Editor's Note
The Magical Work of the Eye M.D.
Ophthalmologists have all the fun. They get to peer into and fix that most amazing organ with its anatomy and physiology visible to their sophisticated scopes. They get to restore that most precious sense—sight, taking patients from darkness to light. And they get to use all those gadgets.
As a young child who frequently visited the eye doctor, I was fascinated by the alternating red and green lights, the ever-changing eye chart with the big “E” always at the top of the letter pyramid, the panel of handled lenses that clicked into the gigantic refraction glasses as the ophthalmologist said, “Now read line 4.” Today, the pyramid of letters and the refraction equipment still exist, but the modern ophthalmologist’s office is a Star Trek collection of high-tech contraptions, all of which seem to have bright lights at their center. With their shimmering vertical light, slit lamps probe corneas, anterior chambers, and lenses. With their piercing bullet of light that leaves images of spots and retinal vessels swimming in your visual field, ophthalmoscopes delve into the vitreous humor and retina. Tonometers eerily approach your cornea with a bluish-green circle of light to measure intraocular pressure. And those are just the basics. The gadgetry for cataract, retinal, and refractive surgery in 2009 make today’s ophthalmologist a veritable prestidigitator.
The magic ophthalmologists wield has advanced since their medieval forebears treated cataracts with a needle through the cornea to punch the lens into the vitreous, leaving their subjects with blurred vision instead of blindness. Indeed, ophthalmology has come a long way since I started in practice in the 1970s, when I still saw aphakic patients with their shaggy-edged pupils and bottle-bottom glasses and made rounds on cataract patients who routinely spent five days in the hospital. Today’s state-of-the-art cataract procedure has patients walking out of the surgery center within hours and throwing away all but their reading glasses. Future advances promise artificial lens implants that will approach the function of native lenses so even reading glasses can be dumped.
Eliminating the need for glasses has been a major goal of ophthalmologists and their patients. Ever since the first cornea contact lenses appeared in 1949, patients have tried to rid themselves of something hanging on their face to improve their vision. Contacts got softer and longer-lasting, but patients still had to insert and remove something from their eye periodically until LASIK. Familiar with lasers because of retinal photocoagulation and other intraocular procedures, ophthalmologists eagerly embraced LASIK, becoming sculptors of the eye and giving many patients a glasses-free life.
And modern has borrowed from ancient as retinologists have traveled full circle back to the medieval practice of inserting needles in the eye. By injecting genetically engineered monoclonal fragments to slow vessel growth in “wet” macular degeneration, retinal specialists are making definitive inroads in the treatment of a disease with a previously dismal prognosis.
I’m sure an ophthalmologist’s day isn’t all fun. Like all physicians, they have to deal with patients with vague symptoms that won’t go away and treatments that don’t work. Unlike most physicians, they have to walk with patients who lose their sight, a skill that takes a true magical touch.