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How far has ophthalmology come in 50 years?

By Prof Nitin Verma

Ophthalmology has changed dramatically over the past 50 years. Ophthalmologists are now treating and managing conditions proactively rather than reactively, as was the case in the past. A prime example was the timing of cataract surgery. A few decades ago cataract surgery was performed only when the patient was severely visually disabled, with the philosophy being that it was best to intervene surgically only when the patient would have nothing to lose if the cataract surgery went wrong. Techniques for intracapsular cataract extraction included “tumbling”, the Smith Indian technique, instrument assisted extraction with the erysiphake, capsule forceps or cryotherapy with or without the use of zonulysis. Even when cataract surgery was performed, it was very often without the use of a microscope using 8-0 silk sutures to close the wound and leaving the patient aphakic. By today’s standards, the visual results were often poor and the complication rates were high.

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With the advent of intraocular lenses, small incision cataract surgery with phacoemulsification, better intraocular lens power calculation formulae, cataract surgery has evolved into refractive surgery, which is being offered earlier and earlier to patients once they start complaining of visual disability. Cataracts are often in much earlier stages in their development when surgical intervention is planned.

As you would expect, looking more broadly we can see that, in every area of ophthalmology, the treatments and methods we use today produce significantly better results than were achieved 50 years ago.

The ophthalmic therapeutic armament was very limited and most of the drugs that ophthalmologists used had serious side-effects. An example of this was the use of topical Pilocarpine and Eserine in the management of glaucoma. These were often made in hospital pharmacies. Surgical techniques in the earlier days included cyclodialysis, iridenclesis and sector iridectomy. The complications of these medical and surgical therapies were very serious and were well known.

Screening programs for diseases such as glaucoma, diabetic retinopathy and childhood eye disorders were limited and very often by the time disease was detected, it was fairly advanced. In addition, blindness from infectious diseases such as tuberculosis, syphilis and leprosy were common.

Over the years a lot of disruptive medical technologies have come in (“disruptive” is a word used to define a technology that radically changes the way we do things; in this instance the way we practice ophthalmology). Examples of disruptive ophthalmic technologies include Optical Coherence Tomography, phacoemulsification and the use of intravitreal anti-VEGF agents for the management of ocular diseases. The YAG and Argon lasers are other examples of disruptive technologies that have come into common use over the past few decades.

From being a specialty that not many people were interested in and being low on the “scale” of popular medical disciplines, ophthalmology now is a sought after field of specialisation.

To enter the training program today is a very competitive process simply because the specialty has evolved to a very precise art and the results that we can achieve today are nothing short of spectacular.

With the advent and incorporation of artificial intelligence in an ophthalmologist’s day-to-day work, this will only make things better for patients, the profession and, of course, the community at large. A/Prof Nitin

Prof Nitin Verma will be further exploring this topic, including looking ahead to what the next 50 years of ophthalmology might bring, in RANZCO’s member magazine, Eye2Eye , later in the year.

Last updated: June 13, 2019

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