We acknowledge the important contributions of our many colleagues and coworkers who have helped advance ophthalmic ultrasound over the last 4 decades. We also acknowledge more than 30 years of continuous support of our research by the National Eye Institute (grant R01-EY01212), now being continued under grant R01-EB000238 awarded by the National Institute of Biomedical Imaging and Bioengineering.Abbreviations IOL, intraocular lens; LASIK, laser-assisted in situ keratomileusis; 3D, 3-dimensional n the half century since its first ocular application, ultrasound has become a standard diagnostic modality in ophthalmology. The emergence of ophthalmic ultrasound has been brought about by international contributions from physicians, engineers, and sonographers.As detailed with citations in subsequent sections, the development of ophthalmic ultrasound followed a course that differed in several respects from that of other medical specialties. These differences reflect special needs imposed by the nature of ocular tissue and the goals of clinical examinations. The eye presents a microcosm of tissue types in terms of acoustic properties; they include the anechoic vitreous humor, the highly absorptive ocular lens, the thin (150-µm) retina, and pathologic structures (eg, choroidal melanomas) with complex internal structures. The overall geometry of ocular tissues is relatively simple, permitting many early examinations to provide useful clinical results on the basis of A-mode examination and B-mode images with limited gray scale. Early success with simple systems delayed an emphasis on developing gray scale B-mode instruments, which were first introduced in other specialties. Biometry (eg, measurement of the axial length of the eye) is particularly important in ophthalmology; thus, much early attention was directed at measuring propagation velocities and developing high-frequency transducers that could resolve dimensions on the order of the corneal thickness (0.5 mm). The need to accurately image and measure tissue contours led to the development of sophisticated B-mode systems and motivated some of the first studies of ultrasonic beam aberration by tissue structures.The most important difference between ophthalmic requirements and those of other specialties is the need to examine small structures. This requires the use of higher frequencies, which are practical because the eye is superficial, and its chambers contain low-absorption, waterlike ocular humors. Ophthalmic ultrasound has benefited from the emergence of requisite high-