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ophthalmology: transition
Why transition? Because I think I have lived through what
I would define as the end of an era and the transition to
our current times. The transition has consisted in coming
from the multi-faceted ophthalmologist –the one practising
the whole of the specialty: means for diagnosis, medical and/or
surgical treatments- to the univalent ophthalmologist –who,
keeping up with the ever-increasing complexity of the specialty,
performs only a distinct part of ophthalmology.
I began in Ophthalmology by mid-20th century. The education
received in the Faculty of Medicine regarding the subject
for this specialty, was far from enough to consider myself
able to practice it, even though the teacher, D. Mariano Soria,
was an excellent ophthalmologist and knew how to teach. It
was necessary, therefore, to broaden and practice the received
knowledge under the supervision of a good teacher and within
an institution allowing it. I was lucky that the Head of the
Service of Ophthalmology of Santa Creu and Sant Pau’s
Hospital was then an uncle of mine, Dr. F. Bordàs.
He and his collaborators in the Service were my teachers.
There, I acquired the required education to start practicing
the specialty by early 1950s, until the period noted as the
multi-faceted ophthalmologist’s. In fact, ophthalmology,
established as a university discipline in the beginning of
the 20th century, had become reduced to a theoretical and
generalist subject, becoming necessary to round off through
practical extra-university training. Once this theoretical
and practical training had been completed, the ophthalmologist
was better off to solve a variety of situations coming up
in daily practice. Thus, it was necessary to do everything:
sight recovery (sight testing, orthoptics, etc) diagnose with
a terrifying shortage of means, medical treatments with an
extremely reduced range of medicines, surgery often conditioned
by the above mentioned problems for preliminary diagnosis
as well as by yet poorly updated equipment.
The transition to the univalent ophthalmologist was due to
the development of new technical instruments along the 1950s
and the 1960s, such as: new diagnosis means –ElectroRetinoGram
(ERG), Scanner, Retinal Angio-Fluoresceingraphy (AFGR)-, new
pharmacological treatments –antibiotics, ocular hypotensors,
etc-, improvements in surgical practice –cryosurgery,
laser, etc- and new elements for sight recovery –precorneal
lenses, intraocular lenses, etc. This complexity, due to technological
changes, had exceeded the possibility for a single physician
to undertake everything satisfactorily.
Thus, for the patients’ benefit, there are nowadays
retina specialists, glaucoma specialists, etc, without detriment
for these specialists’ knowledge of the whole discipline
of ophthalmology. What is kept in the future for tomorrow’s
ophthalmologists?
Dr. Enric Mateu Bordàs
Ophthalmologist
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