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by Nasreen Syed, MD
Figure 1. Transillumination of an eye illustrating an intraocular tumor.
History: Pathology is the medical specialty that has applicability to every organ system and tissue in the body. Due to the broad spectrum of conditions pathologists see, it is not unusual to find sub-specialization within the field. Sub-specialization tends to be particularly common in academic and tertiary referral centers and provides an opportunity for more in-depth study and knowledge of a particular organ system or tissue.
The F. C. Blodi Eye Pathology Laboratory is an example of such sub-specialization. This ophthalmic pathology laboratory has been a part of UI Hospitals and Clinics since the 1950s. Since its inception, it has been a section of the Department of Ophthalmology and Visual Sciences, with close ties to the Department of Pathology.
Historically, the ophthalmic pathology laboratory was set up in the Department of Ophthalmology to provide a resource for further study of eye diseases and education for physicians in training. The first director of the laboratory was its namesake, Frederick C. Blodi, M.D. The laboratory soon grew to fill a niche in the Department of Ophthalmology that included the macroscopic and microscopic examination and diagnosis of surgical and autopsy specimens. At Blodi's retirement as department head, Thomas Weingeist, M.D., now professor and head of the Department of Ophthalmology and Visual Sciences, organized a fund-raising campaign to create an endowed professorship and name the eye pathology laboratory in honor of Blodi, who chaired the department from 1967 to 1984. Robert Folberg, M.D., an internationally recognized eye pathologist and researcher, was appointed as the first Frederick C. Blodi Professor and Director of Ophthalmic Pathology. The tradition of excellence in Ophthalmic Pathology continues in the Blodi Eye Pathology Laboratory today.
Today: Ophthalmic pathologists are a heterogeneous group of sub-specialists who have dedicated all or part of their medical practice to the pathological analysis of tissues from the eye and ocular adnexa (conjunctiva, eyelid, lacrimal system, and orbit). There is no established training pathway for ophthalmic pathology and no board certification in ophthalmic pathology. The majority of ophthalmic pathologists are board certified ophthalmologists who have additional fellowship training in ophthalmic pathology. A slightly smaller group includes board certified pathologists with additional fellowship training in ophthalmic pathology. The smallest group consists of those who are board certified in both ophthalmology and pathology. A minimum of one year of fellowship training in ophthalmic pathology is necessary to meet the criteria for ophthalmic pathologists.
The American Association of Ophthalmic Pathologists—an organization with more than 100 members—represents ophthalmic pathologists throughout the U.S. The work of ophthalmic pathologists varies depending on the setting in which they practice. Most are located at or associated with an academic center or teaching hospital with an ophthalmology training program. Their pathology practice may be in an independent laboratory or in a division of the pathology department. Most ophthalmic pathologists also have some clinical and/or basic science research interests in the field of ophthalmic pathology and related areas of ophthalmology. Having training in both ophthalmology and pathology provides the ophthalmologist with unique advantages in the diagnosis and study of ocular tissues.
The ophthalmic pathologist plays a particularly important role as teacher for residents in ophthalmology programs and, in some cases, pathology programs. The Ophthalmology Residency Review Committee and the American Board of Ophthalmology are committed to teaching residents ophthalmic pathology and have made study in this field a necessary requirement for completion of residency and board certification in ophthalmology.
Practice: The number of free-standing ophthalmic pathology laboratories in the U.S. is relatively small and has been shrinking with growing economic pressures on academic centers. The Department of Ophthalmology and Visual Sciences at the UI Roy J. and Lucille A. Carver College of Medicine is proud to have an independent ophthalmic pathology laboratory that serves UI Hospitals and Clinics and the state of Iowa. The F. C. Blodi Eye Pathology Laboratory is staffed with two ophthalmic pathologists. Both physicians are involved in the education of residents in ophthalmology and pathology as well as medical students.
How can the ophthalmic pathology laboratory be of use to your clinical practice? The F.C. Blodi Eye Pathology Laboratory is physically located at the Medical Research Center building in the Carver College of Medicine. The laboratory is fully certified and accredited by the College of American Pathologists as an anatomic pathology laboratory. The laboratory makes gross and microscopic examination of surgical pathology specimens from the eye and ocular adnexa and from autopsy eyes. It is fully equipped to process and section histological specimens and to do special histologic stains. Immunohistochemical stains are available as well.
The lab does a limited amount of cytology, including examination of vitreous and aqueous humor specimens. A detailed surgical pathology report is issued on every specimen sent to the ophthalmic pathology department. Although most specimens are read within two working days, some may take up to a week due to prolonged fixation or preparation time. The laboratory receives ocular specimens for consultation from ophthalmologists throughout the country and even from foreign countries.
Since a variety of unusual and unique disease processes may affect the eye and surrounding tissues, the ophthalmic pathology lab may be of particular help to other pathology labs that may not have expertise in examining the eye and eye tissues, such as the cornea, conjunctiva, and orbital lesions. The lab can be helpful in trying to make a difficult or unfamiliar diagnosis. Examples of such cases include intraocular tumors, such as retinoblastoma and uveal melanoma, glaucoma, conjunctival pigmented lesions, vitreous large cell lymphoma, and sebaceous cell carcinoma of the eyelid, to name a few. The ophthalmic pathology lab can be helpful in both the gross and microscopic preparation of tissue that may need special handling, such as eyes and corneas. Consultation or second opinions on difficult cases are available as well. The laboratory has an archive of tissues that dates back to the mid 1960s and is a valuable resource for research projects and clinicopathologic correlation.
Referral service: For more information or to submit a specimen for pathologic examination and/or consultation, please call UI Consult at 800-322-8442 or contact us in writing at: F. C. Blodi Eye Pathology Laboratory, 233 MRC, UI Carver College of Medicine, Iowa City, IA 52242. In the event that you have an unusual or uncommon specimen, you also may contact us directly at 319-335-7095, fax at 319-335-7193, or email at email@example.com. Visit our website at http://www.medicine.uiowa.edu/eye/path-lab/ for more information.
Nasreen A. Syed, M.D., is Director of the F. C. Blodi Eye Pathology Laboratory. She is a board certified ophthalmologist who is fellowship-trained in the field of ophthalmic pathology. She also holds a second appointment in the Department of Pathology. She completed her residency in ophthalmology at the Medical College of Wisconsin in Milwaukee, WI and spent two years as an ophthalmic pathology fellow at the University of Wisconsin in Madison.
Patricia A. Kirby, M.D., is a neuropathologist in the Department of Pathology, with a special interest in ophthalmic pathology. She received her training in Anatomic Pathology in South Africa and her training in neuropathology at the Royal College of Pathologists in London.