Ophthalmology (/ˌɒfθælˈmɒlədʒi/ or
/ˌɒpθælˈmɒlədʒi/) is the branch of medicine that deals with
the anatomy, physiology and diseases of the eyeball and orbit. An
ophthalmologist is a specialist in medical and surgical eye disease.
Their credentials include a doctorate degree in medicine, followed by
an additional four years of
Ophthalmology residency training.
Additional training may be sought through a fellowship in a particular
specialty of eye pathology. Ophthalmologists are allowed to
medically treat eye disease, prescribe glasses or contact lenses,
implement laser therapy, and perform surgery when needed.
Ophthalmologists may participate in academic research on the diagnosis
and treatment for eye disorders.
2.2 Specialized tests
3 Ophthalmic surgery
6.1 Ancient near east and the Greek period
6.2 Ancient India
6.3 Medieval Islam
6.4 Modern Period
6.5 Ophthalmic surgery in Great Britain
6.6 19th and 20th centuries
6.7 Central Europe
7 Professional requirements
Australia and New Zealand
7.10 United Kingdom
7.11 United States
8 Notable ophthalmologists
8.1 18th–19th centuries
8.2 20th–21st centuries
9 See also
11 External links
A partial list of the most common diseases diagnosed and treated by
Refractive error including near-sightedness, far-sightedness, etc.
Strabismus (misalignment/deviation of eyes)
Proptosis (bulged eyes)
Excessive tearing (nasolacrimal duct obstruction)
Fundoscopy by using 90 diopter lens with the slit lamp
Following are examples of methods of diagnosis performed in a eye
Intraocular pressure measurement
Slit lamp exmination
Optical coherence tomography
An Ophthalmolgist performing Lasik
For a comprehensive list of surgeries performed by ophthalmologists,
see eye 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 expert eye surgeon is responsible for selecting the
appropriate surgical procedure for the patient, and for taking the
necessary safety precautions.
Ophthalmology includes subspecialities which 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
Medical retina, deals with treatment of retinal problems through
Vitreo-retinal surgery, deals with surgical management of retinal and
posterior segment diseases and disorders. Medical retina and
vitreo-retinal surgery sometimes together called posterior segment
Oculoplastics and orbit surgery
Pediatric ophthalmology/strabismus (misalignment of the eyes)
Veterinary specialty training programs in veterinary ophthalmology
exist in some countries.
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, while
differences in anatomy or disease prevalence, whether subtle or
substantial, may differentiate the two.
Ancient near east and the Greek period
Ebers Papyrus from ancient Egypt dating to 1550 BC, a section
is devoted to eye diseases.
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 (5th century BC) and others, that this
fluid was the medium of vision and flowed from the eye to the brain by
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
Rufus of Ephesus (1st century AD) 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
Celsus the Greek philosopher of the 2nd century AD gave a detailed
description of cataract surgery by the couching method.
The Greek physician
Galen (2nd century AD) 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
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
The Indian surgeon
Sushruta Samhita in
about 6th centry CE 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.
Ophthalmology in medieval Islam
Anatomy of the Eye, 1200 CE
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
Ibn al-Haytham (Alhazen), in his
Book of Optics
Book of Optics explained that vision
occurs when light bounces on an object and then is directed to one's
Ibn al-Nafis, an Arabic native of Damascus, wrote a large textbook,
Book on Experimental Ophthalmology, divided into two
parts, On the Theory of
Ophthalmology and Simple and Compounded
Avicenna wrote in his Canon "rescheth" which means "retiformis" and
Gerard of Cremona
Gerard of Cremona translated this around 1150 into the new word
In the 17th and 18th centuries, hand lenses were used by Malpighi, and
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 discovered until
Gottfried Reinhold Treviranus in 1834.
Georg Joseph Beer
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
popularizing the instrument used to perform the surgery (Beer's
In North America, indigenous healers treated some eye diseases by
rubbing or scraping the eyes or eyelids.
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
King George III of England in 1772. His skill at
removing cataract legitimized the field. The first dedicated
ophthalmic hospital opened in 1805 in London; it is now called
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
19th and 20th centuries
The prominent opticians of the late 19th and early 20th centuries
Ernst Abbe (1840–1905), a co-owner of at the Zeiss Jena
factories in Germany where he developed numerous optical instruments.
Hermann von Helmholtz
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. In Berlin,
Albrecht von Graefe
Albrecht von Graefe introduced iridectomy 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 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. German ophthalmologist,
Gerhard Meyer-Schwickerath is
widely credited with developing the predecessor of laser coagulation,
photocoagulation. In 1946, he 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) by with a
self-constructed device on the roof of the ophthalmic clinic at the
University of Hamburg-Eppendorf.
Polish ophthalmology dates to the 13th century. The Polish
Ophthalmological Society was founded in 1911. A representative leader
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
Ophthalmology in Warsaw from 1963 to 1976, was the first to
use lasers in her practice.
Ophthalmologists are physicians (MD/MS after MBBS or D.O./DOMS/ DNB,
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
See also: Royal Australian and
New Zealand College of Ophthalmologists
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.
Bangladesh to be an ophthalmologist the basic degree is an MBBS.
Then they have to obtain a postgraduate degree or diploma in specialty
ophthalmology. 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
In Canada, an ophthalmology residency after medical school is
undertaken. The residency lasts a minimum of five years after the MD
degree which culminates in fellowship of the
Royal College of Surgeons
Subspecialty training is undertaken by about 30% of
fellows (FRCSC) in a variety of fields from anterior segment, cornea,
glaucoma, vision rehabilitation, uveitis, oculoplastics, medical and
surgical retina, ocular oncology, ocular pathology, or
neuro-ophthalmology. About 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 the
Royal College exam in either English or
In Finland, physicians willing to become ophthalmologists must undergo
a five-year specialization which includes practical training and
In India, 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 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
Society and various state-level ophthalmological societies hold
regular conferences and actively promote continuing medical education.
In Nepal, to become an ophthalmologist, three years postgraduate study
is required after completing MBBS degree. The postgraduate degree in
ophthalmology is called MD in Ophthalmology. This degree is currently
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. Few Nepalese citizen also study
this subject in Bangladesh, China, India,
Pakistan and other
countries. All the graduates have to pass
Nepal Medical Council
Licensing Exam to become a registered
Ophthalmology 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
promote continuing medical education.
See also: Irish College of Ophthalmologists
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 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 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.
In Pakistan, 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. 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 doctors, 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 the College of
Ophthalmology and Allied Vision Sciences in
Lahore and the
Pakistan Institute of Community
Subspecialty fellowships are also being offered in the
fields of pediatric ophthalmology and vitreoretinal ophthalmology.
King Edward Medical University, Al Shifa Trust
Rawalpindi, and Al- Ibrahim
Eye Hospital Karachi have also started a
degree program in this field.
Ophthalmology is a considered a medical specialty that uses medicine
and surgery to treat diseases of the eye. There is only one, duly
recognized by the PMA and the PCS, professional organization in the
country: the Philippine Academy of
Ophthalmology (PAO). 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 completed residency training at a
hospital accredited by the Philippine Board of Ophthalmology
(accrediting arm of PAO). 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
which varies in length depending on each program's requirements.
In the United Kingdom, three colleges grant postgraduate degrees in
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 prerequisite for
Royal College of Glasgow grants FRCS. Postgraduate
work as a specialist registrar and one of these degrees is required
for specialization in eye 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 – fewer pro
rata than in any other nation in the European Union.
Medical education in the 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 or the American Osteopathic
Association and are board-certified by the American Board of
Ophthalmology or the American Osteopathic Board of
United States physicians who train in osteopathic
medical schools hold the Doctor of Osteopathic
Medicine (DO) degree
rather than an MD degree. The same residency and certification
requirements for ophthalmology training must be fulfilled by
Physicians must complete the requirements of continuing medical
education to maintain licensure and for recertification. Professional
bodies like the
American Academy of Ophthalmology and American Society
Cataract and Refractive
Surgery organize conferences, help
physician members through continuing medical education programs for
maintaining board certification, and provide political advocacy and
The following is a list of physicians who have significantly
contributed to the field of Ophthalmology:
Albrecht von Graefe
Theodor Leber discovered Leber's congenital amaurosis, Leber's
hereditary optic neuropathy, Leber's miliary aneurysm, and Leber's
Carl Ferdinand von Arlt
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. His son Ferdinand Ritter von Arlt, the
younger, was also an ophthalmologist.
Jacques Daviel (France) claimed to be the 'father' of modern cataract
surgery in that he performed extracapsular extraction instead of
needling the cataract or pushing it back into the vitreous. He is said
to have carried out the technique on 206 patients in 1752–53, of
which 182 were reported to be successful. These figures are not very
credible, given the total lack of both anaesthesia and aseptic
technique at that time.
Franciscus Donders (1818–1889) (Dutch) published pioneering analyses
of ocular biomechanics, intraocular pressure, glaucoma, and
physiological optics. 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
oculiste of the lycees, the civil hospices and all the charitable
institutions of the departments of the Empire". He was known also
for his free interventions, mainly in favour of poor people.
Albrecht von Graefe
Albrecht von Graefe (1828–1870) (Germany) 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. He introduced a cataract extraction technique
that remained the standard for over 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). He
was probably the most important ophthalmologist of the 19th century.
Allvar Gullstrand (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, a great German polymath, invented the
ophthalmoscope (1851) and published important work on physiological
optics, including colour vision (1850s).
Julius Hirschberg (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.
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 (Netherlands) introduced the
Snellen chart to study
Vladimir Petrovich Filatov (1875–1956) (Ukraine) contributed to the
medical world the tube flap grafting method, corneal transplantation,
and preservation of grafts from cadaver eyes and tissue therapy. He
founded the Filatov Institute of
Eye Diseases and Tissue Therapy,
Odessa, one of the leading eye-care institutes in the world.
Ignacio Barraquer (1884–1965) (Spain), in 1917, invented the first
motorized vacuum instrument (erisophake) for intracapsular cataract
extraction. He founded of 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
Fuchs' dystrophy and Fuchs heterochromic
Tsutomu Sato (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
Sir Harold Ridley (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.
Charles Schepens (Belgium) was the "father of modern retinal surgery"
and developer of the Schepens indirect binocular ophthalmoscope whilst
Eye Hospital. He was the founder of the Schepens Eye
Research Institute in Boston, Massachusetts. This premier research
institute is associated with Harvard Medical School and Massachusetts
Eye and Ear Infirmary.
Marshall M. Parks was the "father of pediatric ophthalmology".
Ignacio Barraquer (1916–1998) (Spain) was the "father of
modern refractive surgery". In the 1960s, he developed lamellar
techniques, including keratomileusis and keratophakia, as well as the
first microkeratome and corneal microlathe.
Tadeusz Krwawicz (Poland), in 1961, developed the first cryoprobe for
intracapsular cataract extraction.
Svyatoslav Fyodorov (Russia) was the "father of ophthalmic
microsurgery". He improved and popularized the radial keratotomy,
invented a surgical cure for cataract, and developed the scleroplasty.
Charles Kelman (United States) developed the ultrasound and mechanized
irrigation and aspiration system for phacoemulsification, first
allowing cataract extraction through a small incision.
Ioannis Pallikaris (Greece) performed the first laser-assisted
intrastromal keratomileusis (LASIK) surgery.
Book of the Ten Treatises of the Eye
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Tipografica Trani (Napoli). pp. 66–67.
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