The Scope of Ophthalmology

Although the eye and its surrounding structures would seem to provide an ideal anatomical and functional basis for specialisation, ophthalmology can no longer regard itself as a specialty on its own but more the heading for a group of sub-specialties. There are those who know all about the pigment epithelium of the retina and yet bow to those who have a special knowledge of the bipolar cells in the retina. Over the past 100 years the science has advanced at an unbelievable rate and with the increase in our knowledge has come the development of treatments and cures, which have had a great impact on our everyday lives.

The importance of the eye and its function is sometimes underrated, but a consideration of the part played by vision in our consciousness makes us soon realise its value. If we think of dreams, memories, photographs and almost anything in our daily existence, it is difficult to express them without visual references. After a little careful consideration of the meaning of blindness, it is easy to sense the rational and irrational fears that our patients present to us in the clinic. Nevertheless, in a modern European community the effects of blindness are not so apparent as in former years, and blind people tapping their way about the street or begging for food are less in evidence to remind us of the deprivation that they suffer. This is due to the effective application of preventive medicine and the efficacy of modern surgical techniques. However, in the western world we have a new and increasing problem related to the increasing number of elderly people in the population. The problem is that of sensory deprivation owing to degenerative disease. Degenerative changes in the eye are now a major cause of blindness and although support services are being developed there is still no effective cure.

The broad and detailed scientific interest in the eye and vision is witnessed by the large number of journals, conferences and meetings that now exist, possibly more than in any other specialty. There are several hundred ophthal-mological journals all contributing to the scientific literature on the subject and many are now accessible through the internet or on CD-ROM. As an organ of clinical specialisation, the eye does have a special advantage; it can be seen. Using the slit-lamp microscope it is possible to examine living nerves, including nervous system tissues and blood vessels, in a manner that is not possible in other parts of the body without endoscopy or biopsy. So much are the component parts of the eye on display to the clinician that when a patient presents to a casualty department with symptoms, the explanation of the symptoms should be made evident by careful examination. Compare this with the vague aches and pains that present to the gastroenterologist or the neurologist, symptoms that might ultimately resolve without any cause being found for them. The student or newly qualified doctor must be warned that if the patient presents with eye symptoms and no abnormality can be found after examination, then he or she must look again, because it is likely that something has been missed.

Most of the work of the ophthalmologist is necessarily centred on the globe of the eye itself, and there are a number of conditions that are limited to this region without there being any apparent involvement of the rest of the body. Ophthalmology is usually classified as a surgical specialty but it provides a bridge between surgery and medicine. Most of the surgery is performed under the microscope and here the application of engineering principles in the design of finer and finer instruments has played an important part. There is overlap with the fields of the plastic surgeons and the neurosurgeons. On the medical side, the ophthalmologist has links with the physicians and particularly the diabetic specialists and cardiologists, not to mention paediatricians and dermatologists.

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