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Department of Ophthalmology

 

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Ophthalmology | About the Division

 

 

History of Ophthalmology

The Expanding Frontier

As America prepared for its centennial celebration in 1876, life in these United States was changing in ways entirely unforeseen. Nowhere was this change more evident than in the practice of medicine. The rising population was spreading out across the frontier. Medical care was provided largely by physicians with minimal training. A few had been to sophisticated centers in Europe. Everywhere there was perceived a need for better medical education and even specialization.

This was especially true in Ophthalmology. A number of prominent surgeons had been doing surgery on the eyes, but they divided their interests and never devoted enough time or attention to the subject. This was about to change.

Early Advances in Ophthalmology

 

In 1854, a Viennese scientist, Hermann von Helmholtz had invented the ophthalmoscope, making possible direct visualization of the interior of the eye. Its use proved to be difficult and time-consuming, and general surgeons seldom had the patience for it. The ability to master its intricacies by a patient few made possible the early creation of a new specialty.

Frans Cornelius Donders, Professor in Utrecht had published an historic document on the refraction and accommodation of the eye, a complex subject that appealed to the new specialists. The complex optical characteristics of the eye became the basis for the new specialists.

Albrecht Von Graefe had described the "curative Effects of Iridectomy in Glaucoma" together with many other entities in clinical ophthalmology. Most of his observations were of enormous importance to the new ophthalmologists.

Ophthalmology Becomes a Specialty

With these startling advances, Ophthalmology seemed to be on its way. Academic recognition of the new specialists became the order of the day and University of Pennsylvania doctors would play a large role. The American Ophthalmological Society was founded in 1864 by a group in New York. Academic Chairs were established at Miami Medical College in Cincinnati in 1860, at Bellevue Medical College in1868, and at Harvard Medical College in 1871.

Philadelphia Takes the Lead Under William F. Norris

In Philadelphia William Fisher Norris and George C. Strawbridge, both graduates of the Medical School of the University of Pennsylvania returned in 1870 from several years in Europe where they had studied in the eye clinics of Vienna and most of the other European capitols. Both had become familiar with the newly invented ophthalmoscope, and Strawbridge had taken a course with Donders. Norris had purchased the original drawings from von Jaeger's famous Atlas of Diseases of the Ocular Fundus. Upon their return, both were appointed as lecturers in Ophthalmology at the University of Pennsylvania. Four Years later, Norris was elected as the first Professor of Diseases of the Eye at the University of Pennsylvania. This was the fourth such appointment made in the United States.

Norris was an excellent choice. He had been diligent in his studies and was a good teacher. Medical education was a primary concern among the other members of the faculty at the University of Pennsylvania as well as at other centers in America. At Penn, Dean William Pepper and William Norris were prime movers in the creation of a University-owned hospital built primarily for education of medical students, a first of its kind. The 146-bed facility began admitting patients on June 4, 1874. Eye patients were admitted and a clinic was established in the basement.

Secure with the support of the University, and with the knowledge that he was as well prepared for the task as anyone in the country, Norris set about building a department and joining others in establishing an academic network which would be prepared to coordinate the changes in the practice of Ophthalmology that new technologies and new discoveries would make necessary. Leaders in the field were challenged to make use of new information being revealed nearly every day. At the University of Pennsylvania, interest in the new images being seen through the ophthalmoscope were discussed in depth, and the practical use of the Donders revelations stimulated a wide interest in refraction in management of ocular complaints.

Norris invited George A. Piersol to join the department while he was still a medical student. The Professor had read the graduation thesis written by young Piersol, entitled Microscopical Anatomy of the Cornea. Piersol accepted the invitation. Ultimately he was elected to the Chair of Anatomy and became one of the most distinguished anatomists of his time. He was most famous for his textbooks on Anatomy and Histology.

Norris also was involved in the writing of textbooks. In 1895, a chapter on "Medical Ophthalmology" appeared in Dr. William Pepper's System of Medicine. In 1892, Textbook of Ophthalmology, written by Norris with his former student and associate Charles Oliver was published and was widely used. In 1896, the same two authors combined to produce a four volume System of Diseases of the Eye. More than sixty prominent authorities were asked to contribute.

One of the most significant contributions by members of the ophthalmic faculty was in the field of refractive errors. S. Weir Mitchell, a neurologist, backed by the work of Risley and others, was convinced that some kinds of headaches were the result of eyestrain caused by refractive errors. Led by Sam Risley, the ophthalmologists, using careful refractive methods were able to provide precisely accurate measurements and were thus able to relieve many visual symptoms.

The de Schweinitz Years

Following the unexpected death of William F. Norris in November of 1901, the University of Pennsylvania Trustees acted quickly on the advice of S. Weir Mitchell, and elected George E. de Schweinitz to become the second holder of the chair in Ophthalmology. A native of Pennsylvania and a graduate of the Perelman School of Medicine, de Schweinitz was an ideal choice. He was a scholarly sort, tall and an impressive speaker. He was never married, but was handsome and was widely admired by the ladies.

The fledgling specialty of Ophthalmology was in need of leadership. De Schweinitz was an uncommonly visible leader. At home, he was very active, making the department one of the strongest anywhere. Under his leadership, the eye dispensary and ophthalmic pathology laboratory were renovated and enlarged, and an operating room for eye surgery was created in the Agnew Wing. Nationally, he was active in efforts to establish standards for ophthalmic care. De Schweinitz was a leader in the 1917 founding of the American Board of Ophthalmic Examination (renamed the American Board of Ophthalmology), the nation's first certifying board. It is worthy of note that Dr. de Schweinitz was the first and only ophthalmologist to hold the office of President of the American Medical Association. He also carried on a large private practice. Among the prominent patients who sought his advice was President Woodrow Wilson.

Education Becomes a Priority

In 1916, the University of Pennsylvania organized the Graduate School of Medicine. There, Thomas B. Holloway, M.D., who would succeed de Schweinitz as department chair (1924-1936), created a first rate program offering specialized training in ophthalmology. Under Holloway's leadership, a slit lamp microscope was installed in the eye dispensary making it possible to examine minute changes in the anterior segment of the eye, and a laboratory of perimetry was established for visual field testing.

Ophthalmology Residency Established Under Adler

In the early part of the twentieth century, ophthalmologists began to recognize the great importance of the basic sciences in the practical management of ocular disease. Members of the faculty at Penn were leaders in this direction. In 1905, under the tutelage of Edward T. Reichert, M.D., Professor of Physiology, Penn medical students began laboratory exercises in physiological and physical optics.

The recognition by leaders in Ophthalmology of the importance of the basic sciences in the further development of the specialty led to the appointment of Francis Heed Adler as the next Chairman in 1936. He had previously studied physiology under Merkel Jacobs, Ph.D. and had taught physiology in the School of Medicine. He had published the first textbook in the English language on the physiology of the eye. As chair, he brought the basic sciences to ophthalmology at the University of Pennsylvania and re established a laboratory of ophthalmic pathology. He also started the residency program for graduate training in ophthalmology, selecting Harold G. Scheie, M.D., as his first resident.

Francis Adler was one of the most popular academic leaders in ophthalmology. He was a great teacher and mentor for generations of residents. He published a new book on Clinical Physiology in 1949, which was so well written it became a standard and was republished in countless editions over the years. He also wrote a textbook for medical students, also a legend with many revisions.

Adler was devoted to basic sciences and to education. He served many years on the American Board of Ophthalmology, as a member, chair, and legendary secretary. Many of the candidates for the Board are grateful to Dr. Adler for his acts of kindness during a stressful time.

Dr. Scheie | About: HistoryHarold G. Scheie Creates an Institute

Harold G. Scheie succeeded Adler as head of the Department in 1960. Clinical Research and the residency program flourished under Scheie, who created an elective five-year training program that permitted residents two years of research and advanced study in related basic sciences. In the 1960's, members of the Department contributed to the ophthalmic literature on topics including the aspirations of congenital or soft cataracts, glaucoma surgery, treatment of hyphema (bleeding into the chamber of the eye in front of the iris), and the description of Hurler's disease (gargoylism). As an investigator/clinician, Scheie pioneered an understanding of acute glaucoma and rational method of treatment for it based largely on anatomic and physiologic principles. He was a leader in the management of infantile glaucoma and will be remembered for his many contributions to ophthalmic surgery.

By the late 1960's, the Department of Ophthalmology had outgrown its clinical and laboratory facilities at HUP. At the same time, the development of subspecialties within ophthalmology required more equipment and more space. Through the private fundraising efforts of Scheie, a new six-story, 72-bed facility opened in 1972. Many of the donors had been students of the mentor for whom the building ultimately was named.

Scheie Eye Building | About: History

The Yanoff Years

Within the round walls of the Scheie Eye Institute, the next leader of the Department, Myron Yanoff, M.D., fostered the growth of subspecialties envisioned by Scheie. During his chairmanship (1978-1986), he established a retina service, a cornea service, a glaucoma service and an oculoplastic surgery service, all of which were designed to offer cutting-edge patient care and to train the country's finest ophthalmologists.

Stuart L. Fine Tackles Major Problems in Ophthalmology

In 1991 Stuart L. Fine, M.D. came from the Wilmer Eye Institute of the Johns Hopkins University to become the seventh chair of Penn's Department of Ophthalmology. He brought with him a keen interest in public health and epidemiology, which he has made a focus of the department as it moves into the 21st century. One result of this new direction occurred in 1994 with the creation of the Center for Preventive Ophthalmology, Biostatistics and Epidemiology, and the appointment of a full-time director, Maureen Maguire, Ph.D. This Center has orchestrated a community outreach program to bring eye care to medically underserved people, as well as a program to mentor student and faculty research programs. The strong influence of Dr. Maguire and others in her center on investigation in the department is always visible.

The Department also has shifted some of its research resources toward molecular medicine (genetics) in response to the growing awareness of the role of heredity in determining our destiny. The establishment of the F. M. Kirby Center for Molecular Ophthalmology has made it possible for molecular geneticists to investigate the genetic causes of important eye conditions including cataract, myopia, macular degeneration and other retinal degenerations that might be treated some day with gene therapy. Evidence for success of the department's research enterprise is the fact that it is one of the top five in the nation in funding by the National Eye Institute and the leading recipient of the eye research funds in the Delaware Valley.

Joan M. O'Brien Becomes the Eighth Chair of the Department

In 2010, Joan M. O’Brien moved across the country to become the eighth chair of the Department of Ophthalmology.  She previously served as Professor and Vice Chair of Ophthalmology and Director of the Ocular Oncology Division at the University of California at San Francisco from 1995-2009.

Dr. O’Brien received her medical degree from Dartmouth Medical School in 1986.  She completed an internship in Internal Medicine at Beth Israel Hospital in Boston in 1987, followed by research fellowships in Immunology and Ophthalmic Pathology from 1987-1989.  Dr. O'Brien subsequently completed a residency in ophthalmology at Massachusetts Eye and Ear Infirmary in 1992 and a fellowship in ocular oncology at the University of California at San Francisco in 1993.

Dr. O’Brien specializes in the treatment of ocular tumors, including retinoblastoma, ocular melanoma, conjunctival malignancies, ocular metastases, and ocular and CNS lymphoma.  Her research focuses on the genetics of eye disease, including retinoblastoma, melanoma, and glaucoma.  Dr. O’Brien and her laboratory are currently conducting a large-scale study on the genetics of glaucoma in African Americans, who are four to five times more likely to be affected by this disease.  Her research is supported by the National Eye Institute and the National Cancer Institute. 

With nearly 200 publications in her field, Dr. O’Brien’s research has recently appeared in Nature, New England Journal of Medicine, Journal of the American Medical Association, and Journal of Clinical Investigation.  She has received numerous honors, including a Young Investigator Award and Physician-Scientist Award from Research to Prevent Blindness, a Career Development Award from the American Association for Cancer Research, and an Honor Award and Senior Achievement Award from the American Academy of Ophthalmology.  In 2013, she was inducted into the Institute of Medicine.   Scheie Eye Lobby | About: History

 

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