Refractive errors were being treated since last 25 years only. As of now LASIK is most frequently performed surgical procedure in entire medicine. Almost 6 million being performed yearly around the world with amazing rate of success.

Future of refractive surgery is great. 6/6 vision was considered to be the ultimate possible vision but it is being challenged and newer techniques are already offering better vision than glasses of 6/5, 6/4 by detecting and treating higher order aberrations of eye and cornea. Theoretically it’s possible to get much better vision  up to distance between two photo receptors of retina –  6/1  or better so that one will be able to read news paper from distance of six meters.

Presbyopia was ultimate paradigm to conquer in refractive treatments but corneal inlays, accommodative intraocular lenses, intracor femto laser procedures, cross linking and reversal of ageing natural lens by pharmacological medications  can postpone or reverse presbyopia to give youthful vision in coming future.

Development in intraocular lenses will change current absolute presbyopia to natural accommodative lenses. Any residual refractive errors can also be corrected by light adjustable lenses giving spectacle free vision to all.

Robotic surgeries are already being performed today for cataract by femto lasers assisted corneal incision, capsulotomy and lens division. Future diagnostic tools and lasers will be able to remove refractive errors and cataracts  with much precision and in no time.

Eye is accessible easily and optical properties of eye will make it a easy organ to make changes for artificial intelligence to diagnose and treat.

Refractive procedures almost always involve lasers or incisions, even at the most non-invasive levels. But a change is coming- A new procedure called PiXL (photorefractive intra stromal cross linking aims to use cross linking and UV light to alter corneal collagen and thereby cause a refractive change. It’s the kind of procedure that makes one wonder whether the refractive surgery of the future is surgery at all. Essentially, the procedure using riboflavin, UV light, and a few other tools like cornea topography analysis and eye tracking provides a change in corneal biomechanics to change the corneal optics, rather than use a laser to sculpt tissue. A patterned UV energy beam delivers energy to the cornea.

There are many new discoveries or innovations in Medicine slated for the next few years. Thankfully for patients and doctors medicine does not stop moving. Based on recent articles, Medscape and other medical inputs a few have been stated here.

FMT or fecal microbiota transplant has 90% cure rate for Clostridium difficile infection. Earlier it was patient prepared enemas and colonoscopies transfers. Orally administered frozen fecal capsules and stool banks are the future. Microbial imbalance in the gut is associated with medical conditions as Diabetes, Rheumatoid arthritis. Neurological conditions like Autism and Multiple Sclerosis has been associated with altered gut flora profiles.

Antibiotics like Tedizolid, Dalbavancin, Oritavancin are the new antibiotics approved for Methicillin Resistance Staphylococcus aureus infection. Each of these agents have advantages over the currently available antibiotics for MRSA infection. According to Dr John Barlett of John Hopkins Medical School the pipeline of antibiotics is slow but not dry.

According to JAMA Neurology Stroke Care has to go mobile for better patient care and outcomes. The saying is time is brain. Ambulance based stroke care units would increase the chances of thrombolytic therapy in the first golden hour. A large network of ambulances, Emergency teams and hospital network would be required.

Lancet published the greatest surgical gynaecological news of a successful live birth in a transplanted uterus. 35 years old received a uterus from a 61 years old family friend. A year after the patient underwent a frozen embryo transfer. Both the mother and child are doing well.

Bionic pancreas for type 1 diabetes could be a reality as par reports from Southern California Clinical Diabetes programme. A smart phone like device continuously monitors glucose and communicates this to a device that calculates and releases appropriate doses of insulin. A dependable user friendly system could be available in the near future.

Minimal Invasive surgery is already a well-established practice and an alternative to traditional surgery and robotic surgery. For Minimal invasive cardiac surgery, aids were introduced into the field at the beginning of the new millennium and currently the following procedures can be performed by minimally invasive surgery: Mitral Valve repair and replacement, Aortic valve repair, Atrial septal defects repair, Coronary artery bypass, Removal of cardiac tumours, and Ablation of atrial fibrillation.

The benefits of this type of surgery are numerous. Improved cosmetic result is the most obvious advantage. In addition, because Median Sternotomy is avoided keeping the breastbone intact, trauma and postoperative pain are greatly reduced thereby improving quality of life and reducing hospital stay. On the other hand, patients are still exposed to the usual surgical risks such as bleeding, infection. Apart from these ‘Classical heart surgery operative targets’ there is important field where heart surgery will play an important role. First is in the treatment of advanced heart failure. The chronic shortage of organs for organ transplantation has led to a search for mechanical circulatory support. Currently, some research focuses on designing New Ventricular Assistance devices that may serve not only as bridge for transplantation, but also, a permanent treatment for patients with failing heart. Second, atrial fibrillation (AF) is the most common cardiac arrhythmia. Surgical Ablation may provide an efficient therapeutic approach in patients with medically Refractory AF and in patients undergoing cardiac surgery for other pathology who have concomitant AF.

Cancer is a transformed cell having altered physiology modulating host resources for it’s growth and survival. Interruption of signal transduction in the form of ligand binding, receptor binding or inhibition of key intracellular pathways with small molecules has revolutionized cancer therapies. Some of the success stories include Rituximab in lymphomas, Trastuzumab in breast cancer, imatinib in chronic myeloid leukemia, bevacizumab, VEGF TKls in number of cancers, EGFR inhibition lung, head neck cancers etc.

Preventing cancer cell from escaping immune system is emerging as revolution in cancer therapeutics Blocking CTLA4, blocking PD L1 and PD 1 with antibodies has already achieved success in melanoma, lung, kidney and head neck cancers and being tried in almost every cancer. CAR modified T cell is another leap forward in immune-oncology. Preventing viral induced cancer with vaccine especially HPV related cancers will bring down the burden of some of the common cancers like cervix and oropharynx significantly.

On the diagnostic side, functional imaging, contrast free imaging, molecular imaging, fused structural and molecular imaging is changing the way we stage and assess cancers. The sciences of ‘omics’ will provide critical information about how the cancer cell is thriving. Liquid biopsies, assessment of circulating tumor cell will provide the opportunity to assess in vivo cancer in real time.

Cancer genome atlas and compilation of BIG DATA is taking cancer informatics forward and will identify new targets for cancer therapies. Next generation sequencing and other advanced lab techniques are already available to provide critical inputs to the clinician.

Finally improving access to cancer treatment to the poor and needy will help us meet the ever increasing cancer burden in our country.

Specialization in gastroenterology will proliferate with highly specialized therapeutic endoscopists subsequently hepatologists, nutritional gastroenterologists, micro bioma specialists and genomic/oncologic gastroenterologist participation in patient care. DNA stool test or blood testing will diagnose upper GI cancers as well as colonic malignancies. Endoscopic procedures will become more therapeutic in nature. Endoscopy therapy for gastroesophageal reflux disease will be common procedure. Endoscopic mucosal resection (EMR) / endoscopic submucosal dissection (ESD) & peroral endoscopic myotomy (POEM) will become more routine practice. Endoscopic surgeries for obesity is area of evolution. As our understanding of gut biome is changing manipulation of our gut bacteria will become routine in treating an assortment of disorders including obesity and perhaps mental disorders like depression. Pre / probiotic prescription will become routine like the treatment of peptic ulcer disease with antibiotics was norm in last 20 years. Electronic medical record is here to stay and will be only source of record keeping in next 10 years. Liver transplantation with great success rate changed our perception towards liver disease. Non alcoholic steatohepatitis will be leading cause of liver cirrhosis. Drug’s like Cinecroviric /Elafibrinor / Saroglitazor are future drugs which reverse fibrosis are under trials. Hepatic regenerations from stems cells may reach from laboratory to clinic. New antiviral therapy for hepatitis C made virus on verge of extinct. First case of esophageal regeneration made opening for future applications of stem cells therapy in Oesophageal diseases. Biosimilars made efficacions and cost reductive treatment for crohn’s disease & ulcerative colitis amenable to most patients. Individualised treatment may be norm with more biological in arena of investigations.

The progress in the fight against heart disease has come in the form of novel drugs and procedures. There have been exciting developments in the field of interventional cardiology. Mechanical reperfusion by primary angioplasty has become the standard of care for patients with ST-elevation myocardial infarction. The profile of patients who undergo coronary intervention has dramatically increased in complexity to include patients with advanced age and those with left main stem lesion and chronic occlusions. Bioresorbable scaffold has the potential to overcome the limitations of permanent metallic stents because it provides temporary scaffolding and then disappears. Trans catheter aortic valve replacement offers a way to treat narrowed aortic valve without open heart surgery. This treatment is approved for people considered to be high risk for valve replacement surgery. The implantable cardioverter – defibrillator can be programmed to recognize and treat most prolonged arrhythmia’s: heart block, bradycardia and tachyarrhythmia. We are entering an era in which interventional cardiologists and heart failure specialitists will work hand in hand to offer patients with heart failure novel devices to improve their clinical status and outcomes.

The average life span of human beings has increased and the major contribution has come from advances in cardiovascular disease. It can be said that the future looks bright and there is much to look forward to. What are the lessons that we take from these advances? They were preceded by decades of research, collaboration and joint international research. The current generations of physicians, scientists and researchers have many new powerful tools continue the advances in cardiology begun so effectively by our predecessors in 20^th century. Though we face many challenges, I am hopeful that this can be accomplished.