Ophthalmic pathology suffering, but not dead, a pathologist says

NUREMBERG, Germany — Ophthalmic pathology may be a neglected subspecialty at the present time, but it is not dead yet, according to a world-renowned ophthalmic pathologist

During his fifth presentation of the keynote lecture to the meeting of the German Ophthalmic Surgeons here, David Apple, MD, discussed the rapid decline in interest in ocular pathology and speculated on whether the lapse was to be temporary or everlasting. Dr. Apple based his comments on his 30 years of experience directing a successful pathology laboratory and biodevice research center.

According to Dr. Apple, today the profession’s needs are mostly in the areas of research ocular pathology, biomedical engineering and biodevices research, the latter being most crucial for ophthalmology. Many pathology laboratories throughout the world have not kept pace with changes in these areas, he said, and some authorities have declared that ocular pathology is a "dying specialty." This opinion is based on reasons including a general resistance to change, financial need, lack of support from department chairmen and administrators, and failure of pathologists to reeducate themselves regarding modern needs.

"In my opinion, routine descriptive pathology, which has been practiced since an early time, is seriously wounded," Dr. Apple said. "It will never come back full time. Financially it will not work, and there are too many important things for the future to do. However, if leaders recognize this and give support to pathologists, and let them work with industry, they will turn out to be very successful, and the subspecialty of ocular pathology will indeed survive."

Among the problems faced by pathologists, perhaps financial dilemmas are the most obvious, Dr. Apple said. Many chairmen of departments of ophthalmology do not support ocular pathology due to the pathologist's lack of money-making capabilities for the department. There is also a lack of financial grant support for this type of research. To illustrate this, Dr. Apple drew on his personal experience of applying for federal grants in 1984 when he first started working with IOLs. He said he applied to the National Institutes of Health for funding.

"They told me very quickly 'no,' I couldn't have one," Dr. Apple recalled. "The reasons were because they thought we would not get enough specimens, but they also said that IOLs would not last long. With regard to the number of specimens, as of now we have 17,500, including about 10,000 explants and about 7,000 autopsy eyes.”

Dr. Apple added that academic pathologists must have the ability and willingness to work with the private and corporate sectors. They must also be willing to learn and apply the modern techniques necessary to carry on high-quality biomedical research and provide meaningful contributions to clinical ophthalmology and society. It is time for the leaders in ophthalmology to recognize the potential consequences of allowing further decline in this field, he said.