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On Vision and the Arts

— Michael Marmor, MD, gives his perspective on our most important sense

Ƶ MedicalToday

"The Doctor's Art" is a weekly podcast that explores what makes medicine meaningful, featuring profiles and stories from clinicians, patients, educators, leaders, and others working in healthcare. Listen and subscribe on , , Amazon, , , and .

Few would dispute that vision is just about our most important sense. At least from a neurophysiological perspective, more than half of the human brain is dedicated to processing vision. But it also enables us to meaningfully interact with the world and the people around us, and allows us to engage in many of the activities that bring us joy in life.

Joining Henry Bair and Tyler Johnson, MD, in this episode is , professor emeritus and former chair of ophthalmology at Stanford University School of Medicine. In addition to his significant contributions to our understanding of diseases of the retina, Marmor is a patron of the arts who has published several books on vision and visual art.

Over the course of our conversation, we discuss the fascinating inner workings of eyesight, how art appreciation can help create better doctors, and how Marmor accompanies patients facing vision loss.

In this episode, you will hear about:

  • 2:04 How a desire to "wear multiple hats" -- researcher, surgeon, educator -- led Marmor to ophthalmology
  • 4:01 A brief exploration of the sense of sight
  • 8:07 Marmor's research on the retina and why he believes a thorough understanding of how diseases work is critical for physicians caring for patients
  • 11:53 Why helping a patient understand their condition provides comfort, even with serious illnesses
  • 18:23 Marmor's passion for the fine arts and how his expertise in vision complemented this passion
  • 23:52 What art appreciation can do for physicians and how it gives us new ways of thinking and seeing
  • 33:06 How medical curricula can be improved to integrate the arts and humanities, and the importance of an emphasis on breadth in addition to technical depth
  • 46:29 Why an appreciation for all kinds of art keeps us in touch with culture

Following is a partial transcript (note errors are possible):

Bair: Dr. Marmor, thank you so much for joining us and welcome to the show.

Marmor: My pleasure.

Bair: So you are the first ophthalmologist we've had on, and it's a special occasion, especially for me, since for listeners who aren't aware, I'm interested in ophthalmology as a medical specialty and in fact currently amid the residency application cycle. Needless to say, I'm looking forward to this conversation very much. Dr. Marmor, can you take us all the way back and tell us what first drew you to ophthalmology?

Marmor: Well, that's a long story, which I'll try to make short. My dad was a physician. He was a psychiatrist and wanted to get me interested in psychiatry, of course, as all fathers do in their field. But psychiatry back then -- this was more than half a century ago -- was kind of non-therapeutic. You basically talk to people and not much more was known. And I was a scientist, I was a neuroscientist, trying to be one anyways, and understand the brain.

So after medical school, I decided probably psychiatry was not going to be my field. And I had gone to the NIH and spent 3 years doing basic neurophysiology. But I didn't really want to be only a scientist. I wanted to also see patients and experience personal interactions and do surgery. Neurology was almost as non-therapeutic as psychiatry in those days, and neurosurgery still took half your life before you ever got close to a patient. I started thinking, what else might work? And I was working on the nervous system and on the brain. The retina in the eye is part of the brain. So I just shifted my research to the retina, which were nerve cells and brain cells, and found ophthalmology, a field where I could take care of patients, where I could do surgery, where I could be involved with the basic science. And it served all of those needs very well. And I've been very happy, happy at it now for really, again, for half a century.

Johnson: Michael, one thing I'd like to pause on, this might sound like a funny question, but I actually think it would be fascinating for our listeners who span the gamut, which is to say that some of them are not involved in medicine in any formal way, some of them are early med students and then we have a lot of trainees and doctors. But, of course, even most of the trainees and doctors are not ophthalmologists, or I'm sure we have a few, but most are not.

Can you just walk us through very briefly sort of the postage stamp version of how sight works? As someone who has devoted your life to studying this, because I think that's one of those things that you get, even if you are a doctor, you get at best probably 3 or 4 or 5 days in medical school, those lectures, and then don't have them ever again for many, many years after that. So I think for those who don't know and even for those who once maybe knew for one quiz or exam, but have since forgotten, can you just walk us through very briefly, like how does the eye take light waves from stuff that's happening outside of your body and make it into an intelligible picture that allows you to navigate the world or to be ordered a sunset or whatever?

Marmor: I'll tell you, this doesn't have much to do with ophthalmology. And Stanford students are lucky to get 4 hours, not 4 days. But I'll try to give you a little bit of feeling for this. Vision is important. It's what, in a sense, most animals have contact with the world. And it sometimes is said that the retina is an extension of the brain or an out-part of the brain. We like to say it's the other way around. The brain is an outpouring of the eye because animals developed incredible eyes early in evolution, but they didn't have a central nervous system -- that evolved later.

But how does vision work? Vision depends most significantly on the ability to change light into a neural signal. And that's what the photoreceptor cells in the retina do because of a visual pigment. The most prevalent one is called Dobson, which is light sensitive, and the Dobson molecule changes shape when light hits it, that makes ions move and that creates a neural signal. The other part of an eye physically, in higher animals anyways, is an optical system which lets images be focused by a surface to the eye and by a lens to adjust that focus in to make the image sharp upon the retina. But as I've said, retina is brain. It has several layers of cells, which, actually, we think in our eye before images ever get up to our brain.

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