 Canadian Journal of Ophthalmology The official journal of the Canadian Ophthalmological Society |
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Volume 38, no.1, February 2003 |
| Editorial The value of clinicopathological correlation in patient care, teaching and research in ophthalmology Ocular pathology has been instrumental in the diagnosis of various conditions of the eye. More recently, advances in surgical techniques have enabled us to obtain biopsy and tissue samples from locations inside the eye that we were unable to obtain in the past. Moreover, new techniques in histopathology and molecular biology are now applicable to tiny fragments. Owing to these technical advances in both surgery and pathology, clinicopathological correlation has become extremely important, if not indispensable. As detailed by Dr. Lorenz Zimmerman1 in his exceptional XVII Jackson Memorial Lecture entitled “The Registry of Ophthalmic Pathology: past, present and future” (presented at the 65th Annual Session of the American Academy of Ophthalmology and Oto-Laryngology, Oct. 9–14, 1960, in Chicago), the decision by the Council of the American Academy of Ophthalmology and Oto-Laryngology in June 1921 to establish a museum of ophthalmic and otolaryngologic pathology was the catalyst that was responsible for the eventual creation of the American Registry of Ophthalmic Pathology. The Council members felt certain that without a permanent headquarters and without trained technicians, their vision of an organized collection of histopathological specimens would not be successful. At that time, a representative of the Council approached the surgeon general of the army, who offered the facilities of the Army Medical Museum for the establishment of the proposed collection. The surgeon general agreed not only to provide the physical space for the display of Ophthalmic and Oto-Laryngologic Pathology but also to cooperate further by sending reports of specimens together with photographs of both the gross specimens and the microscopic slides to contributors. The surgeon general assumed responsibility for the preparation of the collection of histopathological material along with the pertinent clinical information related to each case and made it available for viewing at the annual meetings of the American Academy of Ophthalmology and Oto-Laryngology. This was the first time that an organized collection of clinicopathological material was made available on an ongoing basis for ophthalmologists and pathologists. In subsequent years Dr. Frederick H. Verhoeff and Dr. Harry S. Gradle, with the help of Major George Russell Callender, organized a panel of experts to act as consultants to whom the museum could refer difficult cases for diagnosis and clinicopathological correlation. The panel included, in addition to Dr. Verhoeff (who was chairman), Dr. Gradle, Dr. M. Feingold, Dr. William C. Fennoff, Dr. W.E. Cemp and Dr. H. Barkin. This was, in essence, the beginning of the American Registry of Ophthalmic Pathology, as it now exists. As you are no doubt aware, the Registry is located at the Armed Forces Institute of Pathology, Washington, and is under the directorship of Dr. Ian W. McLean. Many of us, particularly during Dr. Zimmerman’s tenure as Chairman of Ophthalmic Pathology and Director of the American Registry of Ophthalmic Pathology, took advantage of the extraordinary collection during our fellowships. There, we learned the value of clinicopathological correlation, as did numerous other ophthalmologists throughout the world. In the United States and Canada many of Dr. Zimmerman’s former students have established impressive laboratories where clinicopathological correlation is one of the most important tools in patient care, teaching and research. Corneal buttons, vitrectomy specimens and retinal biopsy specimens are good examples of areas where clinicopathological correlation is essential to establish the final diagnosis. With today’s technology and the advances in telemedicine, we are able not only to study the histopathological features of a disease but also to learn, simultaneously, the clinical signs and symptoms of that particular condition. The benefits to patients of this type of clinicopathological correlation are limitless. Clinicopathological correlation can also be seen as an important research tool. The new techniques in molecular biology, such as the polymerase chain reaction and in situ hybridization, can now be performed on formalin-fixed, paraffin-embedded tissues. This means that tissue samples obtained many years ago can now be reexamined using new technology. Given all this, is there any doubt about the value of clinicopathological correlation in patient care, teaching and research? I, for one, don’t think so. Should the CJO dedicate more space to this important aspect of ophthalmology? It is my firm belief that the CJO would be not be living up to its mandate of disseminating information to improve patient care, teaching and research if clinicopathological correlation were not an essential part of our Journal. Miguel N. Burnier, Jr., MD, PhD Editor-in-Chief Reference 1. Zimmerman LE. The Registry of Ophthalmic Pathology: past, present and future. Trans Am Acad Ophthalmol Otolaryngol 1961;51:113. |
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