The known history of ophthalmology dates back to the early days of written history, in which initial observations and speculations about the eye were recorded. Over the ages, the understanding of the anatomy and physiology of the eye continued to develop, and several major breakthroughs took place. This has led to our present state of knowledge of the eyes and ocular health.
Ophthalmology operation - Image Copyright: Dmitry Kalinovsky / Shutterstock
In 800 BC, an Indian surgeon named Sushruta described 76 ocular diseases, as well as several ophthalmological techniques and instruments. He was particularly interested in cataract surgery, and has been referred to as the first cataract surgeon.
In ancient times, the anatomical conceptions of the eye were primarily speculatory. The sclera and cornea were understood to form part of the outer layer of the eye, with the pupil and ocular fluid occupying the middle part. This fluid was thought to flow to the brain via a tube. Aristotle introduced empiricism to these fancied structures by dissecting the eyes of animals, and he thus discovered three layers within the eye.
Rufus of Ephesus put forward the concept of a fourth layer, the epithelial layer that covers the eye. He also noted that the eye has two chambers, one filled with water extending from the cornea to the lens, and one filled with viscous fluid occupying the space between the lens and the retina. Galen’s studies also made an impact on our understanding of the eye, as he described the anatomy of the cornea, lens and optic nerve. Vesalius further advanced the knowledge of eye structure, with the discovery of the layers of the sclera, retina, choroid and cornea, which meet at a point.
Throughout the Middle Ages, hand lenses and microscopes were used to study the structure and function of the eye, advancing scientific perception of the organ’s anatomy significantly. However, it remained unclear why the pupil changes in size, and what was the nature of the retina. Additionally, the posterior chamber of the eye had not yet been discovered. Some landmarks of this period include:
- Georg Joseph Beer introduced Beer’s operation as a treatment for cataract.
- Baron Michael Johann Baptist de Wenzel, who was the oculist of King George III, had remarkable skill at removing cataracts and legitimized the field.
- Ernst Abbe is renowned for the development of various optical instruments used in the field of ophthalmology.
- Hermann von Helmholtz invented the ophthalmoscope in 1851.
The first hospital dedicated to the practice of ophthalmics opened in 1805 in London. It still exists, and is known as Moorfields Eye Hospital. Sir Stewart Duke Elder founded the Institute of Ophthalmology there, which made the hospital the largest eye hospital worldwide.
The introduction of the ophthalmoscope in the 19th century brought about a period of consolidation and deepened knowledge of the eye, and treatment of various ocular diseases. This increased the level of precision that was possible in the diagnosis and treatment of ophthalmologic conditions. In particular, the operative treatment of glaucoma was refined at this time, and has helped greatly to improve patient outcomes.
Throughout the 20th century, the investigations in the field of ophthalmology were further expanded. Several subspecialties were introduced to focus on particular areas or diseases of the eye. These include cataract, glaucoma, pediatrics, cornea and oncology subspecializations, among others.
Reviewed by Liji Thomas, MD