The ophthalmologist is the most qualified among health care professionals to diagnose and comprehensively treat disorders of the eye, adnexae, and visual system, as well as to recognize and appropriately manage any associated systemic disease. Training for ophthalmologists consists of an undergraduate degree in science and the humanities, a medical degree from an accredited four-year medical school or school of osteopathy, and a minimum of four years of postgraduate training, at least one year of which is applied to general medical disciplines. Three or more of these years are spent in specialized training in the art and science of ophthalmology—a specialized discipline of caring for the eyes and the visual system based on medical principles. Comprehensive medical training and experience permit and foster recognition of the spectrum of normal physical variation, understanding of normal physiologic and pathophysiologic reactions (including cause-and-effect relationships), knowledge of the boundaries of medical science, the judgment to apply accumulated wisdom appropriately, and the humanity to attend with honesty and empathy.
Medical conditions affecting the eye require a comprehensive understanding of medical diagnostic and therapeutic principles. Systemic diseases of particular concern include those revealed by the eye, those whose management and course may affect the eye, and conversely, those potentially affected by the management of ocular disease. Hypertension and diabetes mellitus are two examples of many conditions that are revealed by the eye. They may be observed in the eye and the eye may be affected by their treatment. Specifically, hypertensive retinal vascular changes require monitoring and appropriate and timely diagnostic evaluations, and medical and surgical treatments may be required to preserve sight in patients suffering from diabetes mellitus. The management of glaucoma illustrates how treatment of ocular disease can have systemic effects. Various medications are used in the treatment of glaucoma, including beta blocking agents, carbonic anhydrase inhibitors, and sulfa compounds. Among the many potential adverse systemic effects of these agents are respiratory depression, cardiac failure, impotence, blood electrolyte imbalance, profound anemia, kidney stones, psychiatric and emotional changes, severe fatigue, and death. In addition, there are risks associated with anesthesia.
The spectrum of ophthalmologic disease includes such complex medical conditions as uveitis, glaucoma, degenerative retinal disease, infectious disease, ocular and adnexal tumors, neuro ophthalmic syndromes including central nervous system tumors and vascular disease (stroke), congenital anomalies and pediatric disorders including strabismus, and genetic syndromes. Structures around the eye including the lids, tear drainage system, orbit (eye socket), and sinuses are also affected by conditions that the ophthalmologist is uniquely qualified to manage. Although other professionals may observe and document signs and symptoms of complicated medical ophthalmic disease, only the qualified ophthalmologist is best prepared to comprehensively evaluate, promptly diagnose, and appropriately manage these conditions.
Management of surgical ophthalmic conditions require special competence. Ophthalmic surgical procedures alter, remove, replace, and/or reshape ocular and adnexal tissue for beneficial therapeutic effect by the use of instruments and other applied physical forces (e.g., laser). Qualified ophthalmologists apply the comprehensive understanding of ophthalmic and systemic disease and trauma that they gained through education and experience to surgical endeavors. This subsumes thorough examination; appropriate diagnostic testing and interpretation; surgical judgment (including avoidance of unnecessary procedures and complications); and understanding of the natural history of disease, potential risks, and treatment options. Further, the ophthalmologist possesses surgical skill; understands the evolution of the healing process; and diagnoses, monitors, and manages complications in an appropriate and timely manner. Ophthalmologists' surgical care encompasses the preoperative and postoperative periods—times when the patient is at risk from all aspects of the procedure. These attributes set a standard for special competence in ophthalmic surgery.
The unique competence of ophthalmologists is broadly based on medical knowledge, judgment, communication skills, professionalism, and tradition, and ophthalmologists consistently apply their competence using their ophthalmologic medical and surgical skills. This competence is amplified by elevated medical standards, continuity of caring, commitment to comprehensive and lifelong education, and humanitarian concern for patient welfare.
Approved by: Ethics Committee, February 1987
Revised & Approved by: Ethics Committee, February 1992
Revised & Approved by: Ethics Committee, June 2004
Revised & Approved by: Ethics Committee, July 2008
Revised & Approved by: Ethics Committee, June 2013
Revised & Approved by: Ethics Committee, July 2018
©2018 American Academy of Ophthalmology®
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