'History is not the past but a map of the past, drawn from a particular point of view, to be useful to the modern traveller'.
- Henry Glassie, US historian (1941)
Ophthalmology is a revolutionary field that has grown leaps and bounds over time. Since ancient times, there has been proof of the practice of ophthalmology. The observations and understanding of the anatomy and physiology of the eye were the paving stones towards several breakthroughs. It is important to understand the past to create an exceptional future. The history of ophthalmology provides insight into the evolution of a field that has made a significant impact on health care.[1,2]
ANCIENT EGYPT: THE EMERGENCE OF OPHTHALMOLOGY
The practice of ophthalmology has been traced back to ancient Babylon. References to eyes were made in the Code of Hammurabi (2250 BC). It was written that if a physician performed eye surgery and saved the eye, he shall receive ten shekels of silver as payment, but any miscarriage of treatment was punished with amputation of the surgeon's hands. Treatment was administered by priests via magical formulas and remedies. Ebers Papyrus, the first ancient written record, was documented in 1550 BC. It contained nine pages dedicated to treating eye diseases.[2,3,4] The most common procedure during this era was found to be epilation, accounting for the frequent discovery of epilation forceps.
ANCIENT GREEK: LAYING DOWN THE ROOTS
During this period, the anatomy of the eye was just mere speculations. This period can be effectively divided into the pre-Hippocratic, Hippocratic and post-Hippocratic eras.
An eminent philosopher cum physician, Alcmaeon of Croton (540–500 BC), was documented as the first to describe the human eye. Along with several other physicians, it was hypothesized that the eye was a two-layered structure. Alcmaeon believed that the eye was attached to the brain via ducts (poroi). He believed that we could see because of elements of fire within the eye.
Then came the medical works of Hippocrates (460–375 BC), which were built on the ideas of Alcmaeon. He composed the Hippocratic Corpus, a collection of his medical works highlighting the prognostic value of eyes in clinical medicine. His description of the eye evolved to a three-layered structure. Further on, Aristotle (384–322 BC) introduced empiricism by dissection of animal eyes and made the description of the optic nerve as a duct connecting the eye to the membranes of the brain.
Then came the Hellenistic era (post-Hippocratic era) following the invasion of Alexander the Great in 330 BC. The first systematic dissection of the human body was done during this era. Herophillus (330–260 BC), a Greek physician, contributed a great deal to further understanding of the eye. It was during this time that clear recognition was given to the structures of the eye.
ANCIENT INDIA: THE SURGICAL ROOTS
Ophthalmology in ancient India was largely contributed by Sushrutha, who is known as the father of Indian ophthalmology. He has documented his findings in Sushruta Samhita, an ancient Sanskrit text on medicine and surgery. It was probably the first documentation of extracapsular cataract extraction using a sharply curved needle to push the cataract away from the field of view. He describes various eye diseases and their symptoms, including cataracts, glaucoma, and inflammation of the eye, along with several surgical procedures.
ANCIENT ROME: EVOLUTION OF OPHTHALMOLOGY
Then came the Roman era. The physicians of the Roman republic were those who came from the Hellenistic era. These Greco-Roman physicians made remarkable progress in redefining surgical instruments and techniques. Celus (25 BC–50 AD) was known as the first physician to create a methodical approach to diseases, as seen in his work De Re Medica. The anatomical discoveries that were made during this period held importance until the Middle Ages.
THE MIDDLE AGES: ARABIAN ERA - THE INCEPTION OF OPTICS
During this period, the majority of the manuscripts on ophthalmology were written in Arabic rather than Latin or Greek. The Arab empire had built its base on Hellenistic medical knowledge. It was when oculists (Kahhal) started to emerge. It was during this time when the scientist Ibn Al-Haytham (965–1040) wrote the Book of Optics (Kitab al-Manazir). This book was known as the optic treasure and contributed greatly to the theory of vision and colour vision. He rejected the extramission theory of light, stating that light did not emit from the eye but from the object.
This era served as the building blocks of European science. During his speech in 1905, Julius Hirschberg mentioned that the Arabs were the ones who fed the lamps of ophthalmology during the total darkness in mediaeval Europe.
EARLY MODERN ERA: THE OPHTHALMIC REVOLUTION
The Renaissance marked the rebirth of science, culture and politics. In this era, George Bartisch (1535–1607) published his comprehensive book on eye diseases and management. He was considered the father of modern ophthalmology. He was the first to perform the enucleation of a cancerous eye on a living patient. Exceptional understanding of the ocular anatomy took place during this time, contributed by Johann Gottfried Zinn, Hippolyte Cloquet and Friedrich Schlemm, whose legacies are reflected in the names of the anatomical structures. Zinn is recognized as the father of ocular anatomy.
MODERN ERA: THE GOLDEN AGE OF OPHTHALMOLOGY
The Golden Age constitutes the early nineteenth century to our current period. Ophthalmology became an explicit area of practice leading to the establishment of the first hospital dedicated to ophthalmology in London in 1805. It came to be known as Moorfields Eye Hospital.
The development of the ophthalmoscope by Herman von Helmholtz in 1851 and the slit-lamp by Allvar Gullstrand in 1911 helped unravel the workings of the inner eye and created a new world of clinical studies.[1,2,12] Gullstrand is the only ophthalmologist who was awarded the Nobel Prize in medicine for his work on optics. International collaborations were forged between Sir William Bowman, Albrecht von Graefe and Fran Donders for further advancements in optics and ophthalmic surgery.
The twentieth century ushered in a period of exponential growth bringing in the first successful retinal detachment surgery (ignipuncture), the first successful laser application in medicine and the golden era of cataract surgery. The contributions of Sir Harold Ridley and Charles Kelman shook up the essence of cataract surgery and paved the way for it to be the marvel it is today.
The history that we know has paved the way for quantum leaps in technological developments. Still, to date, new technology and techniques keep popping up, bringing in a new understanding of that which we already know and that which is hidden from us. Thus, it is important to contemplate the role of history in this ever-advancing field of medicine.
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