Ophthalmologist’s guide

Find out interesting facts about ophthalmology here – for example, which symptoms you can consult an ophthalmologist about or which common examination methods, specialties and therapies are available.

Abstract:

• The ophthalmologist diagnoses and treats eye diseases. This includes the diagnosis of defective vision, but also the treatment of cataracts, glaucoma, conjunctivitis or styes.
• This complex specialty not only includes the diagnosis and treatment of eye conditions, but is also used in trauma surgery and cosmetic surgery (e.g. cataract surgery).
• Even small children’s eyesight is tested as part of early childhood examinations, and their eyes should also be examined regularly as they get older.

What does a doctor of ophthalmology do?

Ophthalmology, as the treatment of one of the most important and complex sensory organs, is one of the oldest specialties in medicine. The tasks of an ophthalmologist are extensive. Training requires completion of medical school, followed by training as a doctor. It is then possible to specialize with additional one-year training courses in the following areas:

• Laboratory examination
• Laser surgery
• Surgery of the eye muscles

After passing the medical examination, an ophthalmologist performs the following tasks:

• Advice on and early detection of eye diseases such as: Amblyopia (amblyopia), glaucoma (glaucoma) and macular degeneration (diseases of the retina of the eye that affect the macula lutea (“yellow spot”))
• Diagnosis, surgical treatment and follow-up care for diseases of the eye, the visual pathway and the optic nerves
• Measurement of visual acuity and prescription of visual aids or recommendation of vision correction through refractive surgery
• Diagnosis and treatment of positional and movement disorders of the eyes, nystagmus (eye tremor) and forced head postures
• Rehabilitation measures for the visually impaired
• Ergo-, sports- and traffic ophthalmology

In addition to the prevention, aftercare and treatment of eye diseases, ophthalmology includes the following specialties:

• Strabology: diagnosis and treatment of strabismus, eye muscle balance disorders, nystagmus and similar disorders
• Neuroophthalmology: detection and treatment of neurogenic changes in vision
• Refractive surgery: Surgical correction of the refractive power of the eye

Which diseases are particularly common in the ophthalmologist’s practice?

The work of an ophthalmologist includes the diagnosis and conservative treatment of eye diseases, but also prevention and rehabilitation – either in their own practice or in a clinic. Apart from this, ophthalmologists can also perform cosmetic or functional surgical procedures. This includes laser surgery to correct defective vision, as well as the surgical removal of cataracts. The following overview shows you the most common eye diseases:

How does the ophthalmologist make a diagnosis?

• A consultation in the practice includes a general examination to check visual acuity as well as a test of the pupil’s normal reaction to light.
• When checking visual acuity, one eye is covered at a time and then tested to see which signs can be clearly recognized from a distance of five metres. The test is then repeated at a distance of 30 centimeters. This is how the ophthalmologist diagnoses the type and severity of a visual defect.
• The conjunctiva and eyelids are also examined. This allows the doctor to determine whether the eye is too dry, for example.
• The scope of the examination may also include Color vision tests, examination of eye position and mobility, examination of the extent of the field of vision.
• If the fundus of the eye is to be examined, the patient is given eye drops containing atropine approximately 30 minutes before the examination in order to dilate the pupil. The doctor can then use strong lighting and a magnifying glass, or alternatively a slit lamp, to examine the back of the eye. The intraocular pressure can also be measured in this way.
• Fluorescence angiography is used to diagnose the condition of the retina even more effectively. For this purpose, the patient is injected with a contrast agent that makes vascular changes in the eye visible.
• In addition to examining the eye and visual acuity, an ophthalmologist’s examination includes questions about the patient’s general state of health and possible chronic diseases. Conditions such as high blood pressure or diabetes, for example, damage the blood vessels and therefore also impair vision in the long term.

Ophthalmologist check-ups – from when?
Ophthalmologists recommend regular consultations from the age of 50 in order to detect diseases such as glaucoma, cataracts and age-related macular degeneration at an early stage. People who suffer from diabetes and hypertension should also see an ophthalmologist regularly. Not all diseases detected early by screening can be completely cured. However, if the diagnosis is made in good time, the progression can be slowed down considerably in many cases.

How can I prepare for my visit to the ophthalmologist?

A visit to an ophthalmologist does not normally require any special preparation. Unlike a blood count, for example, patients do not need to be sober or meet any other requirements. However, the examination of the fundus of the eye is an exception. For this, the doctor administers atropine-based eye drops approximately 30 minutes before the examination. The extract of belladonna, formerly known as belladonna, dilates the pupils and was used as a “beauty remedy” in ancient times.

The administration of atropine makes it easier for the ophthalmologist to illuminate the back of the eye. As the pupils remain dilated for a while, visual acuity is initially impaired after such an examination. For drivers, this means that they should not get behind the wheel again until the effect has completely worn off. There are no precise guidelines for this.

How do ophthalmologists go about treating eye diseases?

Treatment depends on the diagnosis. For example, if you have defective vision – i.e. short-sightedness or long-sightedness – the next step is to prescribe a visual aid. This could be glasses or contact lenses. Alternatively, defective vision can be corrected by surgery under certain circumstances.

• Eye misalignments such as astygmatism or strabismus are also usually treated “mechanically” – with visual aids that take existing misalignments into account.
• If there is an inflammatory disease of the eye, the doctor will first determine the causes and then prescribe appropriate preparations, such as eye drops and/or special creams or gels for the eyelids or eyelid margins. Glaucoma can also be treated with medication to lower the intraocular pressure and thus cure the disease.
• Advanced cataracts are treated surgically. With this procedure, vision can often be completely restored, but surgery can also be successful in the case of macular degeneration. Some ophthalmologists with the appropriate specialization also offer cosmetic procedures in the eye area, such as eyelid lifts.

Special features of eye examinations for children

Children, especially infants and toddlers, cannot communicate fully. Babies also do not yet have fully developed vision. The examination methods must therefore be adapted to the special requirements of very small patients. Abnormalities are often noticed by the pediatrician during postnatal baby and toddler examinations and the young patient is referred to a doctor. Certain tests, such as those for suspected clouding of the lens or misalignments, can be carried out regardless of age; in other suspected cases, diagnostic aids specially developed for small children are used.

Important questions & answers

Sources

• https://www.optometrist.de/optometristen/was-macht-ein-optometrist/was-macht-ein-augenarzt
• https://www.gesundheitsinformation.de/welche-augenuntersuchungen-gibt-es.2966.de.html
• https://de.statista.com/statistik/daten/studie/158849/umfrage/aerzte-nach-taetigkeitsbereichen-in-deutschland/
• https://www.aerzteblatt.de/pdf.asp?id=205547