A Tribute to Ophthalmology

Every profession has its moment of reflection. For doctors, that moment comes every year on Doctors’ Day. This day is not merely about accepting gratitude. It is about acknowledging a legacy, revisiting purpose, and remembering the journey we have taken, both individually and collectively.

Doctor’s Day

As an ophthalmologist, I often find that the most poetic part of my work is dealing with light, the very thing that lets us see. The human eye, with its fragile anatomy and symbolism, has always stood as a metaphor for insight, clarity, and truth. To heal the eye is not just to restore sight; it is to offer someone the world again. To return colour, independence, dignity, and connection.

And so, this Doctors’ Day, I turn not just to the present but to the long arc of history, of medicine, of science, and of the extraordinary evolution of ophthalmology. I honour those who paved the path before us and reflect on what it means to serve through the lens of this exquisite specialty.

The First Healers: Ophthalmology in Antiquity

Sushrut performs couching

Medicine is as old as human suffering. The earliest mentions of ophthalmic care date back to ancient Egypt. Doctors documented eye diseases in the Ebers Papyrus (circa 1550 BCE). Many of the conditions described are recognizable today, like conjunctivitis, trachoma, and cataracts. Even if their treatments were laced with incantations and animal-derived salves, they laid the groundwork for future practices.

In India, the Ayurvedic texts like the Sushruta Samhita laid the foundation for a more structured approach. Sushruta, often called the father of Indian surgery, described more than 70 ocular diseases. He even performed couching for cataracts, a technique that, in a crude way, preceded modern extracapsular extraction. It is astonishing to consider that such surgical endeavours were attempted without modern anaesthesia, sterile technique, or instruments.

Hippocrates writing the Hippocratic Oath

The Greeks added theory. Hippocrates, and later Galen, emphasised the role of the brain in perception. They introduced the idea of the four humours — an early, if erroneous, attempt to understand disease systematically. The Arabs preserved and expanded this knowledge during Europe’s Dark Ages. Luminaries like Ibn al-Haytham (Alhazen) wrote foundational texts on optics and vision. These works would influence science for centuries.

The eye, in these eras, was seen with both reverence and fear. It was an organ of mystery, often considered a window to the soul. Its diseases were among the most dreaded, especially in cultures where visual artistry, literature, or religious study held central importance.

The Age of Anatomy and Optics

The Renaissance brought with it curiosity. Anatomy exploded as a science, with dissection replacing dogma. Andreas Vesalius and others corrected long-standing misconceptions, including those about the eye's structure.

Andreas Vesalius

The invention of the microscope in the 17th century by Antonie van Leeuwenhoek revolutionised our ability to look inward. Suddenly, ocular tissues were no longer just masses but cellular structures.

At the same time, physics marched alongside biology. The study of optics, buoyed by thinkers like Isaac Newton, Johannes Kepler, and later Hermann von Helmholtz, unlocked the rules of light, refraction, accommodation, and the mechanics of vision. It is difficult to overstate how much this intermingling of physics and medicine shaped ophthalmology as a uniquely interdisciplinary field.

In 1851, Helmholtz invented the ophthalmoscope. This simple yet radical device allowed direct visualisation of the retina. It was not just an ophthalmic leap; it was a revolution in internal medicine. For the first time, doctors could look inside the human body non-invasively. The fundus of the eye became a canvas for systemic disease: hypertension, diabetes, infectious disease, and neurological disorders could now be glimpsed through the pupil.

Ophthalmology had found its lens — not just to examine the eye, but to study the body.

From Couching to Clarity: The Rise of Surgical Ophthalmology

The 19th and 20th centuries witnessed the flowering of ophthalmology as a surgical science. As anaesthesia and antisepsis took root in medicine, so did the ability to operate on the eye with increasing safety and precision.

Cataract surgery, once a brutal endeavour of displacement without extraction, was transformed. By the mid-20th century, intracapsular cataract extraction (ICCE) and later extracapsular extraction (ECCE) became standardised. The idea of implanting an artificial lens, championed by Sir Harold Ridley in the 1940s, was initially met with ridicule. He observed inert plastic fragments in pilots’ eyes during World War II.

Sir Harold Ridley

Today, intraocular lens (IOL) implantation is one of the most common procedures globally. Corneal transplantation, once a dream, became a reality with the first successful human graft by Eduard Zirm in 1905. Glaucoma, long a cause of blindness, was gradually demystified through improved tonometry, visual field testing, and surgical advances like trabeculectomy. Diseases of the retina became treatable thanks to innovations like indirect ophthalmoscopy, retinal cryotherapy, and eventually vitrectomy, pioneered by Robert Machemer. Retinal detachment, diabetic retinopathy, and macular degeneration were no longer automatic sentences of blindness.

The invention of the slit lamp, gonioscope, specular microscope, perimeter, fundus angiograph, slit lamp biomicroscope, pachymeter, specular microscope, ocular ultrasound, biometer, and later optical coherence tomography (OCT) reshaped how we examine the eye.

We no longer guess — we see, we scan, we measure.

The Era of Lasers and Light

The second half of the 20th century saw the rise of photocoagulation, a technique that used lasers to treat retinal vascular disorders. The argon laser, YAG laser, and later femtosecond laser became tools of versatility. No longer were lasers confined to science fiction in ophthalmology; they became scalpels.

Eye Laser

LASIK surgery, introduced in the 1990s, forever changed the landscape of refractive surgery. Suddenly, millions could wake up and see the clock. Meanwhile, the rise of anti-VEGF agents like ranibizumab, bevacizumab, and aflibercept ushered in a new era in retinal disease. Diseases that previously caused irreversible blindness could now be treated with a well-timed injection.

As imaging matured, our understanding deepened. OCT angiography, ultra-widefield imaging, and adaptive optics are not just tools but extensions of the human eye, capable of seeing things our natural vision never could.

A New Century, A New Vision

We now live in an age of unimaginable sophistication. Surgeries are performed through 1 mm incisions, with image-guided lasers, 3D heads-up displays, and robotic assistance. AI algorithms are helping detect diabetic retinopathy with more accuracy than junior doctors. Genomic therapies, once science fiction, are now available for rare inherited retinal dystrophies. The bionic eye is no longer fantasy.

But perhaps what has changed the most is not the tools — it is the philosophy. We work within systems that are often broken, burdened, and bureaucratic. Yet, we try to uphold the sanctity of a few minutes spent in truth and compassion. We balance the expectations of science, commerce, and care. We carry the burden of outcomes but also the grace of trust. To be an ophthalmologist today is to be a custodian of clarity; visual, ethical, and emotional.

A Personal Reflection

There is something deeply humbling about looking into someone’s eye. Perhaps it is because it is the only organ where we can see living tissue directly, without incision. The retina pulsates, the blood vessels shimmer, and the optic nerve stands sentinel. It reminds me daily that life is a visible miracle.

Happy patient

On Doctors’ Day, I think not of accolades or titles but of my first cataract patient. Their joy after surgery made me understand the weight of this profession. I think of patients who came too late, whose vision I could not save, and how they taught me grace, resilience, and the limits of our knowledge. I think of mentors who taught me not just technique but temperament. Of nurses who ensured that our hands were safe. Of technicians who stood with us in late-night emergencies. Of residents who question, challenge, and inspire. And most of all, I think of the millions of patients; each eye a story, each visit a privilege. There is so much to learn, ladies and gentlemen.