Ophthalmology. Introduction. János Németh

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1 Ophthalmology Introduction János Németh

2 The eye is the most important square inch of the body Among all specialists (including e.g. internist, dermatologist, pediatrician, surgeon, etc) the eye doctor could provide the most information about the patients

3 The most important square inch Diagnostic power: Arteriosclerosis Hypertension Diabetes mellitus microvascular complications Intracranial pressure elevation Ocular signs of many brain, internal, dermatological, autoimmun,... diseases

4 The most important square inch The vision is the most important sensory pathway providing quick and vital information from the outside word

5 The most important square inch Loss of vision - Blindness Enourmous decrease in QoL (Quality of Life) Permanent disability (unable to work) World-wide health & socio-economical problem WHO Global initiave: Vision 2020

7 Global Blindness 75 Current Projections 75 milions

8 VISION 2020 Aim Elimination of all needless blindness Can It Be A Reality?

9 VISION Current Projections Vision 2020 Targets

10 Causes of Global Blindness 50 mill. Cataract Refractive Errors Trachoma Vit A Def Oncho ciasis Diabetic Retinopathy Glaucoma AMD and other diseases 60% 15% 15% 10%

11 VISION mill. Cataract Refractive Errors Trachoma Vit A Def Oncho ciasis Diabetic Retinopathy Glaucoma AMD and other diseases TREAT- ABLE FOCAL DISEASES MORE DIFFICULT?

12 Prevalence of Blindness EUROPE 0.3% Asia 0.7 % Lat. Amer. 0.5% Africa %

13 Causes of blindness in the World

14 Causes of visual impairment in the World

15 VERYPOOR POOR FAIR GOOD Number Blind / mill pop Others Diab.Ret Glaucoma Cataract Scar

16 Causes of blindness in Hungary Ablatio retinae 1.7% Others 3.3% Retinitis pigmentosa 1.9% ROP 2% Neuritis retrobulbaris 2.2% Age-related macular degen. 29.6% Deg. corneae 2.3% Central (brain) 3.9% Atrophia n.opt. 6.3% Cataracta 6.5% Myopia 11.1% Glaucoma 12.5% Retinopathia diab. 16.5%

19 11 October 2018

20 The eye is the most important square inch of the body

21 History

22 Egyptian papyrus (1600 BC) Many ocular conditions: Blepharitis Chalazion Iritis Cataract Trachoma Ophthalmoplegia Treatment Epilation Lizard blood

23 Cataract surgery Earliest written reference to cataract surgery dates from the 5th century BC, written in Sanskrit by the Hindu surgeon Susruta Cataract couching or reclination (the cataractous lens was displaced away from the pupil into the vitreous cavity) Practised in Egypt, India and Tibet until middle of this century

24 Cataract surgery First written description of the cataract and its treatment in the West appears in 29 AD in the De Medicinae of Celsus Describes the needling or discission of cataracts

25 Galen (second century AD) describes the eye as the most divine organ! Rays proceed from the brain through the optic nerve, retina, lens and cornea toward the object of regard, return to the lens, where vision was manufactured and retransmitted to the brain Removal of the lens would cause blindness (!)

26 MODERN CATARACT EXTRACTION Extracapsular cataract extraction performed in 1747 Has been modified several times during the next two centuries

27 Vision defects 460 BC myopic slaves were sold at a discount - vision defects reduced their value Early Romans complained of presbyopia Emperor Nero held a huge emerald up to his eye while watching the gladiators fight

28 Eye glasses Around 1000 AD appears the first formal visual aid called a reading stone (a glass sphere laid against reading material to magnify the letters) Marco Polo recorded seeing Chinese with framed lenses Armati (died in 1317) is claimed by Italians to be the inventor of spectacles

29 Developments 16 th- 17 th century: Real advance in the practice of ophthalmology was made possible by study of the anatomy of the eye, and by understanding of the mechanism of vision 18 th century: Cataract extraction 19 th century: Operative treatment of glaucoma, ophthalmoscopy

30 Developments Up to the 19th century ophthalmology was a branch of surgery Ophthalmology teaching started in France in 1762 First University Dept. of Ophthalmology: Vienna 1772, Second one in Budapest Helmholtz invented the ophthalmoscope in 1850 Donders ( ) optics Graefe (Germany) Bowman (England)

31 The ophthalmoscope of HELMHOLTZ

32 Scientific breakthroughs Antiviral drugs were used first in ophthalmology for the treatment of ocular herpes infection Corneal transplants were the first succesful homotransplants Clinical application of laser therapy Microsurgery Genetic therapy

33 Ophthalmology-related NOBEL PRICE-LAUREATES Gullstrand (optics) Ramon y Cajal (optic chiasm, astrocytes) Granit, Hartline and Wald (electrophysiology of retina)

34 LOUIS BRAILLE Born in 1809 Six dot alphabet perfectioned in 1827 (was only 18 years old!) Is buried at the Panthéon

35 The eye is the most important square inch of the body

36 OPHTHALMOLOGIST A physician who specialises in the medical and surgical care of the eyes and visual system and in the prevention of eye disease and injury A medically trained specialist who can deliver total eye care, diagnose general diseases of the body and treat ocular manifestations of systemic diseases

37 OPTOMETRIST Health service provider who is involved exclusively with visual problems State licensed to examine the eyes and to determine the presence of visual problems Determine visual acuity and prescribe spectacles, contact lens and eye exercise

38 OPTICIAN Technician who makes, verifies and delivers lenses, frames and other specially fabricated optical devices and/or contact lenses upon prescription

Ophthalmology. Ophthalmology Services

Ophthalmology. Ophthalmology Services Ophthalmology Ophthalmology Services The Ophthalmology service offers the latest and most comprehensive eye care for patients. With a dedicated team of eye surgeons and consultants, we treat vision problems