See historical study by G. Gorin (1982).
Medical specialty dealing with the eyes, dating to 1805. Frans C. Donders's 1864 advances in optics allowed eyeglasses to be fitted to vision problems. The ophthalmoscope made it possible to look inside the eye and relate eye defects to internal conditions. More recent advances include eye exams, early treatment of congenital defects, and eye banks to store corneas for transplants. Ophthalmologists test visual function and examine the eye for faulty development, disease, injury, degeneration, aging, or refractive errors. They prescribe treatment for eye disease and lenses for refraction and perform surgery when needed. Seealso optometry, visual-field defect.
Learn more about ophthalmology with a free trial on Britannica.com.
Ophthalmology is the branch of medicine which deals with the diseases and surgery of the visual pathways, including the eye, brain, and areas surrounding the eye, such as the lacrimal system and eyelids. By convention the term ophthalmologist is more restricted and implies a medically trained surgical specialist. Since ophthalmologists perform operations on eyes, they are generally categorized as surgeons.
The word ophthalmology comes from the Greek roots ophthalmos meaning eye and logos meaning word, thought or 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. However, veterinary medicine is regulated separately in many countries and states/provinces resulting in few ophthalmologists treating both humans and animals.
Many patients when told that they may have an eye problem will be more concerned about diseases that affect vision than other, more lethal diseases. Being deprived of sight can have a devastating effect on the psyche, as well as economic and social effects, as many blind individuals require significant assistance with activities of daily living and are often unable to continue gainful employment previously held while seeing.
The maintenance of ocular health and correction of eye problems that decrease vision contribute greatly to the ability to appreciate the longer lifespan that all of medicine continues to allow. Given the importance of vision to quality of life, many ophthalmologists consider their job to be rewarding, as they are often able to restore or improve a patient's sight. As detailed below, advances in diagnosis and treatment of disease, and improved surgical techniques have extended our abilities to restore vision like never before.
After Galen a period of speculation is again noted by Arab scientists - the lens modified Galen's model to place the lens in the middle of the eye, a notion which lasted until Vesalius reversed the era of speculation. However, Vesalius was not an ophthalmologist and taught that the eye was a more primitive notion than the notion of both Galen and the Arabian scientists - the cornea was not seen as being of greater curvature and the posterior side of the lens wasn't seen to be larger.
Understanding of the eye had been so slow to develop because for a long time the lens was perceived to be the seat of vision, not as part of the pathway for vision. This mistake was corrected when Fabricius and his successors correctly placed the lens and developed the modern notion of the structure of the eye. They removed the idea of Galen's seventh muscle (the retractor bulbi) and reinstated the correct curvatures of the lens and cornea, as well as stating the ciliary body as a connective structure between the lens and the choroid.
Of all the branches of Islamic medicine, ophthalmology was considered one of the foremost. The specialized instruments used in their operations ran into scores. Innovations such as the “injection syringe”, invented by the Iraqi physician Ammar ibn Ali of Mosul, which was used for the extraction by suction of soft cataracts, were quite common. In cataract surgery, Ammar ibn Ali attempted the earliest extraction of cataracts using suction. He introduced a hollow metallic syringe hypodermic needle through the sclerotic and successfully extracted the cataracts through suction.
Ibn al-Haytham (Alhazen), the "father of optics", studied the anatomy of the eye extensively. He made important contributions to ophthalmology and eye surgery and posited the first correct explanations of the process of sight and visual perception in his Book of Optics (1021). He was also the first to hint at the retina being involved in the process of image formation.
Ibn al-Nafis, in The Polished Book on Experimental Ophthalmology, discovered that the muscle behind the eyeball does not support the ophthalmic nerve, that they do not get in contact with it, and that the optic nerves transect but do not get in touch with each other. He also discovered many new treatments for glaucoma and the weakness of vision in one eye when the other eye is affected by disease.Salah–ud-din bin Youssef al-Kalal bi Hama (i.e. the eye doctor of Hama) was a Syrian oculist who flourished in Hama in 1296. He wrote for his son a very elaborate treatise of ophthalmology entitled Nur al-Uyun wa Jami al-Funun (light of the eyes and collection of rules).
The seventeenth and eighteenth 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.
The first ophthalmic surgeon in Great Britain was John Freke, appointed to the position by the Governors of St Bartholomew's Hospital in 1727, but the establishment of the first dedicated ophthalmic hospital in 1805 - now called Moorfields Eye Hospital in London, England was a transforming event in modern ophthalmology. Clinical developments at Moorfields and the founding of the Institute of Ophthalmology by Sir Stewart Duke-Elder established the site as the largest eye hospital in the world and a nexus for ophthalmic research.
In the United States, 4 to 5 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. Most currently practicing ophthalmologists train in medical residency programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) and are board certified by the American Board of Ophthalmology. Some physicians train in osteopathic medical schools may hold a Doctor of Osteopathy degree denoted as DO rather than MD. The same residency and certification requirements for ophthalmology training must be fulfilled by osteopathic physicians (DO degree). Completing the requirements of continuing medical education is mandatory for continuing licensure and re-certification. Professional bodies like the AAO and ASCRS organize conferences and help members through CME programs to maintain certification, in addition to political advocacy and peer support.
In the United Kingdom, there are four colleges that grant postgraduate degrees in ophthalmology. The Royal College of Ophthalmologists grants MRCOphth and FRCOphth (postgraduate exams), the Royal College of Edinburgh grants MRCSEd, the Royal College of Glasgow grants FRCS and Royal College of Ireland grants FRCSI. Work experience as a specialist registrar and one of these degrees is required for specialisation in eye diseases.
In Australia and New Zealand, the FRACO/FRANZCO is the equivalent postgraduate specialist qualification. 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.
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) or 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. Royal colleges of the united kingdom, mainly Royal college of surgeons of Edinburgh (RCSEd), Royal College of ophthalmologists (RCOphth) and Royal college of physicians and Surgeons of Glasgow (RCPSG) are conducting their fellowship and membership examinations since mid 1990s and awarding fellowships and memberships to the successful candidates.
In Pakistan, there is a structured residency program leading into FCPS. Further detail is at http://cpsp.edu.pk/
In Canada, an Ophthalmology residency after medical school is undertaken. The residency lasts a minimum of 5 years after the MD degree although subspecialty training is undertaken by about 30% of fellows (FRCSC). There are about 30 vacancies per year for ophthalmology training in all of Canada.
In Finland, physicians willing to become ophthalmologists must undergo a 5 year specialization which includes practical training and theoretical studies.
Ophthalmology includes sub-specialities which deal either with certain diseases or diseases of certain parts of the eye. Some of them are: