‘My first encounter with ophthalmic matters was when, at 11 years old in 1956, I was prescribed -1D to correct my myopia,’ says Professor Bernard Gilmartin, Emeritus Professor of Optometry at Aston University. ‘This was a complete mystery to me as I was not aware of any history of myopia in my family and very few of my school friends were myopic.’
A trip to the Manchester library for a copy of Bates’ book Better Sight Without Glasses followed. This, says Prof Gilmartin, presented a variety of suggested treatments for myopia, which he says seeded his interest in an area of optics that would come to win him praise from the optical profession.
‘My chief interests at that time were music and football,’ he adds and while his correction was relatively stable throughout school it had increased sufficiently that, contemplating sixth form, he changed his options from the arts to sciences so that I could examine courses that would incorporate myopia as a subject.
‘Optometry, or ophthalmic optics as it was known at that time, was offered in just five university departments across the UK but subsequently, in 1965, I opted to enrol at City University, London, which was the first to offer a degree course in the subject.’
Student life in London in the 1960s was an all-round positive experience, he remembers, but the mystery of myopia deepened further. ‘At that time the major consensus was that axial length, the principle structural correlate of myopia, was almost complete by two years of age and then tapered to full completion by 15 years.
‘Family history was considered, then and now, to be the major determinant with environment playing a minor part. During my time at City, my myopia increased by 4D to -6D and there was still no evidence of a family history.
‘I completed my pre-registration with six months in London before returning to Manchester for the second six months, and although myopia was certainly still a major interest for me, very few postgraduate courses were available at that time.
‘In 1969, I undertook a PhD in experimental psychology in the ophthalmic optics department at City University, London. This project was funded by Rank Xerox for two years and with the advent of colour photocopying concerned visual information processing with colour.
‘The third year of my PhD was combined with a lectureship at City, for which, as a participant in a Manchester post sixth form teaching scheme for a year, had given me some preparation.’
After seven years in London, it was time for a quieter life and Prof Gilmartin moved to the Midlands to take up a full-time post as an optometrist in practice. After two years an opportunity to return to teaching and research in myopia arose and in 1974 he joined the academic staff in the optometry department at Aston University.
As is often the case in life, he remarks, this was to be an interim measure but what followed was a 44-year career at Aston and a teaching of around 4,000 students with supervision of over 20 PhD students.
He continues: ‘Alongside the clinical teaching, my academic subject areas were visual optics, visual perception and ophthalmic drugs. The latter supported my interest in the autonomic control of ocular accommodation and its links with the near vision triad of accommodation, pupil reaction and vergence.
‘This interest underpinned the consensus at the time (the latter part of the 20th century) that myopia was a consequence of sustained near vision that involved high levels of cognitive demand. This notion generated a number of treatment protocols and still prevails to some extent, but has since been displaced by proposals that peripheral vision can override central vision in determining the final refractive status of the developing eye.’
‘By the early 21st century, animal models of experimental myopia could demonstrate specific structural changes to a variety of optical manipulations and this prompted a shift in my research interest towards understanding better structural change in human myopia. Subsequent work using anterior and posterior optical coherence tomography and magnetic resonance imaging (MRI) has been able to define more accurately the distinction between the emmetropic and myopic eye. Of particular note was the ability to display and examine in vivo an eye in three dimensions using MRI.
‘With the likely prospect of at least a quarter of the world’s population becoming myopic, it will be important to understand fully the structural consequences of treatment protocols including the optical and pharmacological methods currently being applied to clinical management.’
When asked if there were things he would have done differently, Prof Gilmartin says: ‘As I suspect is the case for the majority of academics, a major textbook on his or her subject of interest is often confined to the pending tray, but this omission has been greatly offset by the significant academic and clinical achievements of the PhD students I have supervised.’
His advice to the aspiring youth is also unequivocal: ‘My school careers master gave me a blank stare when I first mentioned a career in ophthalmic optics, so I would say to the young optometrist follow your heart not your head in pursuing an academic or clinical interest.’
So much has been achieved but the work goes on, he says: ‘Notwithstanding the clinical management of myopia, the advances of medical technology will continue to present challenging and interesting opportunities for all healthcare professionals.’
