Specializing In Two Tiny Organs

The eye and its supporting cast make up perhaps the most highly specialized and complicated organ system in existence. Approximately 35% of all the sensory input into the brain is made up by the left and right optic nerve, and roughly 65% of all intracranial disease processes have ophthalmologic manifestations.1 A




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plethora of systemic disease processes, therefore, can affect the eye, each in several ways and by different mechanisms.

One of the most important things for medical students to determine when considering ophthalmology as a career is whether or not they would be happy specializing in only one region of the body. This is not to say that there are not vast arrays of disease processes that have ophthalmic manifestations; in fact quite the opposite is true. Rather, the examination skills, diagnostic tools and surgical procedures you learn and use as an ophthalmologist involve a small area of the body and one highly specialized organ system.

Unlike in surgical specialties, the ophthalmologists' surgical field is typically measured in millimeters. The lids and skin surrounding the eye and orbit, the eye itself from the cornea back to the optic nerve, orbits with their bone, vascular, sinus, lymphatic and neural components, and the central nervous system components of vision make up the world of the ophthalmologist. You will become an expert specialist in one particular system and know that structure inside and out. But do not think that it is easy to master the body of knowledge for these two small structures. There is an immense body of knowledge to be learned about the eye.

Ophthalmologists treat a wide range of disorders of the eye. Some of the more common conditions include cataracts (a disorder of lens clarity), glaucoma (a problem of increased intraocular pressure), conjunctivitis (inflammation of the conjunctiva, usually due to infection), and macular degeneration (progressive blindness). For such seemingly small structures, a large number of diseases can affect the eye. Any type of infection — from gonorrhea to herpes—is fair game. Ophthalmologists also deal with all kinds of trauma to the eye, whether it involves the orbit (in which the eye is located) or the eye itself. They operate on detached retinas. They resect intraocular tumors like retinoblastoma if found in time. They treat disorders of the extraocular muscles like strabismus. Even problems of the eyelid, eyelashes, and lacrimal (tear) glands fall under the domain of the ophthalmologist.

To be a good ophthalmologist, you need a solid foundation in general medicine. Many ocular disorders are manifestations of underlying systemic disease, congenital or chromosomal disorders, metabolic defects, connective tissue diseases, diabetes, and hypertension — the list goes on. You will not just find elderly patients with cataracts or glaucoma in an ophthalmologist's office. There will also be patients with inflammatory bowel disease, Grave disease (hyperthyroidism), AIDS, brain tumors, and Bell palsy—all of whom have problems involving the eye. Uveitis (inflammation of the iris, ciliary body, and choroid), for instance, is a common ocular presentation of lupus, Crohn disease, and juvenile rheumatoid arthritis. Like dermatologists, who have to know the skin manifestations of underlying diseases, ophthalmologists require a good understanding of the pathophysiology of these primary disorders. Although the eye condition may at times be secondary, these specialists must maintain their general medical and surgical knowledge across a broad range of disorders. This is a recurrent theme within this specialty.

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