The current face of ophthalmic pathology.
Subject: Ophthalmology (Forecasts and trends)
Ophthalmology (Standards)
Eye diseases (Diagnosis)
Eye diseases (Care and treatment)
Pathology (Forecasts and trends)
Pathology (Standards)
Author: Chevez-Barrios, Patricia
Pub Date: 08/01/2009
Publication: Name: Archives of Pathology & Laboratory Medicine Publisher: College of American Pathologists Audience: Academic; Professional Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2009 College of American Pathologists ISSN: 1543-2165
Issue: Date: August, 2009 Source Volume: 133 Source Issue: 8
Topic: Event Code: 010 Forecasts, trends, outlooks; 350 Product standards, safety, & recalls Computer Subject: Market trend/market analysis
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 230247099
Full Text: In the last 150 years, ophthalmic pathology as a defined discipline has taken shape, thanks to the organized efforts of both ophthalmologists and pathologists. Ophthalmic pathology has contributed steadily to the advancement of the understanding of ocular diseases and the origin, behavior, prognosis, and treatment of ocular and periocular tumors. The practice of ophthalmic pathology has undergone changes mandated mostly by external circumstances and also by the advancement of science and technology. (1,2) In the early stages of the specialty, pioneers in the field, like Dr James Waldrop, were clinicians who had a special interest that took them beyond the clinical presentation into the pathologic processes of disease. Waldrop studied the pathology of retinoblastoma in the late 18th and early 19th centuries in the United Kingdom.1,2 Later, in the second half of the 20th century, there were both ophthalmologists and pathologists who worked full time in ophthalmic pathology and who contributed to most of the knowledge that we currently have for the discipline. The pioneers of this era were and are both pathologists and great leaders of the specialty--one in America, Prof Lorenz E. Zimmerman, of the Armed Forces Institute of Pathology, Washington, DC, and the other in Europe, Prof Norman Ashton, from London. Both helped shape what we now know as the basis of ophthalmic pathology by describing their findings and publishing peer-reviewed manuscripts and books but, more importantly, by sharing their knowledge and experience with many physicians interested in ocular pathology and the study of tumors of the eye.

Now, at the beginning of the 21st century, new generations of ophthalmic pathologists are ideally trained in both ophthalmology and pathology and perform an ophthalmic pathology fellowship, and they practice ocular pathology as well as either ophthalmology or pathology. In the current era, the specialty faces many challenges: there is a shortage of fully trained ocular pathologists and a lack of support by ophthalmology departments that threatens even the educational and research missions of the ocular pathologist. (2) Added to these, the changing face of medicine in the current environment, with the enormous challenges in the health care system, has made it almost impossible for the ophthalmic pathologist to practice only the subspecialty. On the other hand, during the last few decades, science, and especially biotechnology, has advanced at an accelerated pace. Molecular diagnosis, nanotechnology, and imaging have been incorporated as essential tools in patient care. Contemporary ophthalmic pathologists have a unique opportunity to integrate the fundamental, well-founded knowledge of ophthalmic pathology with these new modalities and successfully have an impact on the treatment of their patients.

It is encouraging for those dedicated to ophthalmic pathology to see the quality and number of articles published in this Ophthalmic Pathology Joint Theme Issue between the Archives of Ophthalmology and the Archives of Pathology & Laboratory Medicine. Both journals--the Archives of Ophthalmology (since 1869) and the Archives of Pathology & Laboratory Medicine (since 1926)--were recently named one of the top 100 most influential journals in biology and medicine of the past 100 years by the Biomedical and Life Sciences Division of the Special Libraries Association, and each was the only representative of its specialty. Although ophthalmic articles appear in both journals as part of this joint theme issue, those with emphasis on pathology or diagnostic pathology techniques can be found in Archives of Pathology & Laboratory Medicine, whereas the more clinically oriented papers appear in Archives of Ophthalmology (

In this joint issue, the original articles, case reports, resident reviews, and research letters reflect the evolution, the challenges, and the contemporary practice of ophthalmic pathology. Original articles explore new prognostic factors, report validation of molecular tests, and describe molecular techniques in the diagnosis and prognosis of tumors and infectious diseases. There is an article on the use of nanotechnology in preclinical studies for the treatment of retinoblastoma, and other articles relate new imaging techniques to the histopathology of certain diseases. A series of articles (3) on the ophthalmic sites that appear in the American Joint Committee on Cancer's International Union Against Cancer TNM Staging Manual, 7th Edition, details the changes and new prognostic factors, and integrates in some cases molecular factors and clinicopathologic correlation. I invite you, then, to look at the articles in both journals because they are different from each other, although all are related to ophthalmic pathology and the study of tumors.

It is revitalizing to witness the great response that this joint issue has had among established ophthalmic pathologists as well as new contributors around the world. No less impressive was the work that was put out by ophthalmic pathologists and others in related fields who served as reviewers for both journals for the many manuscripts submitted for this joint issue. Our challenge is to continue advancing the field by keeping up with the progress in science and technology and by integrating the technologies to our well-founded knowledge of ocular disease to shape the new and evolving face of ophthalmic pathology.

Accepted for publication August 22, 2009.


(1.) Klintworth GK. Ashton lecture: ophthalmic pathology from its beginning to the high technology of this millennium. Eye. 2001;15:569-577.

(2.) Apple DJ, Werner L, Mamalis N, Olson RJ. The "demise" of diagnostic and research ocular pathology: temporary or forever? Trans Am Ophthalmol Soc. 2003;101:12 7-140.

(3.) Edge SE, Byrd DR, Carducci MA, Compton CA, eds. AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer; 2009.

Dr Chevez-Barrios earned her medical degree from the University of Mexico in Mexico City. She completed fellowships in anterior segment surgery and ophthalmic pathology as well as her ophthalmology residency at the Luis Sanchez Bulnes Hospital in Coyoacan, Mexico. She then completed fellowships in ocular pathology at Baylor College of Medicine and retina at the University of Texas Medical School at Houston. Dr Chevez-Barrios completed her residency in anatomic and clinical pathology at Baylor College of Medicine. She is an associate professor in pathology at Weill Medical College, Cornell University, Department of Pathology at the Methodist Hospital, and she is a clinical assistant professor of ophthalmology at Baylor College of Medicine and a clinical associate professor in the Department of Pathology at M. D. Anderson Cancer Center, University of Texas, Houston. She is also an associate member of the Methodist Hospital Research Institute and the research codirector of the Retinoblastoma Center of Houston.

Patricia Chevez-Barrios, MD

From the Department of Pathology and Laboratory Medicine, Weill Medical College of Cornell University, the Department of Pathology, Division of Laboratory Medicine, University of Texas M. D. Anderson Cancer Center, the Department of Ophthalmology, Baylor College of Medicine, the Retinoblastoma Center of Houston, and the Ophthalmic Pathology Program, The Methodist Hospital, Houston, Texas.

This editorial is being published simultaneously in the August 2009 issue of Archives of Ophthalmology.

The author has no relevant financial interest in the products or companies described in this article.

Reprints: Patricia Chevez-Barrios, MD, Ophthalmic Pathology Program, The Methodist Hospital, 6565 Fannin St, MS205, Houston, TX 77030 (e-mail:

Dr Chevez-Barrios has published many peer-reviewed journal articles and book chapters, and she has received grants supporting her research in retinoblastoma. She practices as a pathologist and ophthalmic pathologist, and she is involved in basic and translational research in retinoblastoma--the most common malignant intraocular tumor in children. For her interest in this field, she has participated in the first gene therapy trial in retinoblastoma and now participates in national and international clinical trials to standardize criteria for the use of adjuvant chemotherapy and to evaluate high-risk features in children with retinoblastoma. Dr Chevez-Barrios is program director of an Accreditation Council for Graduate Medical Education-accredited ophthalmic pathology fellowship program. She also heads the Methodist Hospital Research Institute Summer Student Program, in its fifth year in 2009, where college students from universities around the country participate in research at laboratories at the Methodist Hospital Research Institute. She is a member of the editorial board of the Archives of Ophthalmology and the Archives of Pathology & Laboratory Medicine. She is the recipient of several awards, including teaching awards and the 2007 Achievement Award from the American Academy of Ophthalmology.
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