Ophthalmology facts for kids

Quick facts for kids
Ophthalmology

Ophthalmologists perform cataract surgery using an operating microscope
System	Eye and visual system
Significant diseases	Cataract, retinal disease (including diabetic retinopathy and other types of retinopathy), glaucoma, corneal disease, Category:Disorders of eyelid, lacrimal system and orbit, uveitis, strabismus and disorders of the ocular muscles, ocular neoplasms (malignancies, or cancers, and benign eye tumors), neuro-ophthalmologic disorders (including disorders of the optic nerve)
Significant tests	Ophthalmoscopy, visual field test, optical coherence tomography
Specialist	Ophthalmologist

Ophthalmology ( off-THAL-mol-Ə-jee) is a clinical and surgical specialty within medicine that deals with the diagnosis and treatment of eye disorders. A former term is oculism.

An ophthalmologist is a physician who undergoes subspecialty training in medical and surgical eye care. Following a medical degree, a doctor specialising in ophthalmology must pursue additional postgraduate residency training specific to that field. This may include a one-year integrated internship that involves more general medical training in other fields such as internal medicine or general surgery. Following residency, additional specialty training (or fellowship) may be sought in a particular aspect of eye pathology.

Ophthalmologists prescribe medications to treat ailments, such as eye diseases, implement laser therapy, and perform surgery when needed. Ophthalmologists provide both primary and specialty eye care—medical and surgical. Most ophthalmologists participate in academic research on eye diseases at some point in their training and many include research as part of their career. Ophthalmology has always been at the forefront of medical research with a long history of advancement and innovation in eye care.

Diseases

A brief list of some of the most common diseases treated by ophthalmologists:

• Cataract
• Excessive tearing (tear duct obstruction)
• Proptosis (bulged eyes)
• Thyroid eye disease
• Eye tumors
• Ptosis
• Diabetic retinopathy
• Dry eye syndrome
• Glaucoma
• Macular degeneration
• Retinal detachment
• Endophthalmitis
• Refractive errors
• Strabismus (misalignment or deviation of eyes)
• Uveitis
• Ocular trauma
• Ruptured globe injury
• Orbital fracture

The most valued pharmaceutical companies worldwide whose leading products are in Ophthalmology are Regeneron (United States) for Macular degeneration (AMD) treatment and Bausch Health (Canada) for Front of eye.

Diagnosis

Indirect ophthalmoscopy

Fluorescein angiography

Eye examination

Following are examples of examination methods performed during an eye examination that enables diagnosis

• Visual acuity assessment
• Ocular tonometry to determine intraocular pressure
• Extraocular motility and ocular alignment assessment
• Slit lamp examination
• Dilated fundus examination
• Gonioscopy
• Refraction

Specialized tests

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.

Optical coherence tomography angiography (OCTA) and Fluorescein angiography to visualize the vascular networks of the retina and choroid.

Electroretinography (ERG) measures the electrical responses of various cell types in the retina, including the photoreceptors (rods and cones), inner retinal cells (bipolar and amacrine cells), and the ganglion cells.

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 ophthalmological diagnosis and in recording eye movements.

Visual field testing to detect dysfunction in central and peripheral vision which may be caused by various medical conditions such as glaucoma, stroke, pituitary disease, brain tumours or other neurological deficits.

Corneal topography is a non-invasive medical imaging technique for mapping the anterior curvature of the cornea, the outer structure of the eye.

Ultrasonography of the eyes may be performed by an ophthalmologist.

Ophthalmic 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.

Subspecialties

Ophthalmology includes subspecialities that deal either with certain diseases or diseases of certain parts of the eye. Some of them are:

• Anterior segment surgery
• Cornea, ocular surface, and external disease
• Glaucoma
• Neuro-ophthalmology
• Ocular oncology
• Oculoplastics and orbit surgery
• Ophthalmic pathology
• Paediatric ophthalmology/strabismus (misalignment of the eyes)
• Refractive surgery
• Medical retina, deals with treatment of retinal problems through non-surgical means
• Uveitis
• Veterinary specialty training programs in veterinary ophthalmology exist in some countries.
• Vitreo-retinal surgery, deals with surgical management of retinal and posterior segment diseases

Medical retina and vitreo-retinal surgery sometimes are combined and together they are called posterior segment subspecialisation

Etymology

The Greek roots of the word ophthalmology are ὀφθαλμός (ophthalmos, "eye") and -λoγία (-logia, "study, discourse"), 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.

History

Ancient near east and the Greek period

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.

Ancient India

The Indian surgeon Sushruta wrote the Sushruta Samhita in Sanskrit in approximately the sixth century 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 compatible with the method of couching. He has been described as one of the first cataract surgeons.

Medieval Islam

Anatomy of the Eye, 1200 A.D.

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-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".

Modern period

Early Ophthalmology instruments

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.

Jacques Daviel performed the first documented planned primary cataract extraction on Sep. 18, 1750 in Cologne. 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.

Notable ophthalmologists

The following is a list of physicians who have significantly contributed to the field of ophthalmology:

18th–19th centuries

• 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., von Arlt'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.
• Franciscus Donders (1818–1889) (Dutch) published pioneering analyses of ocular biomechanics, intraocular pressure, glaucoma, and physiological optics and he made possible the prescribing of combinations of spherical and cylindrical lenses to treat astigmatism
• Joseph Forlenze (1757–1833) (Italy), specialist in cataract surgery, became popular during the First French Empire, healing, among many, personalities such as the minister Jean-Étienne-Marie Portalis and the poet Ponce Denis Lebrun; he was nominated by Napoleon "chirurgien oculiste of the lycees, the civil hospices and all the charitable institutions of the departments of the Empire", 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)

• L. L. Zamenhof (b.1859) (Poland) was a Polish ophthalmologist who created the constructed international auxiliary language known as Esperanto.

Allvar Gullstrand

• Allvar Gullstrand (1862–1930) (Sweden) was a Nobel Prize-winner in 1911 for his research on the eye as a light-refracting apparatus, he described the 'schematic eye', a mathematical model of the human 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 German polymath, invented the ophthalmoscope (1851) and published important work on physiological optics, including colour vision.
• Julius Hirschberg (1843–1925) (Germany) in 1879 became the first to use an electromagnet to remove metallic foreign bodies from the eye and in 1886 developed the Hirschberg test for measuring strabismus
• 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 in Salzburg where she ran a private eye clinic.
• Socrate Polara (1800–1860, Italy) founded the first dedicated ophthalmology clinic in Sicily in 1829, entirely as a philanthropic endeavor; later he was appointed as the first director of the ophthalmology department at the Grand Hospital of Palermo, Sicily, in 1831 after the Sicilian government became convinced of the importance of state support for the specialization
• Herman Snellen (1834–1908) (Netherlands) introduced the Snellen chart to study visual acuity

20th–21st centuries

• Vladimir Petrovich Filatov (1875–1956) (Russia) contributed the tube flap grafting method and corneal transplantation; he founded the Filatov Institute of Eye Diseases and Tissue Therapy, Odessa, one of the leading eye-care institutes in the world.
• Shinobu Ishihara (1879–1963) (Japan), in 1918, invented the Ishihara Color Vision Test, a common method for determining Color blindness; he also made major contributions to the study of Trachoma and Myopia.
• Ignacio Barraquer (1884–1965) (Spain), in 1917, invented the first motorized vacuum instrument (erisophake) for intracapsular cataract extraction; he founded the Barraquer Clinic in 1941 and the Barraquer Institute in 1947 in Barcelona, Spain.
• Ernst Fuchs (1851–1930) was an Austrian ophthalmologist known for his discovery and description of numerous ocular diseases and abnormalities including Fuchs' dystrophy and Fuchs heterochromic iridocyclitis.
• Tsutomu Sato (1902–1960) (Japan) pioneer in incisional refractive surgery, including techniques for astigmatism and the invention of radial 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.
• Charles Schepens (1912–2006) (Belgium) was the "father of modern retinal surgery" and developer of the Schepens indirect binocular ophthalmoscope whilst at Moorfields Eye Hospital; he was the founder of the Schepens Eye Research Institute, associated with Harvard Medical School and the Massachusetts Eye and Ear Infirmary, in Boston, Massachusetts.
• Tom Pashby (1915–2005) (Canada) was Canadian Standards Association and a sport safety advocate to prevent eye injuries and spinal cord injuries, developed safer sports equipment, named to the Order of Canada, inducted into Canada's Sport Hall of Fame.
• Marshall M. Parks (1918–2005) (United States) was the "father of pediatric ophthalmology".
• José Ignacio Barraquer (1916–1998) (Spain) was the "father of modern refractive surgery" and in the 1960s, he developed lamellar techniques, including keratomileusis and keratophakia, as well as the first microkeratome and corneal microlathe.
• 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 popularized radial 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 for phacoemulsification, first allowing cataract extraction through a small incision.
• Helena Ndume (b.1960) (Namibia) is a renowned ophthalmologist notable for her charitable work among people with eye-related illnesses.
• Rand Paul (b. 1963) (United States) worked as an ophthalmologist before becoming a US senator.
• Andromahi Rapanou ((b. 1984) (Greece), specialist in Retinal Pathology

Images for kids

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  New York Ophthalmic Hospital, 1893

See also

In Spanish: Oftalmología para niños