Journal of the Formosan Medical Association (2016) 115, 1025e1031

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REVIEW ARTICLE History and development of ophthalmology in Yu-Chih Hou a, Gale A. Oren b, Muh-Shy Chen a,c, Fung-Rong Hu a,* a Department of Ophthalmology, National Taiwan University Hospital, National Taiwan University College of , , Taiwan b Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA c Department of Ophthalmology, Cardinal Tien Hospital, College of Medicine, Fu Jen University, , Taiwan

Received 21 March 2016; received in revised form 17 September 2016; accepted 24 September 2016

KEYWORDS Western medicine was first introduced to Taiwan by medical missionaries in the mid-19th cen- evolution; tury. Modernization of medicine was systematically transplanted to Taiwan in the Japanese history; colonial period, and ophthalmology was established third among hospital departments, ophthalmology; following internal medicine and surgery. Dr Hidetaka Yamaguchi, an ophthalmologist, was Taiwan the first head of the Taihoku Hospital, later known as National Taiwan University Hospital (NTUH; Taipei, Taiwan). Ophthalmologists during the colonial period conducted studies on tropical and infectious eye diseases. After World War II, ophthalmologists at NTUH played an important role in medical education, residency training, studies, and teaching. Dr Yan-Fei Yang established the Taiwan Ophthalmological Society in 1960 and instituted its official journal in 1962. Dr Ho-Ming Lin established the Department of Ophthalmology at the Tri-Service General Hospital in the 1950s and the Veterans General Hospital in the 1960s. Taiwan ophthalmologists eradicated trachoma by 1971. Cataract surgery and penetrating keratoplasty were initially performed in the 1960s. Currently, there are about 1600 ophthalmologists in Taiwan con- ducting an estimated 120,000 cataract surgeries and 600 corneal transplantations annually. Many subspecialty societies have been established recently that serve to educate Taiwanese ophthalmologists and to connect with international ophthalmic societies. Taiwan ophthalmol- ogists continue to contribute to the advancement of ophthalmic knowledge globally. Copyright ª 2016, Formosan Medical Association. Published by Elsevier Taiwan LLC. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by- nc-nd/4.0/).

Conflicts of interest: The authors have no conflicts of interest relevant to this article. * Corresponding author. Department of Ophthalmology, National Taiwan University Hospital, 7, Chung-Shan South Road, Taipei 10002, Taiwan. E-mail address: [email protected] (F.-R. Hu). http://dx.doi.org/10.1016/j.jfma.2016.09.011 0929-6646/Copyright ª 2016, Formosan Medical Association. Published by Elsevier Taiwan LLC. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). 1026 Y.-C. Hou et al.

Introduction These and many other medical missionaries played an important role in the provision of healthcare. William Taiwan is also known as Formosa, meaning “beautiful is- Campbell, a Scottish Presbyterian missionary, founded the 2 land,” as named by the Portuguese cartographer, Lopo island’s first school for the blind at during that era. Homem, as he first laid eyes on this previously uncharted Their associated hospitals have evolved into the three large green island in 1544. Later, the island was invaded and Christian hospital chains in Taiwan. While they may have ruled by several foreign powers over the next 400 years.1,2 been the first to introduce Western medical practice to The course of medicine in Taiwan was profoundly influ- Taiwan, the systematic modernization of medicine came enced by its destiny of frequent changes in sovereignty over later. the years and can be roughly classified into three periods: precolonial period, Japanese colonial period, and post- Japanese colonial period colonial period. Internal medicine and surgery initially were the two major disciplines of established medical practice in Westernization of healthcare in Taiwan Taiwan, but ophthalmology as a specialty received sub- stantial attention later on because of its unique charac- teristics. Taiwanese ophthalmology was significantly A half century of Japanese colonial rule began in 1895 when influenced by Japan and the United States, and subse- Taiwan was ceded to Japan by the Ch’ing Dynasty, China. quently, ophthalmology played an important role in Japan strove to turn Taiwan, its first colony, into a show- Taiwanese medical history. case to demonstrate parity with the Western imperial powers1; subsequently, the Japanese medical education and healthcare system were transplanted to Taiwan during Precolonial period this period. In effect, the entire style of care was system- atically transformed from Chinese medicine to Western Early history medicine. In 1897, there were 1046 traditional Chinese medicine practitioners; by 1945, only 97 remained.10 In- fectious diseases were rampant at that time, including Early accounts of the Formosan aborigines by outsiders dysentery, , typhus, cholera, small pox, measles, mentioned bathing in streams as the main treatment for and trachoma.2 Great strides were made in improving sickness3; however, witchcraft and herbs were recorded as public health for the island, including building water and the prevalent treatments for an extensive period. The early sanitation systems, mandating compulsory immunizations, Chinese immigrants also brought with them their own and dealing with epidemics and contagious diseases, etc.11 practice of traditional Chinese medicine. In 1624, the Dutch landed at Anping Harbor, Tainan in Southern Taiwan. The doctors from the Dutch East India Company may have been First hospital in Taiwan during Japanese period the first Western doctors in Taiwan, but, unfortunately, no record of their medical practices remained. After Japanese troops entered Taipei (Taihoku in Japa- nese), the “Japanese Taiwan Hospital” was first established Missionaries in the Dadaocheng district of Taipei City on June 20, 1885. Initially, there were only two departments (internal medi- cine and surgery), serviced by 10 medical doctors, nine Missionaries, combining medicine with religion, contributed pharmacists, and 20 nurses, all of whom came from a great deal to the furthering of medical services in Taiwan. Japan.12 In 1896, a total of seven hospitals were set up In 1865, the first Presbyterian medical missionary, Dr James among the initial four districts of Taiwan. Dr Shinpei Goto, a L. Maxwell (1836e1921), arrived from England and began politician with a medical background who served as Civil preaching and practicing medicine in Tainan. Dr Maxwell Governor between 1898 and 1906, is considered to be the introduced Western medicine to the island and established father of the Taiwan modernization. As the head of the the first ward-based hospital in southern Taiwan.4,5 Home Ministry’s Medical Bureau and the Taiwan Govern- Reverend George Leslie Mackay (1844e1901) arrived ment General (TGG) medical advisor in 1896, he invited Dr from Canada in 1872 and, with the help of several doctors, Hidetaka Yamaguchi, an ophthalmologist, to be the first established medical and dental services in Northern head of the “Taipei Hospital” and the first president of the Taiwan. He continued his work in Taiwan until his death in TGG Medical School. The wooden “Japanese Taiwan Hos- 1901. The Mackay Memorial Hospital, established in 1912, pital” was renamed “Taihoku Hospital,” and in 1923 it was was named in his honor.6,7 rebuilt in attractive red brick. It’s now known as National Dr David Landsborough III (1870e1957) from Scotland, Taiwan University Hospital (NTUH; Figure 1). who arrived in Taiwan in 1895, established a hospital in Changhua where he devoted 40 years to his mission. Dr David Lansborough IV (1914e2010), born in Taiwan, First medical during Japanese continued his father’s work for another 28 years.8 period Dr Gushue-Taylor (1883e1954) arrived in 1912 from En- gland and spent more than 30 years caring for patients at The only institution of medical education during the colo- both British and Canadian medical missions in Taiwan. He nial period was the TGG Medical School, which was estab- and his wife established the Happy Mount leprosy colony in lished in Taipei in 1899. Thirty-seven years later, it was northern Taiwan in 1934.9 renamed Taihoku Imperial University Medical School, and is History of ophthalmology in Taiwan 1027

ophthalmological paper published in a Taiwan medical journal.15 Among the succeeding chairs, Dr Toru Motegi played a significant role in the modernization of ophthalmology and the organization of ophthalmological academic meetings in Taiwan. Because Taiwan is in a subtropical region, he conducted several studies in tropical eye diseases, including uv-related conjunctivitis (4.38% in young males)16 and pterygium (6.5% in males and 7.1% in females).17 He made a significant contribution to the medical literature by publishing 76 papers and also presented 125 lectures from 1930 to 1938. In 1937, he presented a paper “Trachoma research in Taiwan” at the International Ophthalmology Society in Cairo, Egypt. He organized an academic meeting series, “Taiwan Ophthalmological Focus Talks,” starting in 1933, which were held in a different prefecture each time; there was 16 meetings and 273 lectures in all through 1943. When he became chairman in 1938, he launched another aca- demic meeting series, “Taihoku Imperial University Ophthalmological Focus Talks,” which were held two or three times annually. These meetings helped raise the ac- ademic standards of ophthalmology at the university hos- pital and other hospitals in Taiwan.

Postcolonial period

National Taiwan University Hospital Figure 1 National Taiwan University Hospital. The red brick hospital was rebuilt from the original wooden architecture in At the end of World War II in 1945, Taiwan was returned to 1923 (A) and became the Outpatient Department of National Chinese rule. The “Taihoku Imperial University” was Taiwan University Hospital (B). renamed “National Taiwan University” (NTU). Dr Lin-Yuan Chiou became the first chairman of the Department of Ophthalmology at the NTU Hospital (NTUH), but he left for now known as National Taiwan University College of Medi- China following the 228 Massacre of 1947. He was suc- cine (NTUCM). Prior to 1945, the majority of local oph- ceeded as chair by Dr Shin-Lin Hu, who was arrested at a thalmologists either came from Japan or were educated at hospital faculty meeting in 1950 and was imprisoned for 10 the Taihoku Imperial University.13 years during the period of the Chinese Nationalist Party, also known as (KMT). Ophthalmology during the Japanese period 1910e1997 Dr Yamaguchi established the Department of Ophthal- Dr Yan-Fei Yang, the third chairman of NTUH’s Department mology as separate from internal medicine in March 1897. of Ophthalmology, held the chair position for 20 years, and The Department of Ophthalmology became the third clin- under his leadership a solid foundation for the future ical department at Taipei Hospital and the first ophthal- development of the department was established. He mology department in Taiwan.2,14 Because of this unique completely changed the medical educational system from consideration, ophthalmology received a great deal of the original Japanese lecture structure to the American attention at that time. This event served as a model in medical education system. The original system of charting other newly established hospitals in other districts, as de- medical records in German was also converted to an English partments of ophthalmology were set up earlier than other system. Subspecialty clinics were set up in 1954, which specialties. included trachoma, refraction, glaucoma, strabismus, and Dr Yamaguchi recruited Dr Shosaku Seo as the first amblyopia. chairman of the Department of Ophthalmology. Initially, Dr Yang authored the Manual of Ophthalmology for in- there were five doctors in the department. Owing to the terns, and edited the Lectures of NTUH Ophthalmology for lack of textbooks at that time, Dr Seo translated Handbuch residents. Medical clerks had lectures in general ophthal- der Augenheilkunde, which was edited by Edouard Meyer, mology and underwent training and practice to improve for teaching medical students. Later, several German their skills in giving ophthalmologic examinations. In a 4- books were used as textbooks including Lehrbuch und week-long course, interns attended a 12-lecture series on Atlas der Augenheilkunde by P. Axenfeld, Lehrbuch der topics in ophthalmology, and also trained under residents Augenheilkunde by E. Fuchs, and Augenarztuche Eingriffe and attending while caring for admitted pa- by J. Meller. Drs. Yamaguchi and Seo authored the first tients. These improvements in ophthalmological education 1028 Y.-C. Hou et al. significantly impacted the training outcomes of medical development of healthcare in Taiwan, especially with sol- students and residents in Taiwan. diers and veterans. Among them, Dr Ho-Ming Lin was To further raise the levels of academic professionalism, assigned to establish the Department of Ophthalmology at Dr Yang established the Ophthalmological Society of the the Tri-Service General Hospital and became the first Republic of China in 1960 (later renamed as the Ophthal- departmental chairman in 1949. He discovered vitamin A mological Society of Taiwan). He became the first president deficiency in soldiers with night blindness who were sub- of the society and continued in that capacity from 1960 to sequently treated successfully with fish oil and carrots. He 1978. (His successor, Dr Chen-Wu Chen, succeeded in 1978, also treated soldiers with vitamin B deficiency and optic and Dr Liang-Shi Ko followed in 1986.) Dr Yang also insti- neuropathy who improved after adding brown rice and tuted the official journal of the society, Transactions of the fruits to their diets. As an associate professor at the Insti- Ophthalmological Society of the Republic of China, in 1962, tute of the National Defense Medical Center in 1950, Dr Lin which was renamed Acta Societatis Ophthalmologicae wrote educational materials on the prevention and treat- Sinicae in 1992. In the inaugural issue of the transactions, ment of trachoma, and trained military doctors to help Dr Yang reported a 68% success rate using electro- control trachoma among soldiers and veterans.21 The Vet- coagulation for treating retinal detachment.18 When Dr erans General Hospital was established in Taipei in 1954, Yang passed away in 1997, he donated his body to the and Dr Lin became the founding chairman of Department of NTUCM for anatomical education. Ophthalmology there in 1959, and retained this position (chairman) for 23 years. Most ophthalmologists trained in Ophthalmologists from NTUH military and veterans hospitals in Taiwan were students of Dr Lin. 1918e1997 Dr Wu-Fu Chen was born to a family of devout members of Trends of epidemic diseases the Presbyterian Church in Yilan in Northeast Taiwan. Dr Chen graduated from Taihoku Imperial Univer- Trachoma sity Medical School in 1943. After a 3-year training program in ophthalmology at Taihoku Hospital, he returned to his Trachoma was highly prevalent in the colonial period and hometown and founded a hospital to serve the people of was considered to be the major cause of preventable Yilan County, at that time a poor area lacking doctors and blindness. The prevalence rate was 44.9% in 1913, 38.7% in medical care. Because of his religious beliefs and humani- the period from 1915 to 1917, 35.3% from 1922 to 1925, and tarian way of life, he often went to the mountain areas to then 22.95% in 1929.15 A mass survey by NTUH showed a take care of indigenous patients free of charge. high prevalence rate of trachoma among students, 73.35% Although many people were helped because of his in 1950.15 skillful care and charity, some patients unavoidably still lost In 1952, the Expert Committee on Trachoma of the their sight. In 1959, Dr Chen established the “Mu-Kuang World Health Organization (WHO) proposed treating Rehabilitation Center for the Blind” and also developed trachoma with aureomycin and terramycin.22 A mass devices to help rehabilitate blind patients in Luodong in campaign against trachoma in Taiwan allocated by the Yilan County. When he learned about Dr Albert Schweitzer’s United Nations Children’s Fund started in 1954, initiated by work at Lambare´ne´, Gabon, he was inspired to write to Dr Dr Fakhry A. de Assaad in cooperation with the ophthal- Schweitzer, who replied with an encouraging letter to him mologists of NTUH. Prior to treatment, the prevalence rate in 1959. Dr Chen became known as the “Taiwanese Dr of primary school children was 46.9% in Taipei City and Schweitzer,” and is remembered for his devotion to the 75.1% in the Taipei suburbs. After 6 months of treatment poor and blind. with topical 1% terramycin twice a day or terramycin in combination with oral tresamide, the cure rate was 1926e2009 77.1%.15 Dr Pei-Fei Lee (also known as Pei-Fei Li), a founding Because of the good response in this initial trial, a member of the Asia-Pacific Academy of Ophthalmology, nationwide survey and treatment program began in 1960, received advanced training at NTUH. He reported a 2.25% and the prevalence of active trachoma decreased to 21.8% prevalence of primary glaucoma among the Chinese in 1960 in 1961, and then to 4.7% in 1968.23 By 1971, the WHO and used the Scheie procedure to treat primary glaucoma announced that Taiwan was no longer a trachoma-endemic 19 with an 86.4% success rate. In 1969, he first introduced area. the application of microsurgery to treat a variety of ocular 20 diseases in Taiwan. Later, Dr Lee moved to United States Myopia and became an internationally respected glaucoma specialist. Over the past 50 years in Taiwan, it has been found that as the level of education and quality of life increase, the Military hospitals in Taiwan prevalence of myopia also increases. In 1959, Dr Liang-Shi Ko found that the rate of myopia in primary school children When the KMT troops retreated from China to Taiwan in in Taipei was 5.31%.24 From 1983 to 2000, a nationwide 1949, the original Japanese military hospitals were also study of refraction in > 10,000 schoolchildren was con- taken over by the KMT troops. These Chinese military ducted by Drs. Luke Long-Kung Lin and Yung-Feng Shih at medical doctors played another important role in the NTUH.25 It was found that the prevalence of myopia and History of ophthalmology in Taiwan 1029 high myopia (> À6 diopters) was substantially increased in medical school in Taiwan, was founded in in all age groups over this period. It is thought that long pe- 1957, Dr Chen established the Department of Ophthal- riods of near work may be contributing to the growing mology and became its first chairman, and continued to prevalence and severity of myopia in Taiwan. serve for 22 years. Dr Chen was also the founder of Kaoh- siung Eye Bank of the Red Cross Society (Taiwan’s first eye Development of cataract, vitroretinal surgery, and bank) in 1965.32 Dr Chen first reported using a local appli- corneal transplantation cation of mitomycin C in trabeculectomy to enhance con- trol of intraocular pressure in 1983, which became a 33 The practice of cataract surgery in Taiwan began with popular method of treating glaucoma worldwide. lens aspiration in soft cataract performed by Dr Yan-Fei In 1976, Chang Gung Memorial Hospital was estab- Yang in 1956.26 In 1961, a-chymotrypsin was used in lished by the Formosa Plastic Group and later became intracapsular cataract extraction, and anterior camber one of the largest medical centers in Taiwan. This private intraocular lens implantation was first done in 1972.27,28 medical group eventually built and set up seven medical Phacoemulsification procedures were also first per- centers located around Taiwan. As the east coast of formed in 1972.29 Extracapsular cataract extraction and Taiwan is relatively poor and underdeveloped compared posterior chamber intraocular lens implantation were with west coast, it also has lacked adequate large hos- started in the late 1980s.28 Surgery for repair of retinal pitals. The Tzu Chi Foundation established Buddhist Tzu detachment evolved from initial diathermy18 in the 1960s Chi General Hospital in Hualien in 1986 on the east coast, to scleral buckle in the 1980s and pars plana vitrectomy in and later set up another six large hospitals around the 1990s. Taiwan. These two biggest private medical groups also Penetrating keratoplasty was first done with the use of established their own medical schools. As time went on, 4 mm trephine and conjunctival flap fixation by Dr Yu Na in additional private large medical centers were also 1954. Later, Dr Na used 5.5 mm trephine with overlay established and have played an important role relating to corneal suture. During the period from 1954 to 1960, he healthcare in Taiwan. The ophthalmologists working at performed penetrating keratoplasty on 23 eyes in 21 cases these private medical centers provide high-quality eye and reported a success rate of 91.3% (21/23 eyes).30 care to their patients and also conduct substantial med- Although the first eye bank had been established previ- ical training and research. ously by Dr Chen-Wu Chen, the National Taiwan Eye Bank was launched at NTUH and the National Cheng Kung Uni- versity Hospital in 2014, and began harvesting donor cor- International cooperation neas nationwide. Over the past 10 years, an average of 121,500 cataract The Ophthalmological Society of Taiwan was involved in the surgeries, 1600 retinal detachment surgeries, and 600 founding of the Asia-Pacific Academy of Ophthalmology, corneal transplantations were performed annually.31 As for which was established in 1960, and became a member of corneal transplantation, half of all donor corneas were the International Congress of Ophthalmology a year later. In imported from foreign countries prior to the establishment 2011, an English version of its official journal, the Taiwan of National Taiwan Eye Bank in 2014. However, the number Journal of Ophthalmology, was launched. of domestic donor cornea has exceeded the number of Taiwan has hosted several international and Asia-Pacific th imported donor corneas in 2015. conferences since 1998, such as the 7 International Myopia Conference in 1998, the 18th Congress of the Asia- Pacific Academy of Ophthalmology in 2001, International Development of private hospitals Workshops on Granulomatous Uveitis and Ocular Behce˛t’s Disease in 2013, and the 4th Asia Cornea Society Biennial Since the beginning of the Japanese colonial period, Scientific Meeting in 2014. The Taiwan Academy of healthcare was provided mainly by government-owned Ophthalmology was established in 2006, and several of its hospitals and local private clinics. In addition, after World subsidiary subspecialty societies are affiliated with other War II, most of the large medical hospitals (including international ophthalmic societies. NTUH), military hospitals, veterans’ hospitals, and county Taiwan ophthalmologists are also very active in global hospitals were established by the government. At that health and humanitarian medical assistance initiatives. time, most private hospitals were too small to provide high- Taiwan’s basic premise of foreign assistance work is to quality medical service. honor friendships and promote international cooperation.34 Starting with a delegation of military doctors sent to Libya 1922e2016 in 1962, other missions include helping to establish hospi- tals in Saudi Arabia in 1979, providing eye care at the Dr Chen-Wu Chen graduated from NTUCM in 1947 and N’Djamena Freedom Hospital in Chad, and more recently continued practicing in the Department of Ophthalmology performing cataract surgery and other eye care services in of this institution. Dr Chen was devoted to treating and Sri Lanka. In 2012, as part of the Taiwan International preventing the spread of trachoma and became a govern- Cooperation and Development Fund’s “Medical Mission” ment consultant on the disease. He not only trained doc- ophthalmologists provided clinical training in several tors, nurses, and technicians, but also gave many lectures countries in the Pacific regions. Taiwan ophthalmologists and services in the aboriginal communities and in the have also been involved in saving eyesight through ORBIS countryside. When Kaohsiung Medical College, the third International initiatives.35 1030 Y.-C. Hou et al.

Since 2009, Taiwan has been invited to attend the World References Health Assembly as an observer and to participate in a 36 number of WHO programs. As international exchanges 1. Lai JY. Cultural identity and the making of modern Taiwanese have increased over the years, Taiwan ophthalmologists painting during the Japanese colonial period (1895e1945). Ann have been better able to contribute to the global Arbor, MI: University of Michigan; 2008. ophthalmic community by participating in cross-border 2. Chuang YM. Tai wan yi liao shi d yi tai da yi yuan wei zhu zhou conferences, collaborative research projects, and (History of Taiwanese Medicine d mainly on National Taiwan publication. University Hospital). Taipei, Taiwan: Yuan Liou Publishing Co., Ltd; 1998 [In Chinese]. 3. Thompson LG. Earliest Chinese eyewitness accounts of the e Medical education Formosan aborigines. Monumneta Serica 1964;23:163 204. 4. Bureau of International Cooperation. Hospital care in Taiwan. Taipei, Taiwan: Department of Health, Taiwan; 2006. Today, there are 11 medical schools in Taiwan, most of 5. Lin CL. The Presbyterian church in Taiwan and the advocacy of which have a 7-year curriculum including undergraduate local autonomy. Sino-Platonic Papers. 1999;92. Available from: studies and a 1-year internship.37 All graduate medical http://www.sino-platonic.org/complete/spp092_ students are required to pass the medical board exami- presbyterian_church_taiwan.pdf. [Accessed March 8, 2016]. nation before they can become medical doctors. Since 6. Rev. George Leslie Mackay. Available at http://thetaiwanese. 2011, all graduate medical doctors have been required to blogspot.com/2006/03/rev-dr-george-leslie-mackay.html. attend a 1-year postgraduate year program before they [Accessed March 6, 2014]. 7. Forsberg CRJ. The life and legacy of George Leslie Mackay: an start residency training. Medical education reform with a interdisciplinary study of Canada’s first Presbyterian mis- 6-year plus 2-year postgraduate training program was sionary to Northern Taiwan (1872e1901). Newcastle Upon implemented in 2011 to strengthen the professional Tyne, UK: Cambridge Scholars Publishing; 2012. competencies of medical students. Since 1988, Taiwan 8. Lai CS, Chen AD, Lai YW, Kuo SJ. The love surrounding the first ophthalmologists (about 40 new residents each year) skin graft in Taiwan: “British skin” that will stay in Taiwanese have been required to complete a 4-year residency- hearts. Ann Plast Surg 2012;69:594e7. training program and pass a board examination. After 9. Roland CG. George Gushue-Taylor and the medical missions of residency training, a few ophthalmologists choose 1-year Formosa. J Med Biogr 1996;4:82e93. subspecialty training. Many ophthalmologists in teaching 10. Chen CF, Shum YC, Yang SP. The modernization of traditional d hospitals go abroad for their subspecialty training Chinese medicine in Taiwan past, present and future. Adv Exp Med Biol 2004;546:35e42. 11. Chin HY. Colonial medical police and postcolonial medical sur- veillance systems in Taiwan, 1895e1950s. Osiris 1998;13:326e38. Conclusion 12. Dai DY, Chuang JY. Tai da yi yuan yi bai nian (A century of National Taiwan University Hospital). Taipei, Taiwan: National The evolution of ophthalmology in Taiwan was driven by Taiwan University Hospital Press; 1995 [In Chinese]. changes in sovereignty, contributions by medical mis- 13. Ho TC, Hu FR, Hou PK, Chen MS. Response to “Medical leaders sionaries, and by the efforts of a number of dedicated in Taiwan during Japanese colonization”. J Formos Med Assoc ophthalmologists over the years. The modernization of 2011;110:794e5. Taiwanese ophthalmology has been deeply influenced by 14. Li YD, Jhang SR, Fan BY, Li FJ. tai wan gong li yi yuan bai nian ji (A centennial history of Taiwanese public hospitals). Taipei, Japanese and Western medicine. Currently, there are Taiwan: Taiwan Public Hospital Association; 2004 [In Chinese]. about 1600 ophthalmologists serving 23 million people in 15. Chen MS. Tai da yan ke bia nian shi (A centennial . Ophthalmology, National Taiwan University Hospital). Taipei, In recent decades, many subspecialty societies have Taiwan: National Taiwan University Hospital Press; 2001 [In been established that serve to educate future Taiwanese Chinese]. ophthalmologists and to connect globally with other inter- 16. Motegi T. Ultraviolet-induced conjunctivitis in North Taiwan. national ophthalmic societies. Ophthalmologists in Taiwan ACTA Soc Ophthal Jpn 1931;35:483e6 [In Japanese]. contribute to the advancement of ophthalmic knowledge 17. Motegi T. Eye influenced by seasonal wind. ACTA Soc Ophthal globally by publishing papers (> 2000 since 1990)31 based on Jpn 1943;47:817e8 [In Japanese]. their clinical and basic research, both in national and in- 18. Yang YF, Ko LK. Treatment of retinal detachment: I. The effect of the electrocoagulation on retinal detachment. Trans Oph- ternational journals. Taiwanese ophthalmologists keep thalmol Soc (ROC) 1962;1:3e14. current of advances in the field by attending local and/or 19. Li PF. Mass screening for glaucoma among Chinese. Trans international meetings, and continue to welcome this Ophthalmol Soc (ROC) 1962;1:19e25. interaction and collaboration. 20. Li PF. Brief review in ophthalmic microsurgery. Trans Oph- thalmol Soc (ROC) 1969;8:80e2. 21. Lin HM. Lin-He-Ming yan ke lun wen ji (The collection of Ho- Acknowledgments Ming Lin works in Ophthalmology). Taipei, Taiwan: Leader- book; 1980. 22. WorldHealthOrganization(WHO).ExpertCommitteeonTrachoma: The authors thank Dr Hunson Kaz Soong for valuable first report. World Health Organ Tech Rep Ser 1952;60:1e22. opinions and comments. This study was supported by 23. Assaad FA, Sundaresan TK, Yang CY, Yeh LJ. Clinical evaluation Department of Ophthalmology, National Taiwan University of the Taiwan trachoma control programme. Bull World Health Hospital, National Taiwan University College of Medicine, Organ 1971;45:491e509. Taipei, Taiwan. History of ophthalmology in Taiwan 1031

24. Ko LS, Liu HS, Yang YF. Study of the refraction on primary 32. Lin SM. Chuen qi Ling huen zhi chuan: Chen-Zhen-Wu yi liao school students in Taipei. J Formos Med Assoc 1959;58: feng xian zhi lu (Reopen the window to the soul: the Chen-Wu 336e53. Chen medical contributions). Taipei, Taiwan: Chen-Zhen-Wu 25. Lin LL, Shih YF, Hsiao CK, Chen CJ. Prevalence of myopia in Prevention of Blindness Foundation; 2015. Taiwanese school children: 1983 to 2000. Ann Acad Med 33. Chen CW. Enhanced intraocular pressure controlling effec- Singapore 2004;33:27e33. tiveness of trabeculectomy by local application of mitomycin 26. Yang YF, Tsai WF. Aspiration technique for soft cataract. Trans C. Trans Asia Pacific Acad Ophthalmol 1983;9:172e7. Ophthalmol Soc (ROC) 1972;11:1e6. 34. Li TW, ICDF d Taiwan. Medicine Beyond Borders. Annual 27. Tsai YH. Enzymatic zonulolysis in intra-capsular cataract Report 2002. Taipei, Taiwan: International Cooperation and extraction. Trans Ophthalmol Soc (ROC) 1962;1:38e43. Development Fund (ICDF); 2002. 28. Chen TT. Results in 100 intraocular lens implantationsepreli- 35. . Public Health, Chapter 14. Republic of China minary reports. Trans Ophthalmol Soc (ROC) 1980;19:132e40. yearbook, 2010. Taiwan: Executive Yuan; 2011. 29. Tu SL. Phacofragmentation and irrigation of cataracts by using 36. Wood R. Taiwan’s Participation in the World Health Assembly. dental ultrasonic apparatus a preliminary case report. Trans April 29, 2009. Available from: http://www.state.gov/r/pa/ Ophthalmol Soc (ROC) 1974;13:73e6. prs/ps/2009/04/122401.htm. [Accessed December 8, 2015]. 30. Na Y. Report on 23 eyes (21 cases) of penetrating keratoplasty. 37. Lai CW. Experiences of accreditation of medical education in Trans Ophthalmol Soc (ROC) 1962;1:57e67. Taiwan. J Educ Eval Health Prof 2009;6:2. 31. Hsu WM, Liu JH. Ophthalmology in Taiwan. Taiwan J Oph- thalmol 2014;4:59e62.