OPHTHALMOLOGY

Ophthalmology is the branch of medicine that deals with the diagnosis, treatment, and prevention of eye diseases. Its history can be traced back to ancient civilizations such as the Egyptians, Greeks, and Romans, who had some knowledge of eye diseases and their treatments. In the 19th century, ophthalmology became a recognized medical specialty, and many advances were made in the diagnosis and treatment of eye diseases.

Today, ophthalmology is a rapidly advancing field, with new treatments and technologies being developed to treat a wide range of eye diseases and conditions. Ophthalmologists work closely with optometrists, opticians, and other healthcare professionals to ensure the best possible care for their patients’ eyesight.

The Lancaster Medical Heritage Museum boasts one of the most extensive Ophthalmology collections around. Dr. Barton Halpern’s collection shows a range of historical information and medical advancements in the field.

EYE DOCTOR’S OFFICE: LATE 19TH/EARLY 20TH CENTURY

This exhibit contains instruments that would have been found in the typical eye doctor’s office (Ophthalmologist or Optometrist) at the beginning of the 1900s.

Throughout the eye exhibit are important framed posters of paintings and images, including a copy of Dr. Fulton’s obituary, pictures of eye doctor’s offices from around the early 1900s, and a picture of Professor Herman Von Helmholtz using his invention of the ophthalmoscope.

This early 1900s eye doctor office was created primarily from the donated collection of Dr. Barton Halpern. It consists of equipment from Lancaster’s 1st board-certified ophthalmologist, Dr. Harry Fulton, who began his practice around 1916, and retired in 1974, at which time Dr. Dale Posy took over his practice.

Dr. Barton Halpern began his practice in 1979, and by chance, Dr. Posy retired later in 1979, and Dr. Clarence Leiphart around 1985. Dr. Halpern took over these early practices as well, thereby acquiring many original ophthalmology instruments from Lancaster PA, seen in this eye doctor’s office, which were ultimately donated to the Lancaster Medical Heritage Museum.

Most of the important ophthalmology instruments are labeled with a number that corresponds to a chart on the wall naming the instrument. There are two framed pictures on the wall of this office exhibit, which represent equipment commonly seen in an ophthalmology office from this period and which loosely form the basis for the layout of this ophthalmology office display.

OPHTHALMOLOGICAL ART

On top is an original painting of the eye by Artist Miles Halpern showing most of the commonly identified structures of the eye.

Adjacent to the painting (to the right) is a digital image of the painting, identifying the structures seen in the painting.

Below is a poster by famed medical artist Frank Netter, showing structures involved in vision including the eye, optic nerves, and brain.

Frank Netter was born in 1906. Although his passion was art, his parents disapproved of a career in this field. He became a physician and a surgeon but began his career during the Great Depression.

He said, “This was in 1933—the depths of the Depression—and there was no such thing as a medical practice. If a patient ever wandered into your office by mistake, he didn’t pay.” He supplemented his income with medical illustrations and soon was able to give up his medical practice and make his living by combining his art passion with his understanding of human anatomy.

CIBA published his medical illustrations and distributed them free to medical students and his work became an integral part of the training of generations of doctors (from Wikipedia). Our poster shows the anatomy of the eyes and their connections to the brain.

MEDICINE CABINET

The medicine cabinet (usually white) was used in doctors’ and dentists’ offices as well as operating rooms to store medicines, medical supplies, and surgical instruments.

Our medicine cabinet contains the surgical instruments of Dr. Harold Fulton, Lancaster’s 1st board certified ophthalmologist. When Dr. Fulton retired, Dr. Dale Posey took over his practice and equipment and when Dr. Posey retired in 1979, Dr. Barton Halpern took over his practice and some of Dr. Fulton’s original equipment. When Dr. Halpern retired, he kept the collection of antique equipment, including Dr. Fulton’s original set of surgical instruments, which he donated to the Lancaster Medical Heritage Museum when it opened in 2022.

Our surgical cabinet also happens to contain an article about Dr. Fulton and his World War 1 diary written by Peter Wever, MD, PhD, from the Netherlands. Dr. Henry Wenz (a family physician from Lancaster PA) used to say that medicine is about stories. The story of how this article came about, and how it circles back to Lancaster, is a story in itself. Dr. Fulton was stationed overseas in World War 1. He kept a diary of his experiences. Somehow Dr Fulton lost his diary, and it ended up on eBay. Dr. Weaver purchased that diary and decided to write an article about the diary.

He traced Dr. Fulton back to Lancaster and in around 2018 contacted Dr. John Bowman, who at the time was very involved with the museum. He asked Dr. Bowman if he had or knew of any pictures of Dr. Fulton. Dr. Bowman had recently seen the ophthalmology collection of Dr. Halpern and contacted Dr. Halpern and asked him if he had any pictures of Dr. Fulton. Dr. Halpern began his ophthalmology in 1979. Dr. Fulton died in 1989 at over 103 years of age, after practicing medicine for 58 years. Dr. Halpern thought that his life was inspirational and had the obituary article, which included a picture of Dr. Fulton hanging in his office until his own retirement.

By the time Dr. Bowman called Dr. Halpern regarding a picture of Dr. Fulton, Dr. Halpern was retired, and his ophthalmology collection was in his home in Lititz, PA. Dr Halpern searched for the framed obituary of Dr. Fulton and found it beneath a box with the initials H.C. Fulton and containing Dr. Fulton’s original surgical instruments. Dr. Halpern sent photos of both the obituary article(containing a photo of Dr Fulton) and pictures of the surgical instruments. Dr. Wever included images of both in his article and credited us for these contributions. His publication about Dr. Fulton’s diary now makes that diary, Dr. Fulton Lancaster PA, a part of the history of World War 1.

DOCTOR SHINGLE

The “doctor shingle” originated in the 1800’s and was made of an actual roof shingle. This shingle was from the Ephrata ophthalmology practice of Dr. Barton L. Halpern and was made on short notice by his wife Leslie around 1985, by modifying an older discarded “shingle”.

DR HARRY CULBERTON FULTON

“IT’S A SMALL WORLD AFTER ALL”

We live in an amazingly connected world! Dr. Henry Wenz, a family physician from Lancaster PA, used to say that medicine is about stories. Dr. Harold Culbertson Fulton was Lancaster’s 1st board-certified ophthalmologist. He began his ophthalmology career in Lancaster in 1916 and retired in 1974, after 58 years of practice. When Dr. Fulton retired, Dr. Dale Posey took over his practice and equipment. Dr. Posey retired in 1979, shortly after Dr. Barton Halpern came to Lancaster. Dr. Halpern took over Dr Posey’s practice and therefore ended up with some of Dr. Fulton’s original equipment! Dr. Halpern was inspired by Dr. Fulton’s long career and 103 years of life and saved a framed copy of his 1983 obituary in his office. When Dr. Halpern retired in 2019, he kept his extensive collection of antique ophthalmology equipment, which he later donated to the Lancaster Medical Heritage Museum when it opened in 2022.

CATARACT SURGERY DISPLAY CABINET

A cataract is a clouding of the normally clear lens in the eye that we are born with. This usually occurs due to aging and can get to the point where it interferes enough with our ability to do the things that we need to do enjoy doing that surgically removing the cataract is recommended. Since the cataract develops on what was

originally a clear “lens”, to have good vision after cataract surgery, the lens must be replaced either with (thick) glasses, contact lenses, or most commonly an intraocular lens (a new lens placed within the eye at the time of the cataract surgery).

Instruments and informational displays regarding cataract surgery.

This display includes instruments used in the history of cataract surgery including: Couching cataract surgery – a surgical technique dating back to the 5th century BC, (but unfortunately still done in some areas of the world), where a sharp needle is inserted into the eye in order to dislodge the cataract. No intraocular lens is implanted. The procedure and the results tend to be poor.

Intracapsular cataract surgery-

This procedure was 1st performed in 1753, when a surgeon removed the entire cataract in one piece. This procedure was originally done by grasping the cataract with a “capsule forceps” and later improved by using a freezing probe to hold it and an enzyme to loosen the attachment of the cataract to the internal structures within the eye.

Extracapsular cataract surgery-

Although technically a crude form was done in the 7th century BC. The 1st modern version of this procedure was performed in 1747. The procedure involves opening up the front “membrane” that surrounds the cataract and then removing the harder center (nucleus) by using light pressure to force it out of the eye and then suctioning out the softer part (cortex).

Phacoemulsification cataract surgery-

This procedure is a variation and improvement upon extracapsular cataract surgery in that it uses a vibrating needle to soften and remove the cataract through a small incision.

Laser Assisted phacoemulsification cataract procedure is a variation of extracapsular cataract surgery in that all the incisions are made with a laser for precision and the cataract is also softened with the laser, after which the cataract is removed by the phacoemulsification.

Intraocular Lens Implantation-

Cataract surgery removes the cloudy lens, but since the surgery removed the lens we use to focus work, the vision is not clear. Cataract glasses (thick lenses), contact lenses, and intraocular lenses (the eye after the cataract is removed), will all improve vision, but modern cataract surgery involves immediately replacing the cataract with a clear lens. The lens is made out of a type of plastic and is foldable to allow it to be placed through a small incision. The lens can be made to correct the distortion of astigmatism (toric), correct near and distant vision (multifocal), and have its power fine tuned after it is placed in the eye (light adjustable) among other things.

On November 29, 1949, Dr. Harold Ridley implanted the 1st intraocular lens in the human eye, ushering in the era of modern cataract surgery. The 1st recording of a cataract surgery with intraocular lens implantation was done by Dr. Ridley in 1951, and represents the 8th surgery that he performed. We are pleased to share a copy of that recording with you!

A video of modern Laser Assisted Cataract Surgery with lens implantation laser assisted cataract surgery uses a precision laser to make all the incisions for cataract surgery and to soften the cataract, making it easier to remove the cataract by means of phacoemulsification cataract surgery.

GLAUCOMA DISPLAY CABINET

This display contains historical instruments and informational displays regarding the diagnosis and treatment of glaucoma. Glaucoma is a group of diseases that damage the optic nerve due primarily due to increased pressure within the eye. This can lead to loss of vision and blindness due to the progressive loss of side vision. Glaucoma can be detected by tests using a variety of instruments including looking at the optic nerve for damage with an ophthalmoscope, visual field testing and measurement of the pressure within the eye with a tonometer, and in some cases by examining the outflow from the eye using a gonioscope.

MACULAR DEGENERATION DISPLAY CABINET

This display contains historical instruments and informational displays regarding the diagnosis and treatment of macular degeneration. We see because our eyes work somewhat like a camera, and the retina is like the film of a camera capturing a representation of what we look like. However, unlike a camera, the retina has a more sensitive area of vision called the macula (and in the center of that the fovea) which is responsible for our fine vision used in most activities including driving, reading, and color vision.

Macular degeneration is usually an aging change in the center of vision that can cause loss of our critically important center of vision. This can be evaluated using a variety of equipment including an ophthalmoscope, Amslergrid, fluorescein angiogram, and OCT (Optical Coherence Tomography).

DIABETIC RETINOPATHY DISPLAY CABINET

This display contains historical instruments and informational displays regarding the diagnosis and treatment of diabetic retinopathy. Diabetes is a medical condition whereby the body does not properly use the sugar we eat and can result in a variety of diseases throughout the body including the eyes.

It can affect the blood vessels in the retina that we see with, causing bleeding and abnormal blood vessel growth within the eye. Instruments used to evaluate this disease include ophthalmoscope and fluorescein angiogram, and treatment can range from control of bold sugar to laser treatment and vitrectomy surgery.

VISUAL FIELDMACHINE EXHIBIT

Historical progression of visual field machines including

TANGENT FIELD VISUAL FIELD MACHINE: Uses a fixation target on a black piece of cardboard to focus your attention. The tester brings a small object from the side toward that fixation target and uses pins on the cardboard to plot areas where you can and can’t see the object.

MECHANICAL VISUAL FIELD MACHINE: uses a mechanical device instead of a piece of cardboard to plot areas where you can and can’t see the object.

SUPRA THRESHOLD VISUAL FIELD MACHINE: uses a bright light at various points in a person’s field of vision to plot areas where you can and can’t see the object

VISUAL FIELDS AND THE HISTORY OF VISUAL FIELD MACHINES

A visual field test measures your “side”(peripheral vision), i.e. how well you can see around the “side” of something you’re looking at. Under normal conditions, the smallest or least intense visible objects are only seen in the central region of the visual field. It is normal to have a blind spot(scotoma) in your field of vision related to where the optic nerve leaves the eye. In the periphery, objects must be larger or more intense to be identified.

Many diseases of the eye and body, including glaucoma, retinal diseases (such as retinitis pigmentosa), strokes, and brain tumors can cause a loss of a part of your field of vision, even though you may see 20/20 on a vision test. Visual field testing is a simple test that plots the areas in the field of vision surrounding you that you cannot see. Visual field testing has progressed over the years.

NORMAL VISUAL FIELD

VISUAL FIELD LOSS FROM GLAUCOMA

VISUAL FIELD LOSS FROM CAUSES OTHER THAN THE EYE (Stroke)

LANDMARKS IN EYECARE SHELVES

Our display shelves contain many of the major eye instruments that are landmarks in the diagnosis and manage eye diseasses

FLAT HORIZONTAL DISPLAY CABINET

Contact Lens Exhibit showing local crafting of contact lenses

The history of contact lenses dates back centuries. In 1887 glass blowers created glass lenses that could be placed “in contact” with the cornea (front) of the eye, (a “contact lens”), to correct vision in eyes that could not see well due to problems with focus, like glasses correct such vision problems. Later lenses were made from plastic and covered the entire front of the eye (“scleral lenses”). In 1958, soft contact lenses were invented using hydrogel and these were approved by the FDA in the US in 1971. Rigid gas-permeable contact lenses were developed in 1978 that allowed better vision and oxygen permeability. These were followed more recently by disposable contact lenses in the 1990s and toric contact lenses that can correct astigmatism (distorted focus).

Artificial Eye Exhibit showing local crafting of artificial eyes

The history of the artificial eye is a journey of compassion, ingenuity, and technology to aid individuals who lost their eye due to trauma or illness. The earliest mention of artificial eyes comes from ancient Egypt, where artisans crafted eye-shaped ornaments out of gold, clay & glass to place over the eye socket of deceased individuals. These were believed to provide sight in the afterlife. During the Middle Ages, artificial eyes were made of glass, gold, and silver. The 19th and 20th centuries saw innovations in materials creating more lifelike artificial eyes made from glass, plastic, and silicone, and designs creating the appearance of a colored iris. Improved materials and surgical techniques for implanting the artificial eye created a more comfortable and realistic-looking eye that moved more naturally. Today, some artificial eyes are made by 3D printing.

EYEGLASS EXHIBIT

Eyeglasses address our modern need for clear vision. In the 1300s an anonymous Italian is credited with inventing glasses, using lenses in a frame to correct farsightedness. Glasses soon became popular with scholars for reading as 1st seen in a 1352 painting. Over the centuries, eyeglasses have benefitted from improvements in craftsmanship and technology.

Frames were originally made from wood and bone and currently metal and plastic. Eyeglass lenses were shaped by grinding glass and more recently by molding plastics. Benjamin Franklin patented bifocal lenses in 1784. Lenses have become more technically advanced over recent decades, with progressive lenses (1950s) allowing a continuous focus from distance to near, and transitional lenses (1960s) able to darken when exposed to light. “Smart” glasses were introduced in 2004, in effect creating a wearable computer screen that can display information and perform a variety of functions.

EYECHART

Antique Snellen vision chart consisting of replaceable cardboard vision charts surrounded by a handcrafted wooden box. Dr Herman Snellen was a Dutch eye doctor who developed a vision chart in 1862 at the request of Dr. Franciscus Donders to help identify vision problems. The Snellen vision test is still the most common vision test in use in the world. It uses a geometric scale (in units of feet) to measure vision. 20/20 vision represents a person’s ability to recognize small distant objects of a defined size at 20 feet away.

For example, if a person’s vision is 20/50, the top number represents the distance (in feet) that the patient is standing from the chart and the bottom number is the size of the objects on the line that this person with 20/20 vision would see at 50 feet because these larger letters would be the same angular size to that person at 50 feet as the smaller letter would be to that person at 20 feet. A person with 20/50 vision would have to move to 20 feet from that larger target to be able to see it as well as a person with 20/20 vision can see it.

The Snellen Chart uses a geometric scale to measure visual acuity, with normal vision at a distance being set at 20/20. The numerator represents the distance that the patient is standing from the chart (in feet), while the denominator represents the distance from which a person with perfect eyesight is still able to read the smallest line that the patient can clearly visualize. For example, a patient standing 20 feet away from the chart who can clearly read until the line of font that a person with normal visual acuity can read from 40 feet away would be measured as 20/40 vision

COMPUTER MONITOR DISPLAY

A continuous display of various eye diseases.

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