

And speaking of giving people hope for better vision, what class of refractive surgery patient is more desperate for a solution than the presbyopes, whose progressively decreasing vision is a constant, frustrating reminder of the ravages of age? However, as the feature, “A Peek into the Presbyopia Pipeline,” on pg. 36 points out, numerous new devices and drugs—envelope-pushers, all—are waiting in the wings for their chance to give presbyopes some relief.

And speaking of pushing the envelope, the grandaddy of all cutting-edge research meetings in ophthalmology, the Association for Research in Vision and Ophthalmology, receives the deluxe treatment in Therapeutic Topics on pg. 48. In it, a squadron of researchers and medical writers from Dr. Abelson’s group Ora, who descended upon the meeting in Baltimore in May, give a detailed report on the highlights of the latest research in such heady disciplines as genetics and stem cell therapy for eye disease. If you weren’t able to attend the meeting, their article will help make you feel as if you didn’t miss a beat.

We hope these and the other articles in this month’s issue help you push your own personal envelope in your daily practice. However, just be sure to watch your altitude.

—Walter Bethke, Editor in Chief