Ophthalmology
Ophthalmology is the branch of medicine which deals with the diseases of the eye and their treatment. The word ophthalmology comes from the Greek root "ophthalmos-" meaning "eye"; ophthalmology literally means "the science of eyes." As a disciple it applies to animal eyes also, since the differences from human practice are surprisingly minor and are related mainly to differences in anatomy or prevalence, not differences in disease processes. By convention the term ophthalmologist is more restricted and implies a medically trained specialist. Since ophthalmologists perform operations on eyes, they are generally categorized as surgeons.
Professional requirements
Ophthalmologists are medical doctors who have completed medical school and embark on a training schedule that generally lasts 6-7 years in most countries. In the US, an ophthalmologist has had at least three years of residency training before qualifying for ophthalmology training. Many ophthalmologists also undergo additional specialized training in one of the many subspecialities. Ophthalmology was the first branch of medicine to offer board certification, now a standard practice among all specialties.
The American Academy of Ophthalmology promotes the use of the phrase "Eye MD" to distinguish ophthalmologists from optometrists, who are doctors of optometry (OD), who are not medical doctors, but can detect, treat, and manage some types of eye disease.
In U.K., MRCOpth, FRCOpth, MRCS, FRCS (postgraduate exams) are required for specialisation in eye diseases.
In Australia, the FRACO is the equivalent postgraduate specialist qualification.
In India, either M.D./M.S./D.O.M.S/D.N.B. in Ophthalmology is necessary before one can expertly deal with various problems of the eye.
Formal specialty training programs in veterinary ophthalmology now exist in some countries.
Sub-specialities
Ophthalmology includes sub-specialities which deal either with certain diseases or diseases of certain part of the eye. Some of them are:
Ophthalmic surgery
- Cataract surgery is a major sight-giving operation that eye surgeons perform by removal of the opaque human lens and replacement with an artificial Intraocular lens implant.
- Phacoemulsification is keyhole surgery with emulsification and aspiration of cataract through a 2.8-3 mm incision and placement of a foldable intraocular lens through the same unenlarged incision. This gives faster rehabilitation and excellent results in trained hands.
- LASIK (Laser assisted-in-situ keratomilieusis) is a type of refractive surgery whereby an excimer laser (193 nm) is used to remodel the corneal stroma after lifting a partial thickness corneal flap made by a microkeratome. Excimer laser ablates tissue without causing damage to adjacent stroma in a finely controlled manner.
Famous ophthalmologists
- Marie Fabry Colinet, wife of Wilhelm Fabry, employs a magnet for removing a foreign body from the eye - 1627!
- Jacques Daviel (Normandy) claimed to be the 'father' of modern cataract surgery in that he performed intracapsular extraction instead of needling the cataract or pushing it back into the vitreous. It is said that he carried out the technique on 206 patients in 1752-3, out of which 182 were reported to be successful. These figures are not very credible, given the total lack of both anaesthesia and aseptic technique at that time.
- Florent Cunier (Belgium) founded the world's first ophthalmologic journal, Annales d'Oculistique, 1838
- Carl Ferdinand Ritter von Arlt, the elder (Austrian) proved that myopia is largely due to an excessive axial length, published influential textbooks on eye disease, and ran annual eye clinics in needy areas long before the concept of volunteer eye camps became popular. His name is still attached to some disease signs, eg, von Arlt's line in trachoma. His son Ferdinand Ritter von Arlt, the younger, was also an ophthalmologist.
- Frans Cornelis Donders (Dutch) published pioneering analyses of ocular biomechanics, intraocular pressure, glaucoma, and physiological optics. Made possible the prescribing of combinations of spherical and cylindrical lenses to treat astigmatism.
- Hermann von Helmholtz, great German polymath, invented the ophthalmoscope (1851) and published important work on physiological optics, including colour vision (1850s).
- Albrecht von Graefe (Germany) Along with Helmholtz and Donders, one of the 'founding fathers' of ophthalmology as a specialty. A brilliant clinician and charismatic teacher who had an international influence on the development of ophthalmology. A pioneer in mapping visual field defects and diagnosis and treatment of glaucoma. Introduced a cataract extraction technique that remained the standard for over 100 years, and many other important surgical techniques such as iridectomy. Rationalised the use of many ophthalmically important drugs, including mydriatics & miotics. The founder of the one of the earliest ophthalmic societies (German Ophthalmological Society, 1857) and one of the earliest ophthalmic journals (Graefe's Archives of Ophthalmology). The most important ophthalmologist of the 19th century.
- Ramon Castroviejo (Spain) pioneer in corneal transplantation surgery.
- Hermengildo Arruga (Spain)
- Ignacio Barraquer (Spain) carried out the first intracapsular lens extraction using enzymatic zonulolysis.
- Sir Stewart Duke-Elder (England) Author of System of Ophthalmology, an immensely influential mid-20th century multivolume compendium of ophthalmic history, embryology, comparative ophthalmology, refraction, ocular basic sciences, medical ophthalmology and therapeutics, but avoiding discussion of surgical techniques (which he viewed as emphemera).
- Sir Howard Ridley (England) may have been the first to successfully implant an artificial intraocular lens 1949, after observing that plastic fragments in the eyes of wartime pilots were well tolerated. He fought for decades against strong reactionary opinions to have the concept accepted as feasible and useful.
