Eyes in Sight: Embodiment, Affect, and Learning to See in Ophthalmology

Abstract

Vision is central to the apprenticeship of ophthalmology residency training. As clinicians who diagnose and treat diseases of the eye, ophthalmologists build their professional identities around the mission of safeguarding their patients’ sight. At the same time, ophthalmologists rely on their own vision as they peer into the eye to detect subtle signs of disease. Based on an extended ethnography of an ophthalmology residency programme, as well as autoethnographic analysis of ophthalmology training, this article explores how novice trainees learn to view the eye by considering two fundamental examination techniques. The first is slit lamp biomicroscopy, where a table-mounted microscope is used to view ocular structures in fine detail. The second is binocular indirect ophthalmoscopy, where examiners view the retina using a head-mounted instrument in conjunction with handheld lenses. Rather than framing visual interpretation as a cognitive exercise in identifying pathology, I instead consider these techniques as embodied practices where trainees must discipline their movement, attention, and use of instrumentation to make the eye visible. This process of embodiment, in turn, unfolds within a broader terrain of affects as trainees marvel at what they behold, yearn to see more, and fear the limitations of their own vision while they learn to perform challenging examination manoeuvres. Situating the ophthalmic examination in its embodied and affective contexts illustrates the sensibilities that ophthalmology residents come to inhabit during their apprenticeship and which undergird the visual expertise of ophthalmologists.