Ophthalmology 101

History of ophthalmology

Over the past centuries, medical fields have had incredible innovations thanks to technological advancements. Cardiology, dentistry, radiology, psychiatry, ophthalmology, and a lot more fields have benefited from human evolution to develop safer and better care. Resulting in better life quality and higher life expectancy.

The first ophthalmology program was taught at the medical school of the University of Göttingen in 1803. Two years later, the first specialized eye clinic opened in London. Following the invention of the ophthalmoscope (which allows looking into the eye) in 1851, Dutch physician Frans Cornelis started to prescribe eyeglasses for specific vision problems. His first prescriptions have been given in 1864. This was the start of modern ophthalmology.

In the 20th century, regular eye examination and the early treatment of eye defects have helped to advance the field. In 1944, a major change was the development of the eye-bank in New York, which made corneal tissues available more easily for transplantation. Since then, technology and ophthalmology techniques have not stopped improving, which gives ophthalmologists the ability to do advanced surgical procedures with limited risks.

According to the Vision Council of America, almost 75% of adults use some sort of vision correction. Which underlines the importance of knowing what eye care practitioner to choose and when to go to see an ophthalmologist.

What is an ophthalmologist?

An ophthalmologist is a medical doctor (MD) who specializes in eye and vision care. Ophthalmologists are the only practitioners trained to do eye exams, diagnose and treat disease, prescribe medication, and perform eye surgery. They can also give prescriptions to clients for eyeglasses and contact lenses.

The requirements to become an ophthalmologist are four years of college, four years of medical school, and four to five years of additional hands-on training. Once the training is completed, future ophthalmologists need certification with the American Board of Ophthalmology. This certification involves written and oral exams.

When should I see an ophthalmologist?

The function of the human eye works like a digital camera, it receives images. Whatever affects the quality of the vision is the concern of an ophthalmologist. Determining if you should see an ophthalmologist depends on your needs and symptoms. Patients often go to see an ophthalmologist after having seen an optometrist because they can perform a wider range of services and operations. An optometrist is only appropriate if you have healthy eyes and you need a medical checkup or upgrade on your lenses and eyeglasses.

If you are like the 25 million Americans who have a cataract, the 6 million who have conjunctivitis, or the 2.7 million who live with glaucoma you need to consult an ophthalmologist.

Here are some signs you need to see an ophthalmologist:

Having a temporary loss of vision

Seeing wavy, distorted lines, light streaks, and/or jagged lines

Loss of vision or decreased vision in one or both eyes

Having watery or wavy vision, seeing blurry, black spots, shadows, halos around lights, double vision

Seeing sudden spots, flashes, or lights

Changes in color vision

Sensitivity to light

It is imperative to go to see an ophthalmologist if you experience changes to your eyes such as redness, swelling, or discharge. If you notice physical changes such as eyes that turn inwards, downwards, outwards, upwards, or if you have eye pain. It can underline serious eye conditions.

Common surgical procedures and treatments performed by ophthalmologists

Cataracts

A cataract is a very common condition. 90% of people over age 65 have a cataract and 50% of people between age 75 and 85 have a loss of vision due to cataracts. If untreated it can cause blindness.

When a patient is diagnosed with a cataract it signifies that the lens of the eye is becoming cloudy. Cataracts often develop slowly over the years. The main symptoms are blurry vision, fuzzy vision, and/or sensitivity to bright light. As a result, the vision is negatively affected which causes patients to feel like they are looking through a foggy filter or a dirty window. If a cataract has evolved and been diagnosed, the only way to get rid of it is through a surgical procedure. The procedure is generally very safe.

To perform cataract surgery, the ophthalmologist uses drops to numb the eye, and performs a small eye incision beside the cornea using a laser or a very sharp blade. The clouded lens is removed with precise ultrasound and replaced with an implant called an intraocular lens (IOL). As the incision is so small, the pressure of the eye keeps it closed and heals it naturally. Patients will spend approximately 30 minutes recovering from the operation.

Cataract risk factors according to Stanford Health Care:

• Diabetes
• Aging
• Family history
• Years of excessive exposure to sunlight and UV rays
• Smoking
• Obesity
• High blood pressure
• Past eye injury or inflammation
• Previous eye surgery
• Steroid medication use

Glaucoma

Glaucoma is also a very common group of eye conditions that damages the eye’s optic nerve. It affects millions of Americans each year. As cataracts, it gets worse over the years. It is a leading cause of blindness that can be prevented with early treatments. Hence, the need to consult an ophthalmologist if you experience symptoms.

Glaucoma is caused by higher than normal pressure levels of the eyes. Patients diagnosed with glaucoma will need to have the pressure relieved to avoid irreversible vision loss. There are two major types of glaucoma:

1 – Open-angle glaucoma

With open-angle glaucoma, the intraocular pressure (IOP) of the eye rises because the normal amount of eye fluid cannot be drained out of the eye. At first, this type of glaucoma is painless and does not entail vision changes. If it is not diagnosed and treated it can gradually lead to vision loss.

2 – Closed-angle glaucoma

 Closed-angle glaucoma is the result of the iris bulging forward to diminish or block the drainage angle of the eye formed by the cornea and iris. When it happens, fluid cannot circulate correctly, and pressure increases. If the drainage angle gets completely blocked, eye pressure increases very quickly. This is known as an acute attack. A patient who gets an acute attack needs to seek his/her ophthalmologist to help as fast as possible or he/she can go blind.

Signs of an acute attack:

• Sudden severe eye pain
• Sudden blurry vision
• Headaches
• Nausea
• Vomiting
• Seeing rainbow-colored rings or halos around lights

Closed-angle glaucoma often develops slowly with no symptoms. Patients will not know if they have this pathology until symptoms appear or until they have an acute attack.

Medication such as beta-blocker and carbonic anhydrase inhibitor can normally help reduce pressure from glaucoma by improving the drainage or slowing the creation of fluid in the eye. If the medication does not work, an ophthalmologist can perform surgery to stop the progression of the disease. It is necessary to know that vision loss cannot be reversed if glaucoma has already done damages to the eye. That is why it is important to work closely with your eye doctor to watch the progression of the disease and administrate necessary treatments.

A surgeon can perform different surgical procedures depending on how advanced the disease is and how it progresses. For the less advanced cases, a laser can be used to annihilate the symptoms. A surgeon can also do an incision to install small drainage. Those two procedures will reduce the pressure on the eye to avoid optic nerve damage. For very severe cases, an ophthalmologist specializing in glaucoma can perform a more advanced incision. Glaucoma has no cure, but by seeing an eye doctor in the early stages of the disease, patients can be treated adequately and live a normal life.

3 – Secondary glaucoma

Secondary glaucoma is when another medical condition such as cataracts or diabetes causes glaucoma.

4 – Normal-tension glaucoma

Normal-tension glaucoma happens when a patient has blind spots in his/her vision or when the optic nerve is damaged even though the eye pressure is within the average range. Opinions among experts vary and some say this is a form of open-angle glaucoma.

5 – Pigmentary glaucoma

Pigmentary glaucoma is when small pigments of the iris (colored part of the eye) move into the eye fluid and clog the drainage canals.

Glaucoma Risk Factors:

• Age over 40
• Family history
• Poor vision
• Diabetes
• Steroid medication use
• Past eye injuries
• Corneas thinner than usual
• High blood pressure and heart disease
• Being nearsighted or farsighted

Diabetic Retinopathy

Diabetic retinopathy is a condition caused by damages to the blood vessels in the tissue at the back of the eye called the retina. It causes bleeding inside the eye. As its name indicates, diabetic retinopathy can be caused as a side effect of diabetes. It is a common disease that causes vision loss amongst diabetic adults in the United States.

Pterygium

Pterygium is a visible growth that starts on the conjunctiva membrane that covers the white part of the eye over the cornea. It can occur in one or both eyes. It is a very common eye condition with more than 3 million cases in the US per year. The growth is slow and painless, but it might cause irritations and affect vision in the long run.

If a pterygium becomes red and irritated, an ophthalmologist can prescribe eye drops or ointments to be placed onto the eye. When the disease starts to affect sight, it can be removed surgically. Pterygium might return even after a surgical operation. It is really important for patients with this eye condition to wear UV protective sunglasses, use artificial tears, and avoid dry and dusty environments.

The main risk factors for pterygium are long exposure to sunlight, dry environments, outdoor lifestyles.

Conjunctivitis

Conjunctivitis or pink eyes occurs when the conjunctiva (white part of the eye) is irritated. There are three primary types of conjunctivitis:

• Viral conjunctivitis. A virus such as the common cold originates from conjunctivitis. This type of pink eye is very contagious but will usually disappear on its own without treatment after several days.
• Bacterial conjunctivitis. This kind of pink eye is caused by bacteria. It can cause serious damage to the eye if it is left untreated.
• Allergic conjunctivitis. Eyes irritants such as pollen, dust, and animal dander cause this type of pink eye. It can be seasonal due to pollen or all year round due to dust or animal dander.

Recommendations from the CDC

As conjunctivitis are very contagious, limiting its spread is essential. To greatly reduce the risk of spreading conjunctivitis you can follow those simple steps from the CDC:

• Wash your hands often with soap and warm water for at least 20 seconds. Wash them especially well before and after cleaning, or apply eye drops or ointment to, your infected eye. If soap and water are not available, use an alcohol-based hand sanitizer that contains at least 60% alcohol to clean hands. (See CDC’s Clean Hands Save Lives! website for tips on proper handwashing.)
• Avoid touching or rubbing your eyes. This can worsen the condition or spread it to your other eye.
• With clean hands, wash any discharge from around your eye(s) several times a day using a clean, wet washcloth or fresh cotton ball. Throw away cotton balls after use, and wash used washcloths with hot water and detergent, then wash your hands again with soap and warm water.
• Do not use the same eye drop dispenser/bottle for your infected and non-infected eyes.
• Wash pillowcases, sheets, washcloths, and towels often in hot water and detergent; wash your hands after handling such items.
• Stop wearing contact lenses until your eye doctor says it’s okay to start wearing them again.
• Clean eyeglasses, being careful not to contaminate items (like hand towels) that might be shared by other people.
• Clean, store, and replace your contact lenses as instructed by your eye doctor.
• Do not share personal items, such as pillows, washcloths, towels, eye drops, eye or face makeup, makeup brushes, contact lenses, contact lens storage cases, or eyeglasses.
• Do not use swimming pools.

Conjunctivitis often resolves on its own, but treatments can accelerate the recovery. Allergic conjunctivitis is treated with antihistamines. Bacterial conjunctivitis can be treated with antibiotic eye drops.

What to remember?

Like any other surgical field, ophthalmology is complex and solves complex problems. Advancement in technology enables ophthalmologists to have a complete understanding of eye diseases and treatments. Getting diagnosed with eye conditions is never pleasant news and can be scary. That is why ophthalmologists spend years learning and practicing to make sure patients receive the care they need as safely as possible. The most important for patients is to go get diagnosed and take regular eye exams to be able to receive treatments as needed. The sooner an eye condition is diagnosed, the better chance it has to be contained and treated.