what is the most life-and-death subspecialty within ophthalmology?

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Just wondering. I can imagine that ocular oncology by nature deals with some life-and-death type of surgeries. Are there any others?

None. Not even ocular oncology. If you have metastatic melanoma nothing we can do to the eye will change things.

Things we find in clinic might save a life. But not in the OR

Orbit trauma requiring emergency intraoperative release of entrapped extraocular muscles resulting in dangerous and unstable bradycardia (but which one might treat medically until emergent surgery.)

According to my friend, who is a retina surgeon, "simple" cataract surgery in the third world saves more lives than anything he has done practicing in America. He told me that life expectancy in the third world drops to less than a year after onset of blindness. He is active with ORBIS and tries to do as many trips with them as he can.

I would think the following apply:

retinoblastoma, choroidal melanoma, (metastatic orbital malignancies in general), rhino-orbital mucormycosis, any ocular infection causing septicemia, and peri-operative anaesthetic complications. All rare but real!

Plus, saw on discovery the other day rabies can be transmitted through the eye!

If you are looking for a subspecialty, not a specific diagnosis, I would say neuro-ophth, and even that is a stretch. My reasoning is that they order a lot more "emergent" testing than any other subspecialty--ie imaging to rule out aneurysms, tumors etc. Most of the time those tests are negative, but they deal with potentially lethal signs/symptoms a lot more than most subspecialties.

Thanks all. That tip about a person's life expectancy decreasing to <1yr in a 3rd world country is fascinating -- do you happen to know the source?

Originally Posted by TheLesPaul

Thanks all. That tip about a person's life expectancy decreasing to <1yr in a 3rd world country is fascinating -- do you happen to know the source?

I'm hangning out with him this weekend to celebrate my acceptance so I'll ask for a source if I can't find one myself. He said that countries on complete opposite sides of the world would treat blind people very similarly. Typically children are assinged to guide them around and they are generally considered drains on the society. He worked overseas for years after his fellowship finally returning to America.

Here is one article I found. Doesn't have the less than 1 year stat, but it paints a very bleak picture. One that can be helped by assistance.

http://www.cureblindness.org/world-blindness/

Another one that is an interview with a Cure Blindness head honcho:

http://www.share-international.org/a...ure-blind.html

Acute, pupil involving, third nerve palsy comes to mind due to the possiblity of a PCA aneurysm. Had a lady walk into our office last fall, late in the afternoon complaining of a droopy eyelid. I lifted up the lid saw the XT, HypoT and the large pupil and my blood pressure instantly shot up. I was on the phone with the ER within minutes and she was on the way to the ER a few minutes after that!