Tracing the steps of ophthalmology in Persia

Take-home

The history of the Iranian civilization reveals a culture rich in medical achievements, from the Bronze Age to modern time.

Our Ophthalmic Heritage By Arash Mozayan Isfahani, MD, and Norman B. Medow, MD, FACS

Up until 1935, the country of Iran was called Persia, but Iran is what Persians have always called themselves! Why the change, that story is for another day.

The empire of Persia was vast and stretched from the Mediterranean Sea to the Indus River and from the Black Sea to the fringes of Arabia. Unfortunately, few traces of this civilization or its medical culture have survived.

Tracking the history

An intelligent people who gave the world the first charter of human rights also gave the world evidence of one of the earliest ocular prostheses. Said to date circa 2800 BCE, the prosthesis was found in Shahr-E. Sukhteh, The Burnt City. This was a rich and large archeological site of the Bronze Age. The prosthesis is said to have belonged to a woman about 6 feet tall and about 25 to 30 years of age. The imprint of the prosthesis in the eye socket gives clear evidence of its use during her lifetime. The prosthesis was made of a mixture of animal fat and natural tar. Golden wire filaments, each less than 1 mm in thickness, were used to show the conjunctival vessels-adding evidence that cosmesis was important to the early Persian people.

During the Zoroastrian era, which began circa six centuries BCE, ocular ailments were categorized according to color and shape: white eye for cataract; red eye for ocular inflammation; and green eye for glaucoma. The patients received treatment from three different groups of providers: The Doregardi or wondering treaters who practiced on roads or in bazaars; the Tabiban or physicians who did ocular surgeries as well, such as couching; and the specialists who underwent specialized formal training.

During the 9th and 10th centuries, medicine experienced an upsurge in knowledge and skill in part due to Avicenna (980-1037), who write many books, some of which were used in medical schools throughout Europe. He is credited with describing the muscles of the eye and how the optic nerve crossed. He believed early on that strabismus could only be cured if treated at an early age.

Rhazes (850-932) was a great Persian physician. He was born in the Persian province of Khorassan. Considered a genius, his brilliance extended through music, astronomy, mathematics, and chemistry, as well as medicine-he was called “The Experienced” by his colleagues. Hard working even into his old age, he lost his sight at age 80 at the height of his reputation. His sight was lost due to cataracts, for which he refused surgery. Two years later he died.

His generosity to the poor left him penniless. He directed the largest hospital in Baghdad and believed that physicians should not accept, without questioning, all that was done before them. He suggested that the observations of a physician be given great credence in treatment. Among his seminal findings was that the pupillary light response was due to the contraction of small muscles in the iris. He also was the first to describe the differences between the lesions of smallpox, measles, and chickenpox.

Fall of the empire

Alexander’s attacks and conquest marked the fall of the Persian Empire and its status as the primary cultural and scientific center the world had ever known. Added to the loss of life the Persians endured during the fall of their empire, many books and cultural centers were destroyed by Alexander’s troops. The burning of Persepolis, the capital, marked one of the most tragic events in history. Here, Alexander annihilated an unarmed city after having declared victory. Far from its glorious days, Persia underwent attacks from Arabs and Mongols, leading to centuries of instability in the region, until one of the most venerated Iranians in history, Amir Kabir (1807-1852), then prime minister during the Qajar dynasty, established scientific centers such as the university of Dar-ol-Fonoon in 1851.

The following couplet from Ferdowsi’s Shahnameh, inscribed over the university’s entrance gate, marks the start of a new era where science regained its place in a society:

“Capable is the one who is enlightened,

Knowledge rejuvenates the heart of the old.”

International exchanges were again encouraged, and many Iranians traveled to Europe to further their education. One such Iranian, Dr. Mohammad Gholi Shams (1904–1996), chairman of the ophthalmology department at the Tehran University, founded the Iranian Society of Ophthalmology in 1947, which now has more than 1,500 members. The society encourages teaching, research, and improvement of ophthalmic care throughout Iran.

Progression to modern medicine

Treacher Collins, a well-known British physician, who, in 1900, described the syndrome that now carries his name, visited Persia at the end of the 19th century. His visit was to evaluate the eye problem that the Shah’s eldest son was having. Upon his return, he described the country as not being modern in terms of its medical system. Trachoma was the most common ocular ailment at the time and local remedies were all that was available.

In the 20th century, a great transition from traditional to modern medicine occurred. During the 1980s, after the Iraq invasion of Iran, use of chemical warfare resulted in world-renowned experts in the field of ophthalmology to occur out of pure necessity. Today, ophthalmologists, such as Ari Khodadoust, MD, although working in the United States, described the corneal transplant rejection line bearing his name, continues to further the field and inspire young physicians by establishing a state-of-the-art eye institute in Shiraz. Iranian ophthalmologists have continued to flourish in Iran in spite of the problems that the country is undergoing at present.

Arash Mozayan Isfahani, MD,

Norman B. Medow, MD, FACS, is editor of the Our Ophthalmic Heritage column. He is director, pediatric ophthalmology and strabismus, Montefiore Hospital Medical Center, and professor of ophthalmology and pediatrics, Albert Einstein College of Medicine, Bronx, NY. He did not indicate a financial interest in the subject matter.