Old news in ophthalmology

Abstract

Franz Daxecker studied medicine in Innsbruck, Austria. His special research interests are eye tumours, UV light and the eye, and medical history. He is deputy director of the University Hospital for Ophthalmology and Optometry, Innsbruck. At the turn of the first to the second millennium Arabic ophthalmology was at its zenith. Arab ophthalmologists took their knowledge from Greek, Egyptian, and Indian medicine. One celebrated representative of Arabic medicine, Al-Hazen, was an optician, but he still regarded the lens as the main organ of vision. At the same time in Europe, at the medical school of Salerno (9th-11th century), Constantinus Africanus gained insights during his travels through Islamic countries. In the 13th century the thoughts of Greek authors were reproduced without independent innovations. Of these writers Peter Hispanus was not only an ophthalmologist, he also became Pope John XXI in 1276. The great invention in the Middle Ages was glasses. Roger Bacon mentioned a magnifying glass for reading, but eyeglasses had been used for old-age longsightedness since the 14th century. During this period the most significant insights came from the field of anatomy. Leonardo da Vinci and Andreas Vesalius investigated the anatomy of the eye, and Vesalins described an additional seventh eye muscle, the musculus retractor bulbi. The oculist, surgeon, and wound doctor Georg Bartisch published the first textbook of ophthalmology in 1583 (Augendienst) and included both conservative and operative therapy. Felix Platter (1536-1614) recognised that the lens of the eye is a convex lens, and the mathematicians and astronomers Johann Kepler and Christoph Scheiner showed, at the beginning of the 17th century, that a smaller inverse picture forms on the retina. They also recognised the constriction of the pupil with light and convergence with near sight. At the beginning of the 18th century, Antoine Maitre-Jan discovered that cataract is a cloudy lens and in 1745, Jacques Daviel (1696-1762) developed a technique to completely remove it. Pellier de Quensy further developed David's technique and contributed much to its dissemination. In 1722, Saint Yves published a complete description of eye diseases, including glaucoma. The British ophthalmologists Taylor (1703-72) and Woolhouse (1650-1734) recognised that glaucoma destroys visual sensation. In 1812, the first university department of ophthalmology led by Georg Joseph Beer was founded in Vienna and the Viennese Medical school became famous worldwide. Johann Wolfgang yon Goethe's theory of colour was investigated by the British chemist John Dalton (1766-1844). In 1851 ophthalmology was given a new and important examination tool when Hermann von Helmholtz published a description of the ophthalmoscope. The Dutchman Frans Cornelis Donders (1818-89) wrote a book on anomalies of refraction and accommodation. Albrecht von Graefe was a reformer of ophthalmology and the history of modern ophthalmology began with him. He developed the iridectomy and correctly interpreted the excavation of the optic disk in glaucoma. In 1875 Hardy and Gerard discovered pilocarpine for the treatment of chronic glaucoma. Carl Koller published the first paper on local anaesthesia with cocaine in 1884. Eduard Zirm, in Olmütz, did the first successful corneal transplant. The Swedish ophthalmologist Gullstrand, who invented the slit lamp, was the only ophthalmologist to receive the Nobel Prize for medicine, in 1911, for his work on physical and physiological optics. Julius Gonin from Switzerland wrote a paper about the role of the vitreous body and the retinal tear in development of retinal detachment. His endeavours came to fruition in 1922 after localisation and repair of a retinal defect. In 1932, the discovery of sulphonamides by Domack caused the subsequent decrease of gonococcal conjunctivitis, until then a common cause of blindness. Sulphonamides substituted the Cr6d6- prophylaxis (with silver nitrate). With the development of the concept of sterility by Pasteur surgical treatment options developed further. Granit and Karpe introduced the electrophysiological examination of the retina. Goldman constructed the semicircle perimeter for visual field examinations. In 1946 Meyer-Schwickerath, a German ophthalmologist, invented light coagulation, which later led to laser coagulation for the treatment of retinal defects. Thus, the first use of laser in medicine was in ophthalmology. Harold Ridley, an ophthalmologist from London, implanted the first artificial lens after partial removal of a cataract, but the technique was abandoned in 1959 because of numerous complications. A new generation of lenses were the anterior chamber lenses, frequently complicated by glaucoma and corneal damage. The first breakthrough was the iris-clip lens by Brinkhorst; however, this lens had the disadvantage of subluxation. The invention of the posterior chamber lens followed and implantation techniques became more sophisticated. To bring us up to date, the development of fluorescence angiography and ultrasound have brought more new possibilities in eye examination.