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Show Neuro-Ophthalmology in Switzerland Klara Landau, MD Historical Background Neuro-ophthalmology in Switzerland stands on the shoulders of giants. One hundred fifty years ago, Frie-drich Horner was the first ophthalmologist to hold an inde-pendent chair at the University of Zurich. Hans Goldmann invented-among many other examination techniques-the kinetic perimeter named after him while teaching and work-ing at the University of Bern. Adolphe Franceschetti made important contributions to the understanding of genetic dis-eases and to color vision while at the University of Geneva. While serving as chair in Lausanne, Marc Amsler developed his famous "Amsler grid," thus pointing out the importance of the central visual field. Volker Henn made seminal con-tributions in the fields of ocular motor and vestibular research in the Department of Neurology in Zurich. Close collaboration with 2 famous neurosurgeons in Zurich, Hugo Krayenbühl and "Neurosurgeon of the Cen-tury" M. Gazi Yas¸argil, brought Alfred Huber's career to fame far beyond the Swiss borders. His book "Eye Signs and Symptoms in Brain Tumors," which first appeared in 1956 in German and was later translated into English, rep-resents a marvelously documented account of his vast clinical experience as the first Swiss neuro-ophthalmologist (Fig. 1). Alfred Huber together with Tom Hedges founded the Inter-national Neuro-Ophthalmology Society (INOS) and together with Adolphe Neetens from Belgium established the European Neuro-Ophthalmology Society (EUNOS). Two INOS meetings have taken place in Switzerland, the third meeting in 1980, organized by Alfred Huber in Valbella in the mountains of Grisons, and the 15th meeting, organized in 2004 by Avinoam Safran in Geneva. Zurich was the site of the first EUNOS meeting in 1993. Switzerland's Society and Health System What is special about Switzerland and how does it affect our subspecialty? It is a country of 7 million people who speak 4 different languages (German, French, Italian, and Romansh). Despite such diversity, the Swiss have a very stable political system that is based on direct democracy and on autonomy of each of its 23 cantons. The main political and social attitude is pragmatic collaboration between all parties, requiring the willingness to compromise. This organization works well including the country's health care system. Five Swiss Universities offer teaching of medical students: 3 in German (Basel, Bern, and Zurich) and 2 in French (Geneva and Lausanne). Less than 1000 medical students graduate each year, a number that is not sufficient to cover the coun-try's demand. That is why physicians from other EU countries, mainly from neighboring Germany, Austria, France, and Italy move to Switzerland to work, both in hospitals and in private clinics. Why is Switzerland so attractive for physicians? There are several reasons including the stability of the country, the FIG. 1. Alfred Huber, MD, the founder of neuro-ophthalmology as a subspecialty in Switzerland. Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland e28 Landau: J Neuro-Ophthalmol 2013; 33: e28-e30 Worldwide Neuro-Opthalmology Section Editor: Kathleen B. Digre, MD Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. high quality of health care, and universal access. In addition, 10 years ago, a sophisticated reimbursement system was implemented that is quite unique. It is not technical procedures, but rather time that physicians spend with their patients. For neuro-ophthalmologists, this represents a major advantage. Neuro-Ophthalmology in Switzerland Today each large teaching hospital, not just those that are affiliated with the 5 medical schools, have at least a small unit staffed with a fellowship-trained neuro-ophthalmologist (Table 1). These units are mostly, but not exclusively, based in ophthalmology departments and some are located in neurol-ogy. Frequently, the neuro-ophthalmologist combines his or her practice with other subspecialties, such as pediatric oph-thalmology and strabismus, electrophysiology or orbital dis-ease. There exists no formal Swiss Neuro-Ophthalmology Society, but rather a group of colleagues who share their common interest and communicate well. Main neuro-ophthalmology centers are currently located in Aarau, Bern, Basel, Lausanne, Luzern, St Gall, and Zurich. For a period of 6 years, 2 of the 5 ophthalmology chairs were neuro-ophthalmologists: Avinoam Safran in Geneva (1998 till 2010) and Klara Landau (since 2005) in Zurich. The Swiss Ophthalmological Society annual meeting is held each fall alternating among 3 language regions of Switzerland: German (Interlaken), the French (Montreux, Fribourg) and the Italian (Lugano, Locarno). The scien-tific program always includes a neuro-ophthalmology session. In addition, the group from Lausanne holds regular local neuro-ophthalmology teaching courses in French. In the German part of Switzerland, the neuro-ophthalmologists teach in German at their respective hospitals. For decades, a national Winter Ophthalmic Seminar has been held in one of the beautiful Swiss ski resorts with international TABLE 1. Currently active neuro-ophthalmologists in Switzerland Name, City Training Mentor, City Matthias Abegg, Bern Ophthalmology Jason Barton, Vancouver Yael Bellaiche Shavit, Zurich Ophthalmology Neil Miller, Baltimore Anne-Caroline Bessero, Sion Ophthalmology James Acheson, London Francois Xavier Borruat, Lausanne Ophthalmology Michael Sanders, London J. Lawton Smith, Miami Joel Glaser, Miami Norman Schatz, Miami Anna Fierz, Zurich Ophthalmology Eric Eggenberger, East Lansing David Kaufman, East Lansing Christina Gerth-Kahlert, Zurich Ophthalmology Ray Buncic, Toronto Agnes Wong, Toronto Oliver Job, Lucerne Ophthalmology Joel Glaser, Miami Norman Schatz, Miami Aki Kawasaki, Lausanne Neurology Robert Yee, Indianapolis Stanley Thompson, Iowa City Randy Kardon, Iowa City Michael Wall, Iowa City Hanspeter Killer, Aarau Ophthalmology Ron Burde, New York Klara Landau, Zurich Ophthalmology William F. Hoyt, San Francisco Otmar Meienberg, Binningen Neurology William F. Hoyt, San Francisco Daniel Mojon, St Gall Ophthalmology Jeff Odel, New York René Müri, Bern Neurology Charles Pierrot-Desilligny, Paris Anja Palmowski-Wolf, Basel Ophthalmology Erich Sutter, San Francisco Craig Hoyt, San Francisco Misha Pless, Lucerne Neurology Simmons Lessell, Boston Dominik Straumann, Zurich Neurology David Zee, Baltimore Veit Sturn, St Gall Ophthalmology Klara Landau, Zurich Agnes Wong, Toronto Nadja Tajouri, Sion Ophthalmology Joseph Rizzo, Boston Christa Vollrath-Junger, Zurich Ophthalmology Guntram Kommerell, Freilburg William F. Hoyt, San Francisco Konrad Weber, Zurich Neurology Michael Halmagyi, Sydney Ian Curthoys, Sydney Hannes Wildberger, Zurich Ophthalmology Fried van Lith, Rotterdam Harold Henkes, Rotterdam Landau: J Neuro-Ophthalmol 2013; 33: e28-e30 e29 Worldwide Neuro-Opthalmology Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. guests teaching neuro-ophthalmology in English, hosted by local organizers from Lausanne and Zurich. Because of difficulties related to sponsoring regulations, this popular tradition had to be modified and is now available to a rather limited number of practitioners in the German part of Switzerland alone. Irene Gottlob, who used to be in charge of the Neuro-Ophthalmology and Strabismus unit in St Gall before moving to the United Kingdom, established a 2-day spring meeting featuring case presenta-tions in neuro-ophthalmology and strabismus. It has been continued by Daniel Mojon and currently by Veit Sturm. In the summer of 2012, a very successful 2-day practical course in neuro-ophthalmology was held at a lakeside castle near Zurich. The format and the content were prepared by Jonathan Trobe, who delivered introductory lectures followed by intensive work in small groups, supervised by Dominik Straumann, Konrad Weber, and Klara Landau. This course will be repeated in June of 2014 with David Zee joining Jonathan Trobe. It will represent the second EUNOS update course for residents. Outlook The future of neuro-ophthalmology in Switzerland will be determined by curious, creative, and passionate young physi-cians with a genuine interest in answering the many unsolved questions in our subspecialty. It is our responsibility to motivate them and, at the same time, to preserve our favorable health system structures. Looking at the developments in Germany, where neuro-ophthalmology is rapidly losing ground because of shortsighted political decisions and is disappearing from the teaching programs, every effort should be made to avoid a similar development in Switzerland. We owe this to our patients, our colleagues, and our founders including Friedrich Horner, Adolphe Franceschetti, Marc Amsler, Hans Gold-mann, Alfred Huber, Volker Henn, and Avinoam Safran. Klara Landau, MD Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland e30 Landau: J Neuro-Ophthalmol 2013; 33: e28-e30 Worldwide Neuro-Opthalmology Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. |
