STUDY OF EYES - OPHTHALMOLOGY

Ophthalmology is the branch of medicine that deals with the anatomy, physiology and diseases of the eye. An ophthalmologist is a specialist in medical and surgical eye problems. Since ophthalmologists perform operations on eyes, they are both surgical and medical specialists.

Etymology: The word ophthalmology comes from the Greek roots ὀφθαλμός, ophthalmos, i.e., "eye" and -λoγία,-logia, i.e., "study of, discourse; ophthalmology literally means "the science of eyes". As a discipline, 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.

History: The Indian surgeon Sushruta wrote Sushruta Samhita in Sanskrit in about 800 BC which describes 76 ocular diseases (of these 51 surgical) as well as several ophthalmological surgical instruments and techniques.His description of cataract surgery was more akin to extracapsular lens extraction than to couching.He has been described as the first cataract surgeon.

Pre-Hippocrates: The pre-Hippocratics 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 and others, that this fluid was the medium of vision and flowed from the eye to the brain via 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.

Rufus: Rufus of Ephesus recognised a more modern 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 an egg-white-like substance). The Greek physician Galen remedied some mistakes including the curvature of the cornea and lens, the nature of the optic nerve, and the existence of a posterior chamber.

Though 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.

Middle Eastern ophthalmology: Ophthalmology in medieval Islam: 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.

Ibn al-Haytham (Alhazen) an Arab scientist with Islamic beliefs wrote extensively on optics and the anatomy of the eye in his Book of Optics (1021).

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.

17th and 18th centuries: François Pourfour du Petit: The 17th and 18th century saw the use of hand lenses (by Malpighi), microscopes (van Leeuwenhoek), preparations for fixing the eye for study (Ruysch) and later the freezing of the eye (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 of course the nature of the retina. In 1722 Leeuwenhoek noted the existence of rods and cones though they were not properly discovered until Gottfried Reinhold Treviranus in 1834 by use of a microscope.

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 cataracts (Beer's operation), as well as popularizing the instrument used to perform the surgery (Beer's knife).

Ophthalmic surgery in Great Britain: 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 Michael Johann Baptist de Wenzel (1724–90), a German who became oculist to King George III of England in 1772. His skill at removing cataracts legitimized the field.[14] 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.

20th century: The prominent opticians of the late 19th and early 20th century 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 had also studied the optics of the eye.

Central Europe: 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.

Polish ophthalmology dates to the 13th 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 and was shot by the 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.

Professional requirements: Ophthalmologists are physicians (MD/MBBS or D.O., not OD or BOptom) who have completed a college degree, medical school, and residency in ophthalmology. Ophthalmology training 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.

Australia and New Zealand: Royal Australian and New Zealand College of Ophthalmologists: In Australia and New Zealand, the FRACO/FRANZCO is the equivalent postgraduate specialist qualification. It is a very competitive speciality to enter training and has a closely monitored and structured training system in place over the 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/CCT are usually deemed to be comparable.

Canada: In Canada, an ophthalmology residency after medical school is undertaken. The residency lasts a minimum of five years after the MD degree although subspecialty training is undertaken by about 30% of fellows (FRCSC). There are about 35 vacancies per year for ophthalmology training in all of Canada.

Finland: In Finland, physicians willing to become ophthalmologists must undergo a five year specialization which includes practical training and theoretical studies.

India: In India, after completing MBBS degree, post-graduation in ophthalmology is required. The degrees are Doctor of Medicine (MD), Master of Surgery (MS), Diploma in Ophthalmic Medicine and Surgery (DOMS), and Diplomate of National Board (DNB). The concurrent training and work experience is 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 form of fellowship, registrar or senior resident refines the skills of these eye surgeons. All India Ophthalmological Society (AIOS) and various state level ophthalmological societies (like DOS) hold regular conferences and actively promote continuing medical education.

Ireland: 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 3 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, MD or PhD degrees and to undertake clinical fellowships in the UK, Australia and the United States.

Pakistan: In Pakistan, after an MBBS, a four-year full-time residency programme leads to an exit level FCPS examinations in ophthalmology, held under the auspices of the College of Physicians & Surgeons, Pakistan. The tough examination is assessed by both highly qualified Pakistani & 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 years residency programme leads to MCPS while a two-year training of DOMS is also being offered. For candidates in the, ilitary, 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 programmes. In addition to programmes for doctors, various diplomas and degrees for opticians are also being offered to produce competent optic technicians in this field. These programmes are being offered notably by the Punjab Institute of Preventive Ophthalmology (PIPO) in Lahore and the Pakistan Institute of Community Ophthalmology in Peshawar. Sub-specialty fellowships are also being offered in the fields of pediatric ophthalmology and vitreo-retinal ophthalmology. King Edward Medical University, Al Shifa trust eye hospital Rawalpindi & Al- Ibrahim eye hospital Karachi has also started a degree program in this field.

Philippines: Ophthalmology is a considered a medical specialty that uses medicine and surgery to treat diseases of the eye. To become a general ophthalmologist, a candidate must have completed a Doctor of Medicine degree or its equivalent (e.g. MBBS), have passed the physician licensure exam, completed an internship in medicine, and completed residency at any Philippine Academy of Ophthalmology (PAO) accredited program. Attainment of board certification in ophthalmology from PBO is optional, but is preferred and required to gain privileges in most major health institutions. Graduates of residency programs can receive further training in subspecialties of ophthalmology such as neuro-ophthalmology, etc. by completing a fellowship program which varies in length depending on each program's requirements. The leading professional organization in the country is the Philippine Academy of Ophthalmology, which also regulates ophthalmology residency programs and board certification through its accrediting agency, the Philippine Board of Ophthalmology.

United Kingdom: In the United Kingdom, there are three colleges that 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 prequisite for fellowship), the Royal College of Glasgow grants FRCS. Postgraduate work as a specialist registrar and one of these degrees is required for specialisation in eye diseases. Such clinical work is within the NHS, with supplementary private work for some consultants. There are only 2.3 ophthalmologists per 100,000 population in the UK – fewer pro rata than in any other nation in the European Union.

United States: In the United States, four years of residency training after medical school are required, with the first year being an internship in surgery, internal medicine, pediatrics, or a general transition year. Optional fellowships in advanced topics may be pursued for several years after residency. Most currently practicing ophthalmologists train in medical residency programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) or the American Osteopathic Association (AOA) and are board-certified by the American Board of Ophthalmology or the American Osteopathic Board of Ophthalmology and Otolaryngology. United States physicians who train in osteopathic medical schools hold the Doctor of Osteopathic Medicine (D.O.) degree rather than an M.D. degree. The same residency and certification requirements for ophthalmology training must be fulfilled by osteopathic physicians.

Physicians must complete the requirements of continuing medical education in order to maintain licensure and for re-certification. Professional bodies like the AAO and ASCRS: The American Society of Cataract and Refractive Surgery organizes conferences, helps physician members through continuing medical education programs for maintaining board certification, and provides political advocacy and peer support.