The examples and perspective in this article deal primarily with the United States and do not represent a worldwide view of the subject.(December 2020)
|Significant diseases||Blurred vision, cataract, macular degeneration, glaucoma, refractive error, retinal disorders, diabetic retinopathy|
|Significant tests||Visual field test, ophthalmoscopy|
|Glossary||Glossary of medicine|
| Doctor of Medicine (M.D.),|
Doctor of Osteopathic medicine (D.O.),
Bachelor of Medicine, Bachelor of Surgery (M.B.B.S.),
Bachelor of Medicine, Bachelor of Surgery (MBChB)
Ophthalmology ( // ) is a branch of medicine and surgery that deals with the diagnosis and treatment of disorders of the eye. An ophthalmologist is a physician who specializes in ophthalmology. The credentials include a degree in medicine, followed by additional four to five years of residency training in ophthalmology. Residency training programs for ophthalmology may require a one-year internship with training in internal medicine, pediatrics, or general surgery. Additional specialty training (or fellowship) may be sought in a particular aspect of eye pathology. Ophthalmologists are allowed to prescribe medications to treat eye diseases, implement laser therapy, and perform surgery when needed. Ophthalmologists may participate in academic research on the diagnosis and treatment for eye disorders.
A partial list of the most common diseases treated by ophthalmologists include:
Following are examples of examination methods performed during an eye examination that enables diagnosis
Optical coherence tomography (OCT) is a medical technological platform used to assess ocular structures. The information is then used by physicians to assess staging of pathological processes and confirm clinical diagnoses. Subsequent OCT scans are used to assess the efficacy of managing diabetic retinopathy, age-related macular degeneration, and glaucoma.
Ultrasonography of the eyes may be performed by an ophthalmologist.
Eye surgery, also known as ocular surgery, is surgery performed on the eye or its adnexa by an ophthalmologist. The eye is a fragile organ, and requires extreme care before, during, and after a surgical procedure. An eye surgeon is responsible for selecting the appropriate surgical procedure for the patient and for taking the necessary safety precautions.
Ophthalmology includes subspecialities that deal either with certain diseases or diseases of certain parts of the eye. Some of them are:
Medical retina and vitreo-retinal surgery sometimes are combined and together they are called posterior segment subspecialisation
The Greek roots of the word ophthalmology are ὀφθαλμός (ophthalmos, "eye") and -λoγία (-logia, "study, discourse"), [ citation needed ]i.e., "the study of eyes". The discipline applies to all animal eyes, whether human or not, since the practice and procedures are quite similar with respect to disease processes, while differences in anatomy or disease prevalence, whether subtle or substantial, may differentiate the two.
In the Ebers Papyrus from ancient Egypt dating to 1550 BC, a section is devoted to eye diseases.
Prior to Hippocrates, physicians largely based their anatomical conceptions of the eye on speculation, rather than empiricism.They recognized the sclera and transparent cornea running flushly as the outer coating of the eye, with an inner layer with pupil, and a fluid at the centre. It was believed, by Alcamaeon (fifth century BC) and others, that this fluid was the medium of vision and flowed from the eye to the brain by a tube. Aristotle advanced such ideas with empiricism. He dissected the eyes of animals, and discovering three layers (not two), found that the fluid was of a constant consistency with the lens forming (or congealing) after death, and the surrounding layers were seen to be juxtaposed. He and his contemporaries further put forth the existence of three tubes leading from the eye, not one. One tube from each eye met within the skull.
The Greek physician Rufus of Ephesus (first century AD) recognised a more modern concept of the eye, with conjunctiva, extending as a fourth epithelial layer over the eye.Rufus was the first to recognise a two-chambered eye, with one chamber from cornea to lens (filled with water), the other from lens to retina (filled with a substance resembling egg whites).
Celsus the Greek philosopher of the second century AD gave a detailed description of cataract surgery by the couching method.
The Greek physician Galen (second century AD) remedied some mistaken descriptions, including about the curvature of the cornea and lens, the nature of the optic nerve, and the existence of a posterior chamber. Although this model was a roughly correct modern model of the eye, it contained errors. Still, it was not advanced upon again until after Vesalius. A ciliary body was then discovered and the sclera, retina, choroid, and cornea were seen to meet at the same point. The two chambers were seen to hold the same fluid, as well as the lens being attached to the choroid. Galen continued the notion of a central canal, but he dissected the optic nerve and saw that it was solid. He mistakenly counted seven optical muscles, one too many. He also knew of the tear ducts.
The Indian surgeon Sushruta wrote the Sushruta Samhita in Sanskrit in approximately the sixth century AD,which describes 76 ocular diseases (of these, 51 surgical) as well as several ophthalmological surgical instruments and techniques. His description of cataract surgery was compatible with the method of couching. He has been described as one of the first cataract surgeons.
Medieval Islamic Arabic and Persian scientists (unlike their classical predecessors) considered it normal to combine theory and practice, including the crafting of precise instruments, and therefore, found it natural to combine the study of the eye with the practical application of that knowledge.Hunayn ibn Ishaq, and others beginning with the medieval Arabic period, taught that the crystalline lens is in the exact center of the eye. This idea was propagated until the end of the 1500s.
Ibn al-Haytham (Alhazen), in his Book of Optics explained that vision occurs when light lands on an object, bounces off, and is directed to one's eyes.
Ibn al-Nafis, an Arabic native of Damascus, wrote a large textbook, The Polished Book on Experimental Ophthalmology, divided into two parts, On the Theory of Ophthalmology and Simple and Compounded Ophthalmic Drugs.
Avicenna wrote in his Canon "rescheth", which means "retiformis", and Gerard of Cremona translated this at approximately 1150 into the new term "retina".
In the seventeenth and eighteenth centuries, hand lenses were used by Malpighi, microscopes by Leeuwenhoek, preparations for fixing the eye for study by Ruysch, and later the freezing of the eye by Petit. This allowed for detailed study of the eye and an advanced model. Some mistakes persisted, such as: why the pupil changed size (seen to be vessels of the iris filling with blood), the existence of the posterior chamber, and the nature of the retina. Unaware of their functions, Leeuwenhoek noted the existence of photoreceptors,however, they were not properly described until Gottfried Reinhold Treviranus in 1834.
Approximately 1750, Jacques Daviel advocated a new treatment for cataract by extraction instead of the traditional method of couching.Georg Joseph Beer (1763–1821) was an Austrian ophthalmologist and leader of the First Viennese School of Medicine. He introduced a flap operation for treatment of cataract (Beer's operation), as well as having popularized the instrument used to perform the surgery (Beer's knife).
In North America, indigenous healers treated some eye diseases by rubbing or scraping the eyes or eyelids.
The first ophthalmic surgeon in Great Britain was John Freke, appointed to the position by the governors of St. Bartholomew's Hospital in 1727. A major breakthrough came with the appointment of Baron de Wenzel (1724–90), a German who became the oculist to King George III of Great Britain in 1772. His skill at removing cataracts legitimized the field.The first dedicated ophthalmic hospital opened in 1805 in London; it is now called Moorfields Eye Hospital. Clinical developments at Moorfields and the founding of the Institute of Ophthalmology (now part of the University College London) by Sir Stewart Duke-Elder established the site as the largest eye hospital in the world and a nexus for ophthalmic research.
In Berlin, ophthalmologist Albrecht von Graefe introduced iridectomy as a treatment for glaucoma and improved cataract surgery, he is also considered the founding father of the German Ophthalmological Society.
Numerous ophthalmologists fled Germany after 1933 as the Nazis began to persecute those of Jewish descent. A representative leader was Joseph Igersheimer (1879–1965), best known for his discoveries with arsphenamine for the treatment of syphilis. He fled to Turkey in 1933. As one of eight emigrant directors in the Faculty of Medicine at the University of Istanbul, he built a modern clinic and trained students. In 1939, he went to the United States, becoming a professor at Tufts University.German ophthalmologist, Gerhard Meyer-Schwickerath is widely credited with developing the predecessor of laser coagulation, photocoagulation.
In 1946, Igersheimer conducted the first experiments on light coagulation. In 1949, he performed the first successful treatment of a retinal detachment with a light beam (light coagulation) with a self-constructed device on the roof of the ophthalmic clinic at the University of Hamburg-Eppendorf.
Polish ophthalmology dates to the thirteenth century. The Polish Ophthalmological Society was founded in 1911. A representative leader was Adam Zamenhof (1888–1940), who introduced certain diagnostic, surgical, and nonsurgical eye-care procedures. He was executed by the German Nazis in 1940.
Zofia Falkowska (1915–93) head of the Faculty and Clinic of Ophthalmology in Warsaw from 1963 to 1976, was the first to use lasers in her practice.
The prominent opticians of the late nineteenth and early twentieth centuries included Ernst Abbe (1840–1905), a co-owner of at the Zeiss Jena factories in Germany, where he developed numerous optical instruments. Hermann von Helmholtz (1821-1894) was a polymath who made contributions to many fields of science and invented the ophthalmoscope in 1851. They both made theoretical calculations on image formation in optical systems and also had studied the optics of the eye.
Ophthalmologists are physicians (MD/DO in the U.S. or MBBS in the UK and elsewhere or D.O./DOMS/ DNB, not OD or BOptom) who have completed a college degree, medical school, and residency in ophthalmology. Training in ophthalmology equips eye specialists to provide the full spectrum of eye care, including the prescription of glasses and contact lenses, medical treatment, and complex microsurgery. In many countries, ophthalmologists also undergo additional specialized training in one of the many subspecialties. Ophthalmology was the first branch of medicine to offer board certification, now a standard practice among all specialties.
In Australia and New Zealand, the FRACO or FRANZCO is the equivalent postgraduate specialist qualification. The structured training system takes place over five years of postgraduate training. Overseas-trained ophthalmologists are assessed using the pathway published on the RANZCO website. Those who have completed their formal training in the UK and have the CCST or CCT, usually are deemed to be comparable.
In Bangladesh to be an ophthalmologist the basic degree is an MBBS. Then they have to obtain a postgraduate degree or diploma in an ophthalmology specialty. In Bangladesh, these are diploma in ophthalmology, diploma in community ophthalmology, fellow or member of the College of Physicians and Surgeons in ophthalmology, and master of science in ophthalmology.
In Canada, after medical school an ophthalmology residency is undertaken. The residency lasts a minimum of five years after the M.D. degree, which culminates in fellowship of the Royal College of Surgeons of Canada (FRCSC). Subspecialty training is undertaken by approximately 30% of fellows (FRCSC) in a variety of fields from anterior segment, cornea, glaucoma, vision rehabilitation, uveitis, oculoplastics, medical and surgical retina, ocular oncology, Ocular pathology, or neuro-ophthalmology. Approximately 35 vacancies open per year for ophthalmology residency training in all of Canada. These numbers fluctuate per year, ranging from 30 to 37 spots. Of these, up to ten spots are at French-speaking universities in Quebec. At the end of the five years, the graduating ophthalmologist must pass the oral and written portions of the Royal College exam in either English or French.
In India, after completing MBBS degree, postgraduate study in ophthalmology is required. The degrees are doctor of medicine, master of surgery, diploma in ophthalmic medicine and surgery, and diplomate of national board. The concurrent training and work experience are in the form of a junior residency at a medical college, eye hospital, or institution under the supervision of experienced faculty. Further work experience in the form of fellowship, registrar, or senior resident refines the skills of these eye surgeons. All members of the India Ophthalmologist Society and various state-level ophthalmologist societies hold regular conferences and actively promote continuing medical education.
In Nepal, to become an ophthalmologist, three years of postgraduate study is required after completing an MBBS degree. The postgraduate degree in ophthalmology is called medical doctor in ophthalmology. Currently, this degree is provided by Tilganga Institute of Ophthalmology, Tilganga, Kathmandu, BPKLCO, Institute of Medicine, TU, Kathmandu, BP Koirala Institute of Health Sciences, Dharan, Kathmandu University, Dhulikhel, and National Academy of Medical Science, Kathmandu. A few Nepalese citizens also study this subject in Bangladesh, China, India, Pakistan, and other countries. All graduates have to pass the Nepal Medical Council Licensing Exam to become a registered ophthalmologists in Nepal. The concurrent residency training is in the form of a PG student (resident) at a medical college, eye hospital, or institution according to the degree providing university's rules and regulations. Nepal Ophthalmic Society holds regular conferences and actively promotes continuing medical education.
In Ireland, the Royal College of Surgeons of Ireland grants membership (MRCSI (Ophth)) and fellowship (FRCSI (Ophth)) qualifications in conjunction with the Irish College of Ophthalmologists. Total postgraduate training involves an intern year, a minimum of three years of basic surgical training, and a further 4.5 years of higher surgical training. Clinical training takes place within public, Health Service Executive-funded hospitals in Dublin, Sligo, Limerick, Galway, Waterford, and Cork. A minimum of 8.5 years of training is required before eligibility to work in consultant posts. Some trainees take extra time to obtain MSc, M.D. or Ph.D. degrees and to undertake clinical fellowships in the UK, Australia, and the United States.
In Pakistan, after MBBS, a four-year full-time residency program leads to an exit-level FCPS examination in ophthalmology, held under the auspices of the College of Physicians and Surgeons, Pakistan. The tough examination is assessed by both highly qualified Pakistani and eminent international ophthalmic consultants. As a prerequisite to the final examinations, an intermediate module, an optics and refraction module, and a dissertation written on a research project carried out under supervision is also assessed.
Moreover, a two-and-a-half-year residency program leads to an MCPS while a two-year training of DOMS is also being offered.For candidates in the military, a stringent two-year graded course, with quarterly assessments, is held under Armed Forces Post Graduate Medical Institute in Rawalpindi.
The M.S. in ophthalmology is also one of the specialty programs. In addition to programs for physicians, various diplomas and degrees for allied eyecare personnel are also being offered to produce competent optometrists, orthoptists, ophthalmic nurses, ophthalmic technologists, and ophthalmic technicians in this field. These programs are being offered, notably by the College of Ophthalmology and Allied Vision Sciences, in Lahore and the Pakistan Institute of Community Ophthalmology in Peshawar.Subspecialty fellowships also are being offered in the fields of pediatric ophthalmology and vitreoretinal ophthalmology. King Edward Medical University, Al Shifa Trust Eye Hospital Rawalpindi, and Al- Ibrahim Eye Hospital Karachi also have started a degree program in this field.
In the Philippines, Ophthalmology is considered a medical specialty that uses medicine and surgery to treat diseases of the eye. There is only one professional organization in the country that is duly recognized by the PMA and the PCS: the Philippine Academy of Ophthalmology (PAO).PAO and the state-standard Philippine Board of Ophthalmology (PBO) regulates ophthalmology residency programs and board certification. To become a general ophthalmologist in the Philippines, a candidate must have completed a doctor of medicine degree (M.D.) or its equivalent (e.g. MBBS), have completed an internship in Medicine, have passed the physician licensure exam, and have completed residency training at a hospital accredited by the Philippine Board of Ophthalmology (accrediting arm of PAO). Attainment of board certification in ophthalmology from the PBO is essential in acquiring privileges in most major health institutions. Graduates of residency programs can receive further training in ophthalmology subspecialties, such as neuro-ophthalmology, retina, etc. by completing a fellowship program that varies in length depending on each program's requirements.
In the United Kingdom, three colleges grant postgraduate degrees in ophthalmology. The Royal College of Ophthalmologists (RCOphth) and the Royal College of Surgeons of Edinburgh grant MRCOphth/FRCOphth and MRCSEd/FRCSEd, (although membership is no longer a prerequisite for fellowship), the Royal College of Glasgow grants FRCS. Postgraduate work as a specialist registrar and one of these degrees is required for specialization in eye diseases. Such clinical work is within the NHS, with supplementary private work for some consultants.
Only 2.3 ophthalmologists exist per 100,000 population in the UK – fewer pro rata than in any nations in the European Union.
In the United States, ophthalmologists must complete four years of undergraduate studies, a four-year medical degree (MD), one year medical or general surgical residency, three years of ophthalmology residency, and optional one to two years of speciality training. Ophthalmologists are physicians who specialize in the eye and related structures. They perform medical and surgical eye care and also can write prescriptions for corrective lenses (glasses and contacts). They often deal with advanced forms of eye disease in patients with significant systemic illness.
Physicians must complete the requirements of continuing medical education to maintain licensure and for recertification. Professional bodies such as the American Academy of Ophthalmology and American Society of Cataract and Refractive Surgery organize conferences, help physician members through continuing medical education programs for maintaining board certification, and provide political advocacy and peer support.
The following is a list of physicians who have significantly contributed to the field of ophthalmology:
Vitrectomy is a surgery to remove some or all of the vitreous humor from the eye.
Eye surgery, also known as ocular surgery, is surgery performed on the eye or its adnexa, typically by an ophthalmologist. The eye is a very fragile organ, and requires extreme care before, during, and after a surgical procedure to minimise or prevent further damage. An expert eye surgeon is responsible for selecting the appropriate surgical procedure for the patient, and for taking the necessary safety precautions. Mentions of eye surgery can be found in several ancient texts dating back as early as 1800 BC, with cataract treatment starting in the fifth century BC. Today it continues to be a widely practiced type of surgery, with various techniques having been developed for treating eye problems.
Cataract surgery, also called lens replacement surgery, is the removal of the natural lens of the eye that has developed an opacification, which is referred to as a cataract, and its replacement with an intraocular lens. Metabolic changes of the crystalline lens fibers over time lead to the development of the cataract, causing impairment or loss of vision. Some infants are born with congenital cataracts, and certain environmental factors may also lead to cataract formation. Early symptoms may include strong glare from lights and small light sources at night, and reduced acuity at low light levels.
An eye care professional (ECP) is an individual who provides a service related to the eyes or vision. It is any healthcare worker involved in eye care, from one with a small amount of post-secondary training to practitioners with a doctoral level of education.
New York Eye and Ear Infirmary of Mount Sinai (NYEE) is located at East 14th Street and Second Avenue in lower Manhattan, New York City. Founded on August 14, 1820, NYEE is America's first specialty hospital and one of the most prominent in the fields of ophthalmology and otolaryngology in the world, providing primary inpatient and outpatient care in those specialties. Previously affiliated with New York Medical College, as of 2013 it is affiliated with the Icahn School of Medicine at Mount Sinai as a part of the membership in the Mount Sinai Health System.
The Illinois Eye & Ear Infirmary (IEEI) is a center of ophthalmology and otolaryngology research and clinical practice. Currently, the National Institutes of Health (NIH) ranks the department 4th nationally in ophthalmology research funding and 1st in the Midwestern United States and Chicago metropolitan area.
The John A. Moran Eye Center at the University of Utah serves as the largest ophthalmology clinical care and research facility in the Mountain West with more than 60 faculty members and 10 satellite clinics.
Gholam A. Peyman is an ophthalmologist, retina surgeon, and inventor. He is best known for his invention of LASIK eye surgery, a vision correction procedure designed to allow people to see clearly without glasses. He was awarded the first US patent for the procedure in 1989.
Bascom Palmer Eye Institute, of the University of Miami Leonard M. Miller School of Medicine, is a center for ophthalmic care, research, and education. Faculty and staff treat patients from around the world in facilities in Miami-Dade County, Broward County, Palm Beach County, and Collier County. The institute's full-time faculty and researchers encompass many ophthalmic sub-specialties and has been consistently ranked as the #1 eye hospital and vision research center in the country by US News & World Report.
Eric John Arnott, MA, FRCS, FRCOphth was a British ophthalmologist and surgeon who specialized in cataracts, a condition which in many parts of the world still remains the principal cause of blindness. He is known for inventing new surgical techniques for treatment of various ophthalmological disorders, and received professional awards for his contributions.
Steve Charles is a vitreoretinal surgeon who has developed many of the techniques and devices used by vitreoretinal surgeons worldwide. He is a board certified ophthalmologist and vitreoretinal surgeon, a mechanical/electrical engineer who has 48 patents or patents applied for, and has developed many of the techniques and devices used by vitreoretinal surgeons worldwide. He has performed over 38,000 vitreoretinal surgeries, lectured in 50 countries and operated in 25, delivered 17 named lectures, and over 1000 speaking trips. He authored a leading textbook in the field which is now in the 5th edition and in 6 languages and authored over 174 articles in the medical literature and over 50 book chapters.
Raymond Mark Stein, MD, FRCSC, DABO, is a Canadian ophthalmologist. He practices refractive and cataract surgery. He is the medical director of the Bochner Eye Institute in Toronto, Ontario and Chief of Ophthalmology at the Scarborough Hospital.
Gerard Sutton is an Australian ophthalmic surgeon and ophthalmologist in Australia and New Zealand. His specialty is laser vision correction, cataract and lens surgery, and corneal transplantation.
The Royal College of Ophthalmologists, founded in 1988, is an independent professional body and one of the Medical Royal Colleges. They set the standards and examinations for medical doctors aiming to become ophthalmologists, and provide surgical skills training, as well as services to those who have completed their training.
Jeewan Singh Titiyal is an Indian ophthalmologist, credited with the first live cornea transplant surgery by an Indian doctor. He was honoured by the Government of India, in 2014, by bestowing on him the Padma Shri, the fourth highest civilian award, for his services to the field of medicine.
Keiki R. Mehta, an Indian ophthalmologist, medical researcher and writer, is considered by many as the father of Phacoemulsification in India. He is the Chief Surgical and Medical Director at Mehta International Eye Institute, a Mumbai-based specialty eye hospital founded by him. He is known to be the first surgeon to perform a Radial keratotomy in India and is credited with the development of the first soft eye implant in the world, and the Keiki Mehta BP Valve Glaucoma Shunt, a medical implant used in the treatment of neovascular‚ congenital and uveitic glaucoma. He is a recipient of several honours including the Grand Honors Award of the National Eye Research Foundation, Chicago and the Triple Ribbon Award of the American Society for Cataract and Refractive Surgery. The Government of India awarded him the fourth highest civilian honour of the Padma Shri, in 2008, for his contributions to Medicine.
John Marshall MBE, FMedSci, PhD, DSc, FRCPath, FRSB, FRCOphth(Hon), FRCOptom(Hon), FARVO is a British medical scientist and inventor. Currently he is the Frost Professor of Ophthalmology at the Institute of Ophthalmology UCL and Emeritus Professor King's College London. He is a pioneer of laser eye surgery.
Robert E. MacLaren FMedSci FRCOphth FRCS FACS VR is a British ophthalmologist who has led pioneering work in the treatment of blindness caused by diseases of the retina. He is Professor of Ophthalmology at the University of Oxford and Honorary Professor of Ophthalmology at the UCL Institute of Ophthalmology. He is a Consultant Ophthalmologist at the Oxford Eye Hospital and an Honorary Consultant Ophthalmologist at the Great Ormond Street Hospital. He is also an Honorary Consultant Vitreo-retinal Surgeon at the Moorfields Eye Hospital. MacLaren is an NIHR Senior Investigator, or lead researcher, for the speciality of Ophthalmology. In addition, he is a member of the research committee of Euretina: the European Society of Retina specialists, Fellow of Merton College, in Oxford and a Fellow of the Higher Education Academy.
Gerd Uwe Auffarth is a German eye surgeon and is Chairman of the Department of Ophthalmology at the Heidelberg University Eye Hospital and Head of the David J. Apple Center for Vision Research which includes the David J. Apple International Laboratory for Ocular Pathology.
Atul Kumar is an Indian ophthalmologist who is currently the Chief & Professor of Ophthalmology at Dr. Rajendra Prasad Centre for Ophthalmic Sciences (RPC-AIIMS), the national apex ophthalmic centre at All India Institute of Medical Sciences, Delhi. He was awarded the Padma Shri award in January 2007 for his services to the medical field. He specializes in vitreoretinal surgery and also heads the Vitreo-Retinal, Uvea and ROP services at RPC-AIIMS.
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