Vol 36 No 2 Original Article PDF

Philippine ophthalmology has started to reclaim its position as responsive and responsible stalwarts in the firmament of world ophthalmology. While we try our best to advance the frontiers of the science of ophthalmology, we must not forget that, in the end, we will not be clanging cymbals signifying nothing if we did not have love for our patients, our fellow humans.

The evolution of Philippine ophthalmology, rightfully, must be reckoned with the story of filial love. Dr. Jose Rizal, the national hero, became an ophthalmologist for personal reasons—treating his mother’s blindness. He started his medical education at the University of Santo Tomas but obtained his licentiate of medicine at the Universidad Central de Madrid in 1884. He proceeded to an extensive training in the European cities of Madrid, Paris, and Heidelberg under distinguished ophthalmologists like Louis de Wecker from November 1885 to February 1886 and Otto Becker in 1886.

In 1892, Dr. Rizal successfully performed cataract surgery on his mother’s left eye in Hong Kong. However, the right eye, which was operated on while he was in exile in Dapitan, developed endophthalmitis in 1894, making him remark that he understood only then the prohibition on treating members of one’s family.

Jose Rizal became a marked man when he published Noli Me Tangere (Berlin, 1887), a satire on the excesses of the friars in the Philippines. In 1892, he was banished to Dapitan in Zamboanga where he continued to practice ophthalmology. In addition, he taught the locals agriculture and sound public-health practices. It was in Dapitan where he met his future wife, Josephine Bracken, who brought her stepfather for eye treatment. His interest in local flora and fauna even allowed him to send species of animals and plants abroad, which his European scientist friends later named after him.

Indeed, his love of family was only exceeded by his love of country. Since boyhood, his elder brother Paciano initiated him to love of his Malayan birth with a unique civilization, including an extant agriculture, thriving industries, and international trade. Such cultural and commercial history was documented by the Spaniard Antonio de Morga in Sucesos de las Islas Filipinas in 1609, which was translated by Blair and Robertson in the 20th century as The History of the Filipino People.

The Spanish colonizers tried to erase such cultural record and put down nationalist yearnings of the Filipinos if only to maintain their rich colony. Disappointed with the failure of his peaceful methods of getting reforms from the Spanish conquerors, he wrote the sequel to the Noli—the El Filibusterismo (Ghent, Belgium; 1891). The satire in Noli was replaced by an exposition of the use of violence to overthrow the Spanish dominion. At that point, Rizal had already accepted martyrdom to free dear motherland.

Finally, after writing Mi Ultimo Adios, his life ended at the altar of freedom on December 30, 1896. The brightest star of Philippine ophthalmology accomplished in death what he failed to do in life. The Philippine revolution erupted in 1898 and the first Asian republic of the 19th century was born only to be a victim of American imperialism and duplicity. The 20th century brought with it American science and medicine as instruments of erasing the Hispanic influence on the Philippine islands. A century ago, ophthalmology vintage Rizal, was initially replaced by the Philippine General Hospital’s (PGH) Eye Ear Nose and Throat (EENT) department expediently brought to us by the first chairman, Dr. Reinhart Rembe (May 1911–1914). The department trained young resident physicians and interns. The Philippine Medical School (now the University of the Philippines (UP) College of Medicine) required a month-long rotation in the department. Philippine ophthalmology in the 20th century effectively began with Dr. Aristeo Rizal Ubaldo. He was a descendant of the national hero who served as the first Filipino chair of the EENT Department for almost four decades (1914–1951). Only top graduates of the College of Medicine were admitted to the residency program and entrusted with patient care. World War II caused the closure of the EENT Department from 1942–1945. In the post-war, the EENT Department was reborn with Dr. Antonio Fernand Sr. at its helm. He organized the residency training program and encouraged scientific and research studies. He promoted regular staff clinical conferences and invited EENT personnel of the North General Hospital (now the Jose Reyes Memorial Medical Center). Dr. Herminio Velarde Sr. improved on the efforts of his predecessors (July 1955 to 1956). Dr. Geminiano de Ocampo (1956–1966) brought innovative changes in Philippine ophthalmology, including surgical akinesia, fine sutures, intracapsular cataract extraction with capsule forceps, and immaturecataract-lens extraction. De Ocampo more importantly elevated research to greater heights when the Philippine Eye Research Institute (PERI) was founded on June 19, 1965 with the enactment of RA 4593 mandating research in eye diseases afflicting Filipinos.

The first purely research institute in the university separate from the College of Medicine was envisioned to be the research arm of the Eye Department and the repository of Philippine Ophthalmologica. Grants in aid, as well as modern equipment, poured in. Another monumental accomplishment earlier (in 1945) was the establishment of the first PGH Eye Bank. De Ocampo was, indeed, the Doyon of Philippine ophthalmology, personally assigning future leaders in ophthalmology to the various subspecialties after foreign educational training.

On November 9, 1961, the UP Board of Regents saw the need to improve the EENT Department by separating ophthalmology under Dr. G. De Ocampo from otorhinolaryngology under Dr. Carlos Yambao. The division spurred better training and, hence, better patient service. Subspecialties evolved and were organized into various services, including cornea, glaucoma, plastic-lacrimal, retina, uveitis, motility, orbit, and neuroophthalmology. For such accomplishments, among others, Dr. Geminiano De Ocampo was logically elected the first National Scientist in Medicine. Dr. Emmanuel Almeda was appointed officer in charge from February to October 1966. Dr. Liborio Mangubat was appointed chair from July 1968 to June 1976. The basic course in ophthalmology was instituted in the residency program in Ward 4. More residents were admitted, including the first non-UP graduates. Aside from the basic ophthalmology course, postgraduate courses for general practitioners were held. A photography section was added to document histopathologic and unique clinical cases. Dr. Romeo Espiritu became the chair in June 1976 until 1979. Rotation in the various subspecialties was scheduled among the residents and fellows. Through the efforts of Dr. Romeo Fajardo, the first basic course was offered to all residents and practitioners in Ward 4. The department manual (second edition) was duly updated to define better its policies and functions. Dr. Salvador Salceda became chair of the department in June 1979 and concurrently served as director of the Institute of Ophthalmology (IO) (formerly PERI) allowing geographic practice and offering clinical fellowship. IO shared its research facilities with the department, including ocular microbiology and ophthalmic pathology. External ocular and cornea clinics were conducted in the institute. The transfer of the department from Ward 4 to Ward 12 was planned. Subsequently, PGH project team chairman Dr. Salceda planned the transfer of the EENT floor 15 operating rooms to the fourth floor of the PGH central block. The institute was strategically relocated behind Ward 12 from its original 2 building stations between Wards 3 and 5. Dr. Gloria Lim became the first lady chair from June 1982 to 1985. The department asserted its leadership in Philippine ophthalmology during her term. International postgraduate courses in retina, ophthalmic pathology, and uveitis were jointly conducted with the Philippine Academy of Ophthalmology.

Dr. Mario Aquino was appointed chair in July 1985 to 1987. Extracapsular cataract extraction using visoelastic agents and posterior-chamber implants was promoted, improving modern cataract surgery. Dr. Romeo Fajardo chaired the department from July 1988 to 1991. He established the Eye Instrument Center (EIC) in 1989 together with the Ophthalmological Foundation of the Philippines (OFPHIL) bannered by Drs. Felipe Tolentino and Jose Pecson. The landmark project of the partnership was the establishment of the Miyake operating room at the department OR complex honoring the memory of Dr. Miyake who was saved by two Filipino youths during the last war. Modern ocular surgery using state-ofthe-art ophthalmic technology was offered to PGH patients.

Dr. Prospero Tuaño introduced from July 1991 to 1998 new subspecialty services: pediatric ophthalmology at the EIC, low-vision clinic at the OPD, and contact-lens clinic linking with the International Association of Contact Lens Educators (IACLE). The modified residency training program introduced during his term, in cooperation with the Department of Health (DoH), helped address the lack of ophthalmologists in the provinces. He also linked the department with St. Luke’s Medical Center and Sta. Lucia International Eye Bank of Manila. In 1998, the department was officially designated as the Department of Ophthalmology and Visual Sciences (DOVS) to embrace a comprehensive approach to ophthalmic science and practice. Phacoemulsification has become the latest standard for cataract surgery.

The 21st century for DOVS began with Dr. Manuel Agulto as chair in May 2000. Ophthalmic breakthroughs from subspecialty researches were given utmost importance when Dr. Agulto was concurrently appointed director of the Institute of Ophthalmology in May 2001. With a total grant from the Kingdom of Spain through the Agencia Española De Cooperacion Internacional (AECI), a fully equipped National Eye Referral Center was built in cooperation with the UP, PGH, DOH, Philippine Academy of Ophthalmology (PAO), plus other major stakeholders in ophthalmic health. The Sentro Oftalmologico Jose Rizal (SOJR) is now home also to the Philippine Board of Ophthalmology (PBO) and Sta. Lucia Eye Bank.

Latest diagnostic and therapeutic instruments were obtained to ensure world-class eye care. More significantly, the faculty was given the total responsibility of patient care so the SOJR could assume its role not only as the PGH-CM Department of Ophthalmology but also as the national referral center. Dr. Ildefonso Chan was appointed chair in 2006 to maintain and upgrade the SOJR. New phacoemulsification machines, microscopes, and sterilizers were made available to the medical and nursing staff. The Dr. Romeo Espiritu Auditorium was inaugurated to honor an outstanding mentor, researcher and clinician. The SOJR now is a favorite venue for seminars and workshops for the ophthalmic and PGH community. The 50th anniversary of DOVS is celebrated with Dr. Pearl T. Villalon as chair. The Dr. Romeo V. Fajardo Library was inaugurated on February 8, 2011, a fitting tribute to an ophthalmic educator, researcher and leader. Truly like De Ocampo and Espiritu, he dedicated his life to being a superior exemplar in ophthalmology.

As we look back to plan the future, we can very well say that the department has fulfilled its legacy of honor and excellence while serving the country and the world. The vision, an apt word for ophthalmologists, has never seen as clear and focused as seen in the obsession of this past and present generation of ophthalmologists. Philippine ophthalmology has started to reclaim its position as a responsive and responsible stalwart in the firmament of world ophthalmology. While we try our best to advance the frontiers of the science of ophthalmology, we must not forget that in the end, we will not be clanging cymbals signifying nothing if we did not have love for our patients, our fellow humans.