Szemészet, 2004 (141. évfolyam, 1-4. szám)

2004-06-01 / 2. szám

The development of ophthalmic health care in Hungary

over the last 100 years

Németh J.

Semmelweis University, 1st Department of Ophthalmology, Budapest

Two important measures of the quality of ophthalmic health care are, firstly, the “inputs” of resources - numbers of ophthalmic medical staff, and hospital beds; and, secondly, the results - the frequency of blindness and the range of the conditions causing it. This study presents numerical data reflecting the development of ophthalmic health care in Hungary, comparing the prevailing conditions at various dates during the past 100 years.

According to a report by Professor Emil Grósz, the first president of the Hungarian Ophthalmological Society, in 1904 the hospital ophthalmic provision in Hungary was as follows. There were two university ophthalmology departments, in Budapest and Kolozsvár, with 52 and 55 beds respectively; two specialist eye hospitals (Hódmezővásárhely and Brassó, 50 and 32 beds); and 8 trachoma wards in provincial state hospitals (Szeged, Privigye, Zsolna, Alsó-Lendva, Perlak, Zsablya, Ó-Becse, Kalocsa), with a total of 132 beds. There were another 7 hospitals in Budapest and 13 general hospitals in the provinces which had ophthalmic departments; these provided a total of 223 and 305 beds respectively. While the university departments and the specialist hospitals were well-equipped, the rest of the picture was less favourable. The trachoma wards were often in the charge of non-ophthalmologists, and in general hospitals the eye patients were usually cared for in medical and surgical wards. In his analysis of the then situation, Grósz concluded that “...the needs are not being adequately met by the currently existing institutions.” To remedy this, he urged that further eye-hospitals or ophthalmology wards in general hospitals should be set up. He pointed to the shining example of the Hódmezővásárhely eye-hospital, “created, in a very literal sense, by József Imre”, as he put it. The greater part of the costs of the city hospital’s new ophthalmology building and its equipment had been covered by loans which were to be repaid from the relatively modest treatment fees.

In consequence of the inadequate ophthalmic care provision, at the beginning of the 20th century the rate of blindness was higher than in Western European countries. It was noted with regret that in some 45% of the cases of blindness “the vision could have been saved by proper ophthalmic treatment”, as József Imre reported. At the Society’s 1907 general assembly it was proposed that the forthcoming national census should be used to collect statistics relating to blindness. The national survey of 1912 revealed that the most frequent disorders leading to blindness were those affecting the conjunctiva and cornea (34.6%); notable among these were trachoma (6.6%), blenorrhoea neonatorum (6.0%), and smallpox (5.0%). The next most common causes were cataract (24.5%), diseases affecting the optic nerve (11.3%), traumatic eye injuries (9.8%), and glaucoma (8.3%). Further significant groups were diseases of the uvea (3.9%), other congenital diseases (3.0%), and retinal disorders (1.8%). Unknown causes accounted for 2.6% of the cases.

State support was provided to develop the system, and thanks to this the number of ophthalmic beds was increased, from the above total of 849 in 1904 to 1482 in 1929. The world economic crisis of 1931 however led to a subsequent reduction in bed provision. A recovery took place after 1950, and there was gradual development from then until 1990. During this time the number of beds increased from 1269 to 2473, and the number of ophthalmologists from 208 to 801. Following the regime change of this time, there was a reform of the health care system. The number of beds was decreased: in 2001 there was recorded a total of 1723 beds for ophthalmic patients in 6 eye clinics and 56 ophthalmic wards. At the same time however the number of opthalmologists continued to increase. We can say that the standard of ophthalmic care in Hungary is today the equal of that in other developed countries; one demonstration of this is the satisfactorily high rate of cataract surgeries, 4828 annually per million population.

According to the results of our current survey, the principal cause of blindness in today’s Hungary is senile macular degeneration (27.1%). This is followed by diabetic retinopathy (16.3%), glaucoma (13.5%), myopia (10.2%), cataract (6.7%), and atrophy of the optic nerve (5.1%). The rate of blindness increases in those aged over 60; and it is interesting to note that blindness is between 1.6 and 2.3 times more frequent in elderly women than it is in men. It is revealing to look at the statistics for different age-groups. Under age 20, the most frequent cause is retinopathy of prematurity; while for the 21-40 age-group it is myopia. For 41-60 year olds, myopia and diabetes mellitus are the two equal most frequent causes. Above age 60, macular degeneration is the major disorder leading to blindness, and in those over 80 this accounts for more than half the cases.

4 June 2004 - History of Hungarian ophthalmology II.