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A phoropter in use.
A phoropter in use. A phoropter (or phoroptor) is an instrument commonly used by Optometrists and Ophthalmologists during an Eye examination to measure an individual's
Slit lamp examination of eyes in an Ophthalmology Clinic
Slit lamp examination of eyes in an Ophthalmology Clinic

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. The slit lamp is an instrument consisting of a high-intensity Light source that can be focused to shine as a slit Medicine is the art and science of healing It encompasses a range of Health care practices evolved to maintain and restore Human Health by the Eyes are organs that detect Light, and send signals along the Optic nerve to the visual areas of the brain The brain is the center of the Nervous system in animals All Vertebrates and the majority of Invertebrates have a brain 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. Surgery (from the χειρουργική cheirourgikē, via chirurgiae meaning "hand work" is a medical specialty that uses operative manual and instrumental

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. Greek (el ελληνική γλώσσα or simply el ελληνικά — "Hellenic" is an Indo-European language, spoken today by 15-22 million people mainly " 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.

Contents

History

The eye, including its structure and mechanism, has fascinated scientists and the public in general since ancient times. The majority of all input to the brain comes from vision. Many of the expressions in the English language that mean to understand are equivalent vision terms. "I see", to mean I understand.

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.

Sushruta

Sushruta wrote Sushruta Samhita in about fifth Century BCE in India. Sushruta was a surgeon and teacher of Ayurveda who flourished in the Indian city of Kashi by the 6th century BCE The Sushruta Samhita is a Sanskrit text on Surgery, attributed to Sushruta, (6th century BCE the "father of Surgery" He described about 72 ocular diseases as well as several ophthalmological surgical instruments and techniques. Sushruta has been described as the first Indian cataract surgeon. [1] [2] Arab scientists are some of the earliest to have written about and drawn the anatomy of the eye—the earliest known diagram being in Hunain ibn Is-hâq's Book of the Ten Treatises on the Eye. Hunayn ibn Ishaq (Hunein Bit Ishak أبو زيد حنين بن إسحاق العبادي; known in Latin as Johannitius (809-873 was a famous and influential Earlier manuscripts exist which refer to diagrams which are not known to have survived. Current knowledge of the Græco-Roman understanding of the eye is limited, as many manuscripts lacked diagrams. In fact, there are very few Græco-Roman diagrams of the eye still in existence. Thus, it is not clear to which structures the texts refer, and what purpose they were thought to have.

Pre-Hippocrates

The pre-Hippocratics largely based their anatomical conceptions of the eye on speculation, rather than empiricism. Hippocrates of Cos II or Hippokrates of Kos ( ca. 460 BC – ca In Philosophy, empiricism is a theory of Knowledge which asserts that knowledge arises from Experience. 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. Alcmaeon ( Gr) of Croton (in Magna Græcia) was one of the most eminent natural philosophers and medical theorists of antiquity Aristotle advanced such ideas with empiricism. Aristotle (Greek Aristotélēs) (384 BC – 322 BC was a Greek philosopher a student of Plato and teacher of Alexander the Great. 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.

Alexandrian studies

Alexandrian studies extensively contributed to knowledge of the eye. Alexandria ( Egyptian Arabic: اسكندريه Eskendereyya; Standard Arabic: ar الإسكندرية Al-Iskandariyya; Ἀλεξάνδρεια Aëtius tells us that Herophilus dedicated an entire study to the eye which no longer exists. Aëtius Amidenus or Aëtius of Amida ( Gr) was a Byzantine physician and medical writer particularly distinguished by the extent Herophilos, sometimes Latinized Herophilus (335-280 BC was a Greek physician In fact, no manuscripts from the region and time are known to have survived, leading us to rely on Celsius' account—which is seen as a confused account written by a man who did not know the subject matter. The Celsius Temperature scale was previously known as the centigrade scale. From Celsius it is known that the lens had been recognised, and they no longer saw a fluid flowing to the brain through some hollow tube, but likely a continuation of layers of tissue into the brain. Celsius failed to recognise the retina's role, and did not think it was the tissue that continued into the brain.

Rufus

Rufus recognised a more modern eye, with conjunctiva, extending as a fourth epithelial layer over the eye. Rufus of Ephesus ( fl late 1st century AD was an ancient physician and author who wrote treatises on Dietetics, Pathology, Anatomy, and patient The conjunctiva is a clear membrane that covers the Sclera (white part of the Eye) and lines the inside of the Eyelids It is made of lymphoid tissue 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). 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. Galen ( Greek: Γαληνός Galēnos; Latin: Claudius Galenus, Aelius Galenus, Claudius Aelius Galenus, or Though this model was roughly a correct but simplistic modern model of the eye, it contained errors. Yet it was not advanced upon again until after Vesalius. Andreas Vesalius ( Brussels, December 31, 1514 - Zakynthos, October 15, 1564) was an anatomist, Physician A ciliary body was then discovered and the sclera, retina, choroid and cornea were seen to meet at the same point. The ciliary body is the circumferential tissue inside the Eye composed of the Ciliary muscle and Ciliary processes. 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, though he dissected the optic nerve, and saw it was solid, He mistakenly counted seven optical muscles, one too many. He also knew of the tear ducts. The nasolacrimal duct (sometimes called tear ducts) carries Tears from the Lacrimal sac into the Nasal cavity.

After Galen

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. Galen ( Greek: Γαληνός Galēnos; Latin: Claudius Galenus, Aelius Galenus, Claudius Aelius Galenus, or The araB gene Promoter is a bacterial promoter activated by e L-arabinose binding 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. Hieronymus Fabricius is the Latin name by which the Italian Anatomist Girolamo Fabrici ( May 20 1537 &ndash May 21 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.

Muslim ophthalmology

Of all the branches of Islamic medicine, ophthalmology was considered one of the foremost. Ophthalmology was one of the foremost branches in medieval Islamic medicine. 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. An injection is an infusion method of putting Liquid into the Body, usually with a hollow needle and a Syringe which is pierced through A syringe is a simple piston Pump consisting of a plunger that fits tightly in a tube For a topic outline on this subject see List of basic Iraq topics. For the village in Azerbaijan see Mosul Azerbaijan. Mosul (الموصل Al Mūṣul, Kurdish: Mosul/Ninawa, Musul A cataract is a clouding that develops in the crystalline lens of the Eye or in its envelope varying in degree from slight to complete opacity In cataract surgery, Ammar ibn Ali attempted the earliest extraction of cataracts using suction. Cataract surgery is the removal of the lens of the Eye (also called "crystalline" that has developed an opacification which is referred to as a Suction is the flow of a fluid into a partial Vacuum, or region of low pressure He introduced a hollow metallic syringe needle through the sclerotic and successfully extracted the cataracts through suction. A hypodermic needle is a hollow needle commonly used with a Syringe to inject substances into the body [1]

Ibn al-Haytham (Alhazen), the "father of optics", studied the anatomy of the eye extensively. TemplateInfobox Muslim scholars --> ( Arabic: ابو علی، حسن بن حسن بن هيثم Latinized Anatomy (from the Greek anatomia, from ana separate apart from and temnein, to cut up cut open is a branch of Biology that is the consideration 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). Eye surgery, also known as orogolomistician surgery or ocular surgery, is Surgery performed on the Eye or its Adnexa, typically by In Psychology, visual perception is the ability to interpret information from Visible light reaching the Eyes The resulting Perception is also The Book of Optics ( Arabic: Kitab al-Manazir, Latin: De Aspectibus or Opticae Thesaurus Alhazeni [2] He was also the first to hint at the retina being involved in the process of image formation. The vertebrate retina is a light sensitive part inside the inner layer of the Eye. An image (from Latin imago) or picture is an artifact usually two-dimensional that has a similar appearance to some subject &mdashusually [3]

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. TemplateInfobox Muslim scholars --> Ala al-Din Abu al-Hassan Ali ibn Abi-Hazm al-Qarshi al-Dimashqi ( Muscle (from Latin musculus, diminutive of mus "mouse" is contractile tissue of the body and is derived from the Eyes are organs that detect Light, and send signals along the Optic nerve to the visual areas of the brain The ophthalmic nerve is one of the three branches of the Trigeminal nerve, the fifth Cranial nerve. The optic nerve, also called cranial nerve II, is the Nerve that transmits visual information from the Retina to the Brain. A transect is a path along which one records and counts occurrences of the phenomenon of study (e He also discovered many new treatments for glaucoma and the weakness of vision in one eye when the other eye is affected by disease. Glaucoma is a group of diseases of the Optic nerve involving loss of retinal ganglion cells in a characteristic pattern of optic neuropathy. The visual system is the part of the Nervous system which allows organisms to see. A disease is an abnormal condition of an organism that impairs bodily functions and can be deadly [4]

Seventeenth and eighteenth century

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). A microscope ( Greek: ( micron) = small + ( skopein) = to look or see is an instrument for viewing objects that are 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. Antonie Philips van Leeuwenhoek (October 24 1632 &ndash August 30 1723 was a Dutch tradesman and Scientist from Delft, the Netherlands Gottfried Reinhold Treviranus ( February 4, 1776 - February 16, 1837) was a German naturalist.

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, 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. John Freke (1688-1756 was an English surgeon. Together with Percival Pott he was instrumental in separating the profession of surgeon from that of St Bartholomew's Hospital, also known as Barts, is a hospital in Smithfield in the City of London, England. 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.

Professional requirements

Ophthalmologists are medical doctors (M. A physician, medical practitioner or medical doctor who practices Medicine, and is concerned with maintaining or restoring human Health D. ) or Doctors of Osteopathic Medicine (D. O. ). who have completed a college degree, medical school, and an additional four years of post-graduate training in ophthalmology in many countries. Medical education A medical school or faculty of medicine is a Tertiary educational institution—or part of such an institution—that teaches Medicine Many ophthalmologists also undergo additional specialized training in one of the many subspecialities. Ophthalmology was the first branch of medicine to offer board certification, now a standard practice among all specialties.

United States

In the United States, four to five 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.

United Kingdom

In the United Kingdom, there are four colleges that grant postgraduate degrees in ophthalmology. The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom, the UK or Britain,is a Sovereign state located 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. A specialist registrar or SpR is a doctor in the United Kingdom who is receiving advanced training in a specialist field of Medicine in order eventually

Australia and New Zealand

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.

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) 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.

Pakistan

In Pakistan, there is a structured residency program leading into FCPS. Further detail is at http://cpsp.edu.pk/

Canada

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.

Finland

In Finland, physicians willing to become ophthalmologists must undergo a 5 year specialization which includes practical training and theoretical studies.

Veterinary

Formal specialty training programs in veterinary ophthalmology now exist in some countries [3] [4] [5]. Veterinary medicine the application of medical, diagnostic, and therapeutic principles to companion, domestic, exotic, wildlife

Distinction from Optometry

Optometrists in the US can earn a Doctor of Optometry degree (OD). Optometry is a health care profession concerned with Eyes and related structures as well as vision, Visual systems and vision information As primary eye care providers, doctors of optometry are an integral part of the health care team, earning their Doctoral degree just as Dentistry and Podiatry. Dentistry' is the "evaluation diagnosis prevention and/or treatment (nonsurgical surgical or related procedures of diseases disorders and/or conditions of the oral cavity Podiatry or podiatric medicine is a field of Healthcare devoted to the study and treatment of disorders of the Foot, Ankle, and the "anatomical Optometrists are enabled to treat patients with medications and optical aids, including ordering and interpreting examinations, prescribing optical aids such as eyeglasses, treatment of infectious and inflammatory conditions, and treatment of allergies.

Ophthalmologists are surgical specialists who treat diseases affecting the eye, orbit, and visual system of the brain. Surgery (from the χειρουργική cheirourgikē, via chirurgiae meaning "hand work" is a medical specialty that uses operative manual and instrumental Ophthalmologists may also assist other specialists in treating other ocular disorders. Ophthalmologists may treat patients with surgery or medication. Many ophthalmologists receive further training in one or several of the following sub-specialties: Vitreoretinal disease, Pediatric Ophthalmology and Adult Strabismus, Cornea and External disease, Glaucoma, Neuro-Ophthalmology, Uveitis, Ocular Pathology and Oculoplastics. Glaucoma is a group of diseases of the Optic nerve involving loss of retinal ganglion cells in a characteristic pattern of optic neuropathy. Uveitis specifically refers to Inflammation of the middle layer of the Eye, termed the " Uvea " but in common usage may refer to any inflammatory Oculoplastics, or oculoplastic surgery, and includes a wide variety of surgical procedures that deal with the orbit (eye socket eyelids tear ducts and the face

Overlap areas between Ophthalmology and Optometry include:

Sub-specialities

Extraocular muscle surgery for strabismus (Inferior rectus muscle here) in progress
Extraocular muscle surgery for strabismus (Inferior rectus muscle here) in progress

Ophthalmology includes sub-specialities which deal either with certain diseases or diseases of certain parts of the eye. The inferior rectus muscle is a Muscle in the orbit. Actions It depresses, adducts, Rotates laterally, and extorts Some of them are:

Ophthalmic surgery

Notable ophthalmologists

Revisions and sourced additions are welcome.
See also: :Category:Ophthalmologists

Pre-18th century

18th-19th century

20th-21st century

See also

External links

References

  1. ^ Ibrahim B. Eyes are organs that detect Light, and send signals along the Optic nerve to the visual areas of the brain An eye examination is a battery of tests performed by an Optometrist or Ophthalmologist assessing vision and ability to focus on and discern An eye care professional is an individual who provides a service related to the Eyes or vision. Eye color is a Polygenic trait and is determined by the amount and type of Pigments in the Eye 's iris. Ophthalmology was one of the foremost branches in medieval Islamic medicine. Optometry is a health care profession concerned with Eyes and related structures as well as vision, Visual systems and vision information Pediatric ophthalmology is a sub-speciality of Ophthalmology concerned with Eye diseases and vision care in children The Prentice Position is a term from Optics and Ophthalmology. Syed PhD, "Islamic Medicine: 1000 years ahead of its times", Journal of the International Society for the History of Islamic Medicine, 2002 (2): 2-9 [7].
  2. ^ Bashar Saad, Hassan Azaizeh, Omar Said (October 2005). "Tradition and Perspectives of Arab Herbal Medicine: A Review", Evidence-based Complementary and Alternative Medicine 2 (4), p. 475-479 [476]. Oxford University Press.
  3. ^ N. J. Wade (1998). A Natural History of Vision. . Cambridge, MA: MIT Press. .  
  4. ^ Mohamad S. M. Takrouri (King Khalid University Hospital Riyadh), Medical aspects of Ala al-Din Abu'l-Hasan Ali Ibn Abi'l-Haram al-Qurashi (Ibn al-Nafis)'s contributions to science
  5. ^ Pandey SK, Sharma V, Billson FA. A Tribute to Professor J Donald M Gass, MD. Indian J Ophthalmol [serial online] 2005 [cited 2008 Feb 27];53:147. Available from: http://www.ijo.in/text.asp?2005/53/2/147/16190

Dictionary

ophthalmology

-noun

  1. (medicine) The anatomy, functions, pathology, and treatment of the eye.
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