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The period 1975–2000 with a view to the future

2002; Wiley; Volume: 80; Issue: s234 Linguagem: Inglês

10.1034/j.1600-0420.80.s234.11.x

1600-0420

Jan Ulrik Prause,

Ophthalmology and Visual Health Research

This survey focuses upon the last 25 years of the activities of Danish Ophthalmological Society (DOS), with a view to the future. It is based on the presentation given at the joint meeting between DOS and the Danish Medical Society, celebrating the 100-year anniversary of DOS, 17 October 2000. This period of Danish ophthalmology coincides with my own life in ophthalmology, and the presentation is therefore highly biased. Parts of the data presented have been obtained from the splendid book, in Danish, on the resent history of DOS by Godtfredsen et al. (1994). In 1972 DOS had a new set of statutes. The Society has been led since then by a board of five people, headed by a chairman. In addition, a number of special duties is placed in permanent or ad hoc committees. The new structure is efficient, and has made it possible to address the main goals of the Society: • To stimulate scientific activity within ophthalmology; • To perform postgraduate training of ophthalmologists; • To define the content of the ophthalmological specialist training; • To conduct the theoretical courses that are a formal part of the specialist training; • To evaluate and guarantee the quality of the specialist training; • To advise authorities in ophthalmological affairs. During the last 25 years eight people have served as chairmen. They have used their very different personalities to influence the activities and style of the Society. Seen retrospectively, they all seem to have been the ideal choice of their time (Fig. 1). Chairmen of the Danish Ophthalmological Society 1975–2000+: (A) Jens Edmund, 1970–77; (B) Eilif Gregersen, 1977–79; (C) Ernst Goldschmidt, 1979–83; (D) Niels Ehlers, 1983–85; (E) Kresten Work, 1985–89; (F) Erik Krogh, 1989–93; (G) Erik Scherfig, 1993–97; (H) Anne Katrin Sjølie, 1997–2001. Jens Edmund (1923–) was chairman from 1970 to 1977, an extraordinarily long and very successful period. Jens Edmund is a pioneer in Danish retinal surgery, and has many international contacts. One of his main achievements was to guide the Society in an international direction. Consequently he coupled the annual honorary lecture, the Bjerrum lecture, with the annual postgraduate weekend course. He invited a number of highly esteemed international ophthalmologists to give the lecture (Table 1). The first Bjerrum lecturer of the 25-year period was Rudolf Klöti from Zürich. His lecture, on closed intraocular microsurgery–vitrectomy introduced this new technique to the Society and marked the entrance to a new surgical era. Eilif Gregersen (1924–) led the Society through a period during which the lack of ophthalmologists came into political focus. Together with the scientific secretary of DOS, Erik Krogh (1940–), he produced the important report ‘Vision and Eye Care in Denmark’ (Gregersen & Krogh 1979). The report documented the need for more ophthalmologists, since each should serve 35 000 inhabitants in Denmark. During his chairmanship Gregersen advocated formal teaching positions in private practice (praksisreservelægestillinger) and for postgraduate clinical associate professors assigned to the teaching of ophthalmologists in training at the departments. Unfortunately, his work did not lead to drastic improvements in the educational situation. Ernst Goldschmidt (1933–) pushed all his dynamic power and initiative into the Society from 1979 to 1983. He strengthened the profile of the meetings. Textbooks were provided for the members, together with two of the annual postgraduate weekend courses (Pharmacology and Toxicology; Immunology). Joint meetings with other medical societies turned out to be a success during his tenure. Another innovation was meetings devoted to a single subject, such as the meeting in 1980 on social ophthalmology. Administrative aspects were also in focus. Ernst Goldschmidt has many good connections both to politicians and colleagues. In 1979 he completed a report for the Danish Medical Association on the education of medical specialists. In 1983 this new educational system came into being. However, despite the many positive relations of the chairman and many useful discussions, it was not possible for DOS to have formal teaching positions in private practice included in the training programme. Niels Ehlers (1938–), being a superb scientist with major interest in the cornea, continued to strengthen the scientific profile of DOS. The cornea and its diseases were the main subjects for guest speakers, for postgraduate courses and for one of the Bjerrum lectures (Table 1). In June 1985 Niels Ehlers and the Board also hosted the Nordic Ophthalmological Meeting with great success. Kresten Work (1931–) led the Society through a period of consolidation. The scientific meetings were of high quality, and more than 70% of the membership participated in the meetings. Among the more successful events was the Bjerrum lecturer 1987 on radial keratotomy held by S.N. Fyodorov (Table 1 and Fig. 2). Professor Fyodorov arrived from Moscow and was received at the airport by the chairman, but also by four people from the Russian Embassy. Fyodorov gave an interesting presentation to the Society. He was also very open when discussing the political situation in USSR, and was extremely social and interested in Danish affairs. According to the chairman, one of the four people from the Embassy was even more interested, and was returned to the USSR 6 months later, being identified as a KGB spy (Work 1994). Drawing illustrating the Bjerrum lecture 1987 on refractive surgery by S.N. Fyodorov. The cartoon is by Hans C. Fledelius (1939–) ophthalmologist, poet and cartoonist without whom DOS would have been much more vague and grey during the last 25 years. Erik Krogh, who had been one of the authors of the report ‘Vision- & Eye Care in Denmark’ in 1979, acted as chairman for the next 4 years. Again his administrative and political skills helped the Society to formulate important reports that influenced the development of ophthalmology in Denmark. In 1990 the ‘Report on the Future of Ophthalmology’ was launched, and later the report on specialist education was added. During his chairmanship a closer cooperation between the Baltic states and the Nordic countries was introduced within the framework of the Nordic Ophthalmological Committee (NOK). Erik Krogh was able to go to Riga early in 1992, and was followed by a group of four in December 1992, giving lectures to colleagues in Lithuania. This work has been continued and expanded since then. Erik Krogh is still the dynamo of that important work. Erik Scherfig (1939–) took inspiration from his work in the European Board of Ophthalmology and modernized the ophthalmological specialist education with a basis in the report just mentioned. The theoretical courses were reorganized and arranged in two cycles each of five courses. The first cycle dealt with basic disciplines and the second with clinical aspects, ensuring that the young doctor in training can enter the cycles when completing his/her introduction to the speciality. An inspection system evaluating the quality of the various ophthalmological departments teaching ophthalmologists in training was also initiated, and the first steps to activate the system of evaluating the continuing medical education (CME) were taken. Anne Katrin Sjølie (1943–) had the task of bringing DOS into the New Millennium. She did it with great success. The last years have been a continuation of the high scientific level of the meetings. The social aspect has always been an important part of the life of DOS. Often more than 70% of the membership are present at the meetings. This is close to the possible limit, since some have to be on duty. The social activities facilitate positive communication and understanding between ophthalmologists in private practice and in hospitals. At the magnificent 100-year anniversary meeting all social expectations were fully met. Postgraduate training, ophthalmological science and social communication fuse in harmony in the Nordic Ophthalmological Meetings. Before the formation of DOS, the first Nordic Meeting had already been held in Stockholm, Sweden with great success. This may easily be seen from reading the menu of the gala dinner (Fig. 3). In modern times the same spirit is found at the meetings. At the latest Nordic Meeting in Reykjavik, Iceland, the Danish expression ‘to take one’s share of the fluid goods', however, seems to have gained a broader meaning (Fig. 3). The Nordic meetings have always been very popular because of their high scientific value. Nordic people speak languages that are similar. Many of us can communicate without much difficulty, provided that we speak clearly and slowly. However, when discussing scientific matters it seems more accurate and easy for most of the younger generation to use English. This was not accepted by all the professors in 1975, when the Nordic Meeting was held in Lund, Sweden. I gave a paper on corneal collagenases in the tear fluid of patients with corneal melting syndrome. Only one colleague, Dr Pandolfi from Sweden, was familiar with that subject. We had a very interesting discussion. However, my Swedish was not good, and his Danish was even worse, having an Italian background. Therefore, we switched quickly to English, but were stopped brutally by Professor Tengroth from Stockholm. At that time language came before science. At the Nordic Meeting in Copenhagen 1977, some delegates spoke English when presenting, inspired to do so by the President of the meeting Jens Edmund. Today there is a free choice between Nordic languages and English in the scientific section of the meetings. However, in the social sections Nordic tongue still dominates. Acta Ophthalmologica Scandinavica is another important area of interest for DOS. The Journal is owned by the Nordic Ophthalmological Societies, but like most scientific journals, it is constantly trying to improve in quality and in volume. At an extraordinary general assembly, March 23, 1985 the membership decided to have a joint subscription. In the same period the other Nordic Ophthalmological Societies also decided on joint subscription and the time was ripe for a reorganization of the Journal. The result was that a Board of Directors consisting of 10 ophthalmologists – two from each of the Nordic Ophthalmological Societies − was formed. The Journal is run by an elected Chief Editor, who in 2000 was still Niels Ehlers. During 1982 a group of ophthalmologists felt the need for a less formal ophthalmological journal, and Hans Alrø Jørgensen (1937–), Jørgen Bruun-Jensen (1936–) and the Chief Editor of Acta Ophthalmologica Scandinavica (at that time Mogens S. Norn, 1925–) created the ophthalmological tabloid journal Oftalmolog (Fig. 4). In contrast to other tabloid magazines, Oftalmolog does not contain naked females. Practical hints, information on new instruments, cultural and ophthalmological small-talk make up the content of the columns. Throughout the years, the Journal has proved its right to survive. Logo of the ophthalmological tabloid news-journal Oftalmolog and of the interest organization, the Danish Eye Health Society. During the same year another initiative was born to success, i.e. the formation of the interest organization ‘Øjenforeningen Værn om Synet’ (Danish Eye Health Society, Fig. 4). The increased interest and activity in ophthalmological science had demonstrated a need for an increase in economical support. Dansk Blindesamfund (the Danish Association for the Blind) had, together with DOS, created the Committee for the Prevention of Blindness in 1968. However, this organization could not meet the need for funding. DOS tried, together with Dansk Blindesamfund, to create a sufficient economical basis for a much higher level of support − without success, however. Therefore, at the General Assembly in 1982, a new organization was formed. This organization assembles ophthalmologists, optometrists and opticians as well as normal healthy people and ophthalmological patients, with the purpose of collecting money for the prevention and study of eye diseases. The Danish Eye Health Society has grown rapidly since then, and it is now one of the major supporters of Danish ophthalmological science. Ophthalmology has always been swift to apply the latest technological interventions and improvements. During this last 25 years refractive surgery has evolved from intracapsular cataract extraction to minimal incision phaco-emulsification with intraocular lens implantation. Contact lenses are available as cheap disposable devices of high quality, and refractive correction is performed with lasers directly on the corneal tissue, either on the surface – Excimer – or under a stromal flap – LASIK. Implantation of miniature telescopes is performed experimentally on patients with cataract and age-related macula degeneration (AMD). Even the implantation of artificial lenses in eyes with clear lenses is an option under study. The use of vitrectomy is routine and various vitrea substitutes are in use with or without active drugs. Transvitreal biopsy from the retina and choroid is now performed routinely when a histological diagnosis is needed (Scherfig et al. 1989; Prause 1999). Recently, the biopsy technique has been developed to allow internal resection of tumours (Kertes et al. 1998). The technique is still experimental, but in a few years we will know its role in the treatment of intraocular tumours. With the use of PCR techniques, microorganisms previously undetectable in the interior of the eye, can now be identified. Modern molecular techniques allow the determination of genetic disturbances and mutations on intraocular biopsy material. In the near future we will be able not only to detect the cause of disease, but also to correct it by implanting healthy genetic material directly into the diseased regions. AMD has attracted much interest during the period. Photodynamic therapy is now a documented useful treatment of AMD, and subfoveal surgery and macular transposition therapy are under study in many centres. Transplantation of the retina and the retinal pigment epithelium (RPE) were considered impossible a few years ago. However, recent studies have shown that it is possible to transplant these tissues. When DOS celebrated the 100-year anniversary, a competition for the best scientific oral presentation was held among young Danish ophthalmologists. The winner, Jens Folke Kiilgaard (1967–; Fig. 5), gave a talk on ‘The RPE-layer after submacular surgery’. He demonstrated that implantation of amniotic membranes into RPE defects may in the future be a possible treatment of choroidal neovascularization. Jens Folke Kiilgaard; cartoon of the winner of the competition on ‘Best Scientific Paper’ held in celebration of DOS' 100-year anniversary. The future is filled with promise, and modern medical technology harbours the potential to cure most diseases. This, however, not only puts strain upon our economy, but also challenges our ethical standards. We must face the dangerously negative side-effects of the new technologies, and we must set up ethical guidelines for the use of modern techniques. Already today children have been born not only because of love and hope for that child, but also because of love and hope for a bigger brother or sister (Fig. 6). In USA, a child has been born to serve as spare parts for a larger sister. The older woman says: ‘From whom did she get those large blue eyes?’ Mette Dreyer in Politiken, 9 October 2000.