Problems in Ophthalmology

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You explain to the patient that his poor vision is age related and that there are no surgical or medical interventions which can correct this problem. He tells you that he will find an ophthalmologist who can help him. What should you do? Different people will give different answers to this question.


Some will say you should counsel the patient and his family but make sure that his license to operate a motor vehicle is revoked. Still others will say that the easiest thing to do would be to refer him to another physician and let that be the end of it. Whenever we ask such a question, particularly with respect to the welfare and rights of others, we are asking an ethical question.

This chapter examines the nature and scope of ethics as it relates to the practice of ophthalmology, and will do so through an examination of realistic clinical situations, the sort described above. We begin with a brief discussion of the field of ethics and its relationship to clinical ophthalmology. Ethics is the systematic study of what is right and good with respect to conduct and character.

As a branch of both philosophy and theology, ethics seeks to answer two fundamental questions: 1 should we do? As an intellectual discipline, ethics is concerned not only with making appropriate decisions about what we ought to do, but with justifying those decisions. Thus, unlike other forums for the discussion of moral issues e.

In fact, it is the attempt to justify our actions that gives ethics its distinctive character. Medical ethics is an application of ethical rules and principles to the practice of medicine. To ask what a physician should do in a particular case is to ask an ethical question, and to justify our answer we appeal to the same rules and principles that apply to persons in society generally. However, sometimes health care professionals are ethically required to assume risks not shared by laypersons, such as caring for persons with acquired immunodeficiency syndrome AIDS.

To understand why this is, it is helpful to examine what it means to be a physician, and how medicine differs from other sorts of occupations. Unlike members of other kinds of practices business, for example , the physician places the interests of others above her or his own interests. Indeed, this feature of medicine is one of the defining characteristics of the health care professions in general. Every encounter between a physician and a patient implicitly raises ethical issues, because a physician may—and indeed must—ask questions about how the welfare of the patient should be promoted.

  1. References.
  2. Fastest Otolaryngology & Ophthalmology Insight Engine.
  3. Ophthalmology;

Although every encounter between physician and patient raises ethical issues, these issues are not necessarily ethical or. A situation in which two or more choices are morally justifiable, but only one is capable of being acted on at a particular time, represents a moral dilemma.

Glaucoma Surgery

No moral dilemma exists when a patient provides an informed consent to have cataract surgery, but the situation raises a moral issue , namely, whether the physician ought to act in the best interests of the patient and perform the surgery. Moral issues are unavoidable in ophthalmology because of the nature of professions in general and ophthalmology in particular. To ask what one should do as a physician is often to ask a legal question as well, but it is incorrect to reduce the question to a matter for the legislature or the courts to resolve.

There is also a challenge to integrate eye disease into mainstream developments in systemic disorders and neurodegeneration, which I believe will be important both to understand fully the pathogenesis of many conditions but also to develop new models of healthcare that will serve the aging population.

The list of scientific challenges is very long! I am sure that the next 10 years will see huge advances in the understanding of how we see and the exploitation of that knowledge in the next generation of machine vision initiatives. We need to understand much more about the interplay of the vasculature, immune mechanisms and cell death in age-related macular degeneration and diabetic retinopathy. What would be you advice for Young Researchers and Clinicians in the field to advance their career prospects?

If this is abroad then even better. Proper training will give you those bases that will stay with you for the rest of your life and will be the key to advance in your career. So don't be shy about your future, go the best places and work very hard! As they are young and well-qualified ophthalmologists I encourage them to travel and to practice in different European countries, to move towards hospitals and research centres providing surgical facilities as well as facilitating housing and support for young ophthalmologists.

Fortunately, the mentality within clinical medicine in Europe has changed since I was a medical resident. The barrier between academic and private institutions is weakening in the sense that more private institutions are engaging in research activities. Personally, I switched from basic retinal to clinical corneal research after ten years and then later performed research in a private setting. Both of these decisions were unconventional, but the only thing that matters now was the quality of the research. And, I believe that I would not be at the position I am today if I did not take these chances with my career.

Modern Problems in Ophthalmology

The most important thing is to pursue something that holds fascination and that you can be passionate about. Where possible and this is not essential there is much to be said for working in a high quality labs in stimulating environments.

It is critical to read and think widely. Great advances often flow from bringing together diverse ideas. Also consider taking an eye problem to a relevant outstanding lab with no experience in eye disease. It is critical to pay attention to developing creativity as well as an ability to execute experiments with the best possible scientific rigor. Creativity extends to asking the right questions as well as finding novel ways of seeking the answers. I do worry that the current environment can get too earnest and intense. Not good ingredients for creativity so work on ways of enhancing these skills too.

Francesco Bandello , Milano, Italy. Farhad Hafezi , Geneva, Switzerland. Phil Luthert, London, United Kingdom. Marius Ueffing , Tuebingen, Germany. Question Alberto Auricchio Gene therapy of inherited retinal degeneration due to mutations in genes expressed in photoreceptor cells. Biomarkers in AMD. Biobank of Vitreous Body. Correlation between systemic and ophthalmic vascular diseases. Medical robotics computer- robot-assisted systems, virtual reality and bioengineering image processing, process automation, etc. Phil Luthert For me a key issue is to find new ways of integrating the huge amount of data now available to drive the next level of understanding of pathogenesis particularly in retinal disease and to help inform clinical decision-making in ophthalmology.

Marius Ueffing To investigate pathomechanisms for retinal degenerations on a systemic level using experimental as well as computational strategies. Alberto Auricchio The possibility to answer very important scientific questions and, by overcoming major scientific challenges, to provide benefit to patients with blinding conditions. Francesco Bandello to encourage the creation of health networks oriented toward preventive medicine with the help of telemedicine and mobile ophthalmic units to ensure an available and transparent system for the patient, to provide ethical care free from conflict of interest, to create an efficient prevention strategy within a coherent public health system to improve early diagnosis of glaucoma, diabetic retinopathy, age-related macular degeneration, and child amblyopia.

In many cases, the power of suggestion can be key to treatment. Instead, they look for any clues that will help them to convince you of their feigned illness. Every doctor likely has their own way of dealing with these patients; some physicians have quite broad philosophical differences on the topic, while others only differ in the terms they use.

The first step is to introduce the topic. Explain, in a non-judgmental way, that you believe the problem is not physiological. Use phrases like:. Next comes the explanation, which is key to the process.

Ophthalmology Services at Animal Referral Center Fox Valley & Green Bay

I start with something like this:. You were legally blind in that eye after what happened the splash, or the hit on the head. How scary that must have been for you!

What if it just never goes away? Meanwhile, your vision has improved, and the problem has gone away. But now, your brain is not letting the vision in. You can use your own terms and explain it in your own way; the crucial aspect is that it must be non-judgmental. Finally, you offer the patient a prediction on how their vision will improve. For example, I might tell them that their vision will improve every day, clearing from the outside to the center. Why are you ordering another test, if my vision is fine?

But this is finished.