Anophthalmologist is a physician who undergoes subspecialty training in medical and surgical eye care.[3] Following amedical degree, a doctor specialising in ophthalmology must pursue additional postgraduateresidency training specific to that field. In the United States, following graduation from medical school, one must complete a four-year residency in ophthalmology to become an ophthalmologist. Following residency, additional specialty training (or fellowship) may be sought in a particular aspect of eye pathology.[4]
Ophthalmologists prescribe medications to treat ailments, such as eye diseases, implement laser therapy, and perform surgery when needed.[5] Ophthalmologists provide both primary and specialty eye care—medical and surgical.[5] Most ophthalmologists participate in academic research on eye diseases at some point in their training and many include research as part of their career.[6]Ophthalmology has always been at the forefront of medical research with a long history of advancement and innovation in eye care.[7]
The most valued pharmaceutical companies worldwide whose leading products are in Ophthalmology areRegeneron (United States) forMacular degeneration (AMD) treatment andBausch Health (Canada) for Front of eye.[10]
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.
Electrooculography (EOG) is a technique for measuring the corneo-retinal standing potential that exists between the front and the back of the human eye. The resulting signal is called the electrooculogram. Primary applications are in ophthalmologicaldiagnosis and in recordingeye movements.
For a comprehensive list of surgeries performed by ophthalmologists, seeeye surgery.
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.
TheGreek roots of the word ophthalmology are ὀφθαλμός (ophthalmos, "eye") and -λoγία (-logia, "study, discourse"),[14][15] 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, although there are differences in the anatomy or disease prevalence.
In theEbers Papyrus from ancient Egypt dating to 1550 BC, a section is devoted to eye diseases.[2]
Prior toHippocrates, physicians largely based their anatomical conceptions of the eye on speculation, rather thanempiricism.[2] 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, byAlcamaeon (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 physicianRufus of Ephesus (first century AD) recognised a more modern concept of the eye, withconjunctiva, extending as a fourth epithelial layer over the eye.[2] 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 thecouching method.
The Greek physicianGalen (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 aposterior chamber. Although this model was a roughly correct modern model of the eye, it contained errors. Still, it was not advanced upon again until afterVesalius. Aciliary 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 thetear ducts.
The Indian surgeonSushruta wrote theSushruta Samhita inSanskrit in approximately the sixth century BC,[16] which describes 76 ocular diseases (of these, 51 surgical) as well as several ophthalmological surgical instruments and techniques.[17][18] His description ofcataract surgery was compatible with the method ofcouching.[19] He has been described as one of the first cataract surgeons.[20][21]
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.[22]Hunayn ibn Ishaq, and others beginning with the medieval Arabic period, taught that the crystalline lens is in the exact center of the eye.[23] This idea was propagated until the end of the 1500s.[23]
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 andSimple and Compounded Ophthalmic Drugs.[24]
Avicenna wrote in his Canon "rescheth", which means "retiformis", andGerard of Cremona translated this at approximately 1150 into the new term "retina".[25]
In the seventeenth and eighteenth centuries,hand lenses were used byMalpighi,microscopes byLeeuwenhoek, preparations for fixing the eye for study byRuysch, and later the freezing of the eye byPetit. 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 theposterior chamber, and the nature of the retina. Unaware of their functions,Leeuwenhoek noted the existence of photoreceptors,[26] however, they were not properly described untilGottfried Reinhold Treviranus in 1834.
Jacques Daviel performed the first documented planned primary cataract extraction on Sep. 18, 1750 in Cologne.[27]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 ofcataract (Beer's operation), as well as having popularized the instrument used to perform the surgery (Beer's knife).[28]
In North America, indigenous healers treated some eye diseases by rubbing or scraping the eyes or eyelids.[29]
The first ophthalmic surgeon in the UK wasJohn Freke, appointed to the position by the governors ofSt. Bartholomew's Hospital in 1727. A major breakthrough came with the appointment of Baron de Wenzel (1724–90), a German who became the oculist toKing George III of Great Britain in 1772. His skill at removing cataracts legitimized the field.[30] The first dedicated ophthalmic hospital opened in 1805 in London; it is now calledMoorfields Eye Hospital. Clinical developments at Moorfields and the founding of the Institute of Ophthalmology (now part of theUniversity College London) bySir Stewart Duke-Elder established the site as the largest eye hospital in the world and a nexus for ophthalmic research.[31]
In Berlin, ophthalmologistAlbrecht von Graefe introducediridectomy 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 wasJoseph Igersheimer (1879–1965), best known for his discoveries with arsphenamine for the treatment of syphilis. He fled toTurkey in 1933. As one of eight emigrant directors in the Faculty of Medicine at theUniversity of Istanbul, he built a modern clinic and trained students. In 1939, he went to the United States, becoming a professor atTufts University.[32] 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 theUniversity of Hamburg-Eppendorf.[33][34]
Polish ophthalmology dates to the thirteenth century. The Polish Ophthalmological Society was founded in 1911. A representative leader wasAdam Zamenhof (1888–1940), who introduced certain diagnostic, surgical, and nonsurgical eye-care procedures. He was executed by the German Nazis in 1940.[35]
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 physicists of the late nineteenth and early twentieth centuries includedErnst 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 theophthalmoscope in 1851. They both made theoretical calculations on image formation in optical systems and also had studied the optics of the eye.
Christopher Leffler (ed.),Biographies of Ophthalmologists from Around the World: Ancient, Medieval, and Early Modern, Wroclaw 2024, pp. 384, ISBN 9798342679220
Ophthalmologists arephysicians (MD/DO in the U.S. or MBBS in the UK and elsewhere orDO/DOMS/DNB, who typically complete an undergraduate degree, general medical school, followed by a residency in ophthalmology. Ophthalmologists typically perform optical, medical and surgical eye care.
InAustralia andNew 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.
InBangladesh 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.
InCanada, after medical school an ophthalmology residency is undertaken. The residency typically lasts five years, 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 fromanterior segment,cornea,glaucoma,vision rehabilitation,uveitis,oculoplastics, medical and surgical retina,ocular oncology,Ocular pathology, orneuro-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 theRoyal College exam in either English or French.
InIndia, 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.
InNepal, 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.
InIreland, theRoyal 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 inDublin,Sligo,Limerick,Galway,Waterford, andCork. A minimum of 8.5 years of training is required before eligibility to work inconsultant posts. Some trainees take extra time to obtainMSc,MD orPhD degrees and to undertake clinical fellowships in the UK, Australia, and the United States.
InPakistan, 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.[36] 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 theCollege of Ophthalmology and Allied Vision Sciences, inLahore and the Pakistan Institute of Community Ophthalmology in Peshawar.[37] Subspecialty fellowships also are being offered in the fields ofpediatric 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).[38] 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 (MD) 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).[39] 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 theUnited Kingdom, three colleges grant postgraduate degrees in ophthalmology. TheRoyal College of Ophthalmologists (RCOphth) and theRoyal College of Surgeons of Edinburgh grant MRCOphth/FRCOphth and MRCSEd/FRCSEd, (although membership is no longer a prerequisite for fellowship), theRoyal College of Glasgow grants FRCS. Postgraduate work as aspecialist registrar and one of these degrees is required for specialization ineye 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 – fewerpro rata than in any nations in the European Union.[40]
Ophthalmologists typically complete four years of undergraduate studies, four years of medical school and four years of eye-specific training (residency). Some pursue additional training, known as a fellowship - typically one to two years. Ophthalmologists are physicians who specialize in the eye and related structures. They perform medical and surgical eye care and may also write prescriptions for corrective lenses. They often manage late stage eye disease, which typically involves surgery.[41]
Ophthalmologists must complete the requirements ofcontinuing medical education to maintain licensure and for recertification.
Theodor Leber (1840–1917) discovered Leber's congenital amaurosis, Leber's hereditary optic neuropathy, Leber's miliary aneurysm, and Leber's stellate neuroretinitis
Carl Ferdinand von Arlt (1812–1887), 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, e.g., vonArlt's line in trachoma and his son, Ferdinand Ritter von Arlt, the younger, was also an ophthalmologist
Jacques Daviel (1696–1762) (France) performed the first documented planned primary cataract extraction on Sep. 18, 1750 in Cologne.[27]
Franciscus Donders (1818–1889) (Dutch) published pioneering analyses of ocular biomechanics, intraocular pressure,glaucoma, and physiologicaloptics and he made possible the prescribing of combinations of spherical and cylindrical lenses to treatastigmatism
Joseph Forlenze (1757–1833) (Italy), specialist incataract surgery, became popular during theFirst French Empire, healing, among many, personalities such as the ministerJean-Étienne-Marie Portalis and the poetPonce Denis Lebrun; he was nominated byNapoleon "chirurgien oculiste of the lycees, the civil hospices and all the charitable institutions of the departments of the Empire",[42] and he also was known for his free interventions, mainly in favour of poor people
Albrecht von Graefe
Albrecht von Graefe (1828–1870) (Germany) probably the most important ophthalmologist of the nineteenth century, along with Helmholtz and Donders, one of the 'founding fathers' of ophthalmology as a specialty, he was a brilliant clinician and charismatic teacher who had an international influence on the development of ophthalmology, and was a pioneer in mapping visual field defects and diagnosis and treatment of glaucoma, and he introduced a cataract extraction technique that remained the standard for more than 100 years, and many other important surgical techniques such as iridectomy. He rationalised the use of many ophthalmically important drugs, including mydriatics and miotics; he also was the founder of one of the earliest ophthalmic societies (German Ophthalmological Society, 1857) and one of the earliest ophthalmic journals (Graefe's Archives of Ophthalmology)
Allvar Gullstrand (1862–1930) (Sweden) was aNobel Prize-winner in 1911 for his research on the eye as a light-refracting apparatus, he described the 'schematic eye', a mathematical model of thehuman eye based on his measurements known as the 'optical constants' of the eye; his measurements are still used today
Hermann von Helmholtz (1821–1894), a great Germanpolymath, invented the ophthalmoscope (1851) and published important work on physiological optics, including colour vision.
Peter Adolph Gad (1846–1907), Danish-Brazilian ophthalmologist who founded the first eye infirmary in São Paulo, Brazil
Rosa Kerschbaumer-Putjata (1851–1923), Russian-Austrian ophthalmologist who was the first female doctor in Austria, headed "mobile ophthalmological troops" in Russia and reduced the above-average number of blind people inSalzburg where she ran a private eye clinic.[43]
Socrate Polara (1800–1860, Italy) founded the first dedicated ophthalmology clinic inSicily in 1829, as a philanthropic endeavor; in 1831 he was appointed as the first director of the ophthalmology department at the Grand Hospital ofPalermo, Sicily, after the Sicilian government became convinced of the importance of state support for the specialization[44]
Ignacio Barraquer (1884–1965) (Spain), in 1917, invented the first motorized vacuum instrument (erisophake) for intracapsularcataract extraction; he founded the Barraquer Clinic in 1941 and the Barraquer Institute in 1947 in Barcelona, Spain.
Tsutomu Sato (1902–1960) (Japan) pioneer in incisional refractive surgery, including techniques for astigmatism and the invention ofradial keratotomy for myopia.
Jules Gonin (1870–1935) (Switzerland) was the "father of retinal detachment surgery".
Sir Harold Ridley (1906–2001) (United Kingdom), in 1949, may have been the first to successfully implant an artificial intraocular lens 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.
Wajid Ali Khan Burki (1900–1989) (Pakistan), was the "father of medical services" in Pakistan and distinguished ophthalmologist widely recognized as an expert in the field of eye care.
Tom Pashby (1915–2005) (Canada) wasCanadian Standards Association and a sport safety advocate to prevent eye injuries and spinal cord injuries, developed safer sports equipment, named to theOrder of Canada, inducted into Canada's Sport Hall of Fame.[46]
Marshall M. Parks (1918–2005) (United States) was the "father of pediatric ophthalmology".[47]
José Ignacio Barraquer (1916–1998) (Spain) was the "father of modern refractive surgery" and in the 1960s, he developed lamellar techniques, includingkeratomileusis and keratophakia, as well as the firstmicrokeratome and cornealmicrolathe.
Tadeusz Krwawicz (1910–1988) (Poland), in 1961, developed the first cryoprobe for intracapsular cataract extraction.
Svyatoslav Fyodorov (1927–2000) (Russia) was the "father of ophthalmic microsurgery" and he improved and popularizedradial keratotomy, invented a surgical cure for cataract, and he developed scleroplasty.
Charles Kelman (1930–2004) (United States) developed the ultrasound and mechanized irrigation and aspiration system forphacoemulsification, first allowing cataract extraction through a small incision.
Melvin L. Rubin (1932–2014) (United States) was a retinal surgeon and educator; he created the Ophthalmic Knowledge Assessment Program (OKAP) that changed ophthalmic education, and was author of leading textbooksOptics for Clinicians andThe Fine Art of Prescribing Glasses, as well asThe Dictionary of Eye Terminology - currently in its 8th edition. Rubin served as president, and later chairman, of the American Academy of Ophthalmology; and chairman of the American Boards of Ophthalmology.
Helena Ndume (born 1960) (Namibia) is a renowned ophthalmologist notable for her charitable work among people with eye-related illnesses.
Rand Paul (born 1963) (United States) worked as an ophthalmologist before becoming a US senator.
J. Morgan Micheletti (United States) is an ophthalmologist, researcher, inventor, and podcaster known for advancements in ocular health and recipient of the Outstanding Young Texas Ex Award.
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^David C. Lindberg (1997). Helaine Selin (ed.).Encyclopaedia of the History of Science, Technology, and Medicine in Non-Western Cultures. Kluwer Academic Publishers. p. 410.ISBN0792340663.
^Davidson Luke (1996). "'Identities Ascertained': British Ophthalmology in the First Half of the Nineteenth Century".Social History of Medicine.9 (3):313–333.doi:10.1093/shm/9.3.313.PMID11618725.
^Namal Arin, Reisman Arnold (2007). "Joseph Igersheimer (1879–1965): A Visionary Ophthalmologist and his Contributions before and after Exile".Journal of Medical Biography.15 (4):227–234.doi:10.1258/j.jmb.2007.06-63.PMID18172563.S2CID45604124.
^Boyd, Benjamin (2010).Modern ophthalmology : the highlights : the account of a master wintnessing a 60 year epoch of evolution and progress (1950-2010). Panama: Jaypee-Highlights Medical Publishers.ISBN9789962678168.OCLC720191230.
^Parisi, Antonino (1838).Annuario Storico del Regno della Due Sicilie, dal Principio del Governo, di Ferdinando II Borbone. Tipografica Trani (Napoli). pp. 66–67.
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