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Unique Competence of the Ophthalmologist (2004)
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Unique Competence of the Ophthalmologist
The ophthalmologist is the most qualified among practitioners to diagnose and treat disorders of the eye, adnexae, and visual system, as well as to recognize and appropriately manage their association with systemic disease. Currently approved training for ophthalmologists consists of undergraduate education in science and humanities, graduation from an accredited four year medical school, and a minimum of four post graduate years of 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/effect relationships), knowledge of the boundaries of medical science, judgment to apply accumulated wisdom appropriately, and 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 management of ocular disease. The former relationship is exemplified by two of many conditions: hypertension and diabetes mellitus. These conditions may be observed in the eye and the eye affected by their treatment. Specifically, hypertensive retinal vascular changes require monitoring and appropriate and timely diagnostic evaluations, and laser treatments and other surgical intervention may be required to preserve sight in those suffering from diabetes mellitus. Glaucoma management illustrates the systemic effects of treatment of ocular disease. Various medications are used in the treatment of glaucoma including beta blocking agents, carbonic anhydrase inhibitors, and sulfur compounds. Among the many potential adverse systemic effects of these agents are respiratory depression, cardiac failure, impotence, blood electrolyte imbalance, profound anemia, kidney stones, psychic and emotional changes, severe fatigue, risks with anesthesia and death.
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 strabismus, central nervous system tumors and vascular disease (stroke), congenital anomalies and disorders, and genetic syndromes. While others may observe and document signs and symptoms of complicated medical ophthalmic disease, only the qualified ophthalmologist will comprehensively evaluate, promptly diagnose and appropriately manage these conditions.
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). Through education and experience, qualified ophthalmologists apply to surgical endeavors comprehensive understanding of ophthalmic and systemic disease and trauma. 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 are subsumed. 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' operative care encompasses the preoperative and postoperative periods, those 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 in medical tradition, knowledge, judgment, professionalism, and clinical and communication skills and is consistently applied through ophthalmologic medical and surgical skill. This competence is amplified by elevated medical standards, continuity of caring, comprehensive and continuing education, and humanitarian concern for patient welfare. Maintenance of this competence is achieved through lifelong learning. The qualified ophthalmologist brings singular expertise to bear on disease by fusion of comprehensive medical and ophthalmologic capacity, i.e., their unique competence.
Approved by: Ethics Committee, February 1987
Revised & Approved by: Ethics Committee, February 1992
Revised & Approved by: Secretariat for Ophthalmic Practice, June 2004