22nd Annual Meeting Abstracts - 2009

Titles marked with a P* are available in the Proceedings volume for the year of presentation.  Contact Jenny Benjamin, at the Truhlsen-Marmor Museum of the Eye (jbenjamin@aao.org) for further information.

Papers noted as being “Published as…” may not be identical to the Cogan Society presentation or the content in the Proceedings volumes.

From a Country Doctor’s Casebooks: Treatment of Eye Disease in Rural Wisconsin, 1841-1852
Daniel M. Albert
Co-authors: Sarah Atzen, Payam Morgan

Introduction or purpose: Study of types and treatment of ophthalmic disorders by a physician in rural Wisconsin in the mid-19th century

Historical approach or resources: Review of casebooks and associated literature search

Body of paper: Francis Paddock (1814-1889), a graduate of Fairfield Medical College in western New York State, opened a general medicinal and surgical practice in the small town of Salem in Kenosha County, Wisconsin in 1839, where he lived and worked until his death a half century later. Two early volumes of his casebooks spanning the years 1841 to 1852 came to light and are now analyzed from the standpoint of ophthalmic-related problems and their treatment. Dr. Paddock recorded 5122 medical visits during that period, of which 156 (3.1%) were eye-related. Surgical procedures were mostly of a minor nature, although an operation for stabismus is mentioned in 1853, thirteen years after Johann Friedrich Dieffenback first published his procedure. Inflammations of the lid were treated with “penciling” with silver nitrate. Conjunctival and corneal inflammations were treated with “eye water” in “salves” which variously contained lead acetate (“Rush’s Eye Water”), zinc sulfide, and opium solutions. These treatments were relatively expensive, with Dr. Paddock collecting an approximate average of ninety cents for a “penciling” procedure, fifty cents for a vial of eye water, and twenty-five cents for salve, with prices apparently adjusted to the patients’ means. From the same ledgers, for comparison, we note twenty pounds of beef was sixty cents, a pair of “thick” shoes was fifty-nine cents, and laborers were paid fifty cents a day. Dr. Paddock married Martha Munson in 1841, the year the first casebook was begun, and they had 14 children, five who died in early childhood. He was recognized as the first medical professional in the area and was a successful physician, farmer, and businessman. From 1842-1844, he was the supervisor of the town of Salem and commissioner of schools. In 1855, he served his district in the state senate. The Paddock name remains a prominent one in the Salem area. The Village of Paddock Lake is located in Salem, and nearby Paddock Lake, named after Dr. Paddock, is a prominent and well-known feature of the area. 

Summary or conclusions: About 3% of doctor's visits were eye-related, with inflammation of the conjunctiva, cornea and lids, and corneal and conjunctival foreign bodies being the predominant problems. Silver nitrate, lead acetate, and zinc sulfide were the chief therapeutic agents and treatment was expensive.

The History of Ophthalmology at The University of Pittsburgh: Highlights of Contributions in Clinical Care, Education and Research
Albert W. Biglan
Co-authors: Richard W. Hertle, Joel S. Schuman

Introduction or purpose: Since its beginning almost 100 years ago, ophthalmology, eye care education and research have been part of the University of Pittsburgh in western Pennsylvania. We will present highlights of this century old story of Ophthalmology in Western Pennsylvania and The University of Pittsburgh and The University of Pittsburgh Medical Center. 

Historical approach or resources: We have used a combination of resources including, oral histories from present and past staff and trainees, library resources at the UPMC Eye Center and The University of Pittsburgh Medical School. The Pittsburgh Heinz history museum and historical society, multiple internet resources and published ophthalmic historical texts. Body of paper: In May of 1895 three petitioners, Dr. Charles A. Wishart, Dr. Joseph E. Willets and Mrs. Emmet Queen and applied for a charter with which was granted for the “purpose of establishing and maintaining a hospital, by voluntary contributions, for the medical and surgical treatment of diseases of the eyes and ears.” Since its foundation The Eye and Ear Hospital of Pittsburgh has changed its physical locations, its partnerships with the University of Pittsburgh, the local medical community and now the University of Pittsburgh Medical Center. It early leadership included medical giants of the time; Dr.’s Joseph Willetts, Charles Wishart, James Aubrey Lippincott, Ewing Wilber Day, Chevalier Q. Jackson, and William Wightman Blair. The Eye and Ear Institute and the department of Ophthalmology have a history of a strong board of directors and dedicated chairman as well as unselfish volunteerism and institutional support. This paper will highlight the over century of contributions to medical education, discoveries in research and innovations in patient care from the Eye and Ear Hospital and The University of Pittsburgh Department of Ophthalmology. 

Summary or conclusions: Since the founding of the Eye and Ear Hospital in 1895 the institution has transitioned from a privately funded community based hospital to a an internationally recognized academic department while remaining true to its roots of community participation in patient care and education. The first resident was formally accepted in 1924 and since that time, over 300 men and women have graduated with the first female resident accepted in 1957.

The Evolutionist, Three Ophthalmologists and the Prime Minister
David Bisno, M.D.

Introduction or purpose: On the 150th anniversary of the publication of Darwin’s Origin of Species, to bring to the attention of the ophthalmic community newly discovered correspondence between three ophthalmologists, the tormented evolutionist and the Prime Minister. 

Historical approach or resources:

1. The collected correspondence of Charles Darwin

2. Annals of Science 56 (1999), 25-45

3. Personal discussions with Darwin’s biographer, James Moore.

Body of paper: Charles Darwin in the mid-19th Century was carefully charting dangerous intellectual waters. Asking the big questions: who are we? and how did we get here? would require penetrating the fog which had for so long obscured human vision …and he would need help. The Origin was out, (1859); now the tormented evolutionist wanted to include “man.” The 19th century world was a tight, little, medieval domain, which with its Biblically accounted for humanity, was soon to find itself theologically at grips with a myriad of problems. One of those vexing problems was the eye. Would a descriptive understanding of the human eye help Darwin with his Descent of Man? 
As the world in 2009 celebrates the 150th anniversary of the publication of The Origin of Species, in letters which have just come to light, we learn that Charles Darwin turned for help to our colleagues William Bowman in London and Cornelius Donders in Utrecht. And it was to Hugo Magnus, ophthalmologist in Breslau, that William Gladstone turned for help as the Prime Minister attempted to work out the evolution of color vision. With help from ophthalmologists Darwin’s synthesizing mind would take a great body of diverse data and relate it within the confines of a single abstraction. His world numbing evolutionary explanation would include man. Ophthalmologists played their part. It is to the consultations between these men that we turn our attention. 

Summary or conclusions: We now recognize the contributions of European ophthalmologists to Darwin’s Descent of Man.

Bernard Becker “In His Own Words” – Part I “The Formative Years”
George Bohigian , MD

Introduction or Purpose: This presentation will highlight the life and achievements of Bernard Becker, one of the leaders in modern-day ophthalmology. 

Historic Approach or Resources: The presentation will be drawn from transcripts and interviews with colleagues, former residents, family and friends. Photographs will be included. 

Body of Paper: Bernard Becker, MD, is one of the leaders in modern-day ophthalmology. His contributions to science, ophthalmology, resident training and academic medicine have been profound. His teachings have guided many in their professional and private lives. These personal experiences and their effect on his many friends and colleagues will be highlighted.

Part I – “The Formative Years” will review his childhood, education and science background and the early years as chairman of the Department of Ophthalmology at Washington University School of Medicine in St. Louis, MO.

Part II – “The Academic Years” will be presented in 2010 in Chicago and will review his impact on the academic community as the Chairman of the Department of Ophthalmology at Washington University. His influence on ophthalmology and those individuals who came in contact with him will be examined by using his own words and showing how they influenced others.

Summary and conclusions: The achievements and influences of Bernard Becker, MD, will be examined in two parts, using his own words and the personal remembrances of those he mentored over the many years of his academic career. P*

Why Was Carlota Valdivia Blind?
John D. Bullock

Purpose: To analyze Picasso’s famous painting, La Celestina, to determine the etiology of the blindness of his model, Carlota Valdivia

Resources:

1. Texts related to Picasso’s art.

2. Fernando de Rojas’ La Tragicomedia de Calisto y Melibea.

3. Ophthalmic texts related to congenital glaucoma.

4. Ophthalmic photographs of my former patients with congenital glaucoma.

Body of Paper: The title of Pablo Picasso’s 1903 painting, La Celestina, (after Goya) is derived from the principal character of the novel in dialogue, “The Tragic Comedy of Calisto and Melibea,” attributed to the fifteenth century Spanish writer Fernando de Rojas. Celestina is considered one of the greatest characters in all of literature. A young nobleman engages Celestina, a procuress, to assist him in his tragic seduction of a young woman. Celestina enjoys, and profits from, procuring pleasure for others. As the model for this Blue period portrait, Picasso chose Carlota Valdivia, a real-life procuress who operated out of quarters close to his Barcelona studio. Carlota was known to be “wall-eyed” and unilaterally blind, of previously undetermined etiology. Picasso painted her with a non-specific opaque left cornea. Corneal diameter measurements, however, revealed that her blind exotropic eye is 25-33% larger than her presumably sighted and normal fellow eye, suggesting buphthalmos. Picasso’s depiction of her is in virtual photographic detail, contrasting markedly with his later, more abstract, style. 

Conclusions: A detailed ophthalmological analysis of Picasso’s painting, La Celestina, suggests that his model, Carlota Valdivia, may have been blind from congenital glaucoma.

Couching for Cataract in China
Chi-Chao Chan

Introduction or purpose: To present the history of ‘couching for cataract’ in China

Historical approach or resources: Literature search for journal articles via PubMed, Google Scholar, Google, and the book “The Indian Operation of Couching for Cataract” by R.H. Elliot in 1918. 

Body of paper: The operation of ‘couching for cataract’ is one of the most ancient procedures known to surgery. The earliest description of the method is given by Celsus, a contemporary of Jesus Christ. However, the procedure was recorded in “Sushruta Samhita”, a treatise written by Sushruta, the ancient surgeon of India around 600 BC. At the end of the West Han dynasty (206 BC-25 AD), Indian monks/travelers introduced the Indian ophthalmic surgery ‘couching for cataract’ into China. The procedure became accepted during the Tang dynasty (618-970 AD). ‘Couching for cataract’ or ‘Jin pi shu’ in Chinese, was widely practiced after it was remodeled to follow existing Chinese medical concepts as an element of acupuncture. However, it was abolished when the Republic of China was established in 1911. After the birth of the People’s Republic of China in 1949, ‘couching for cataract’ was again encouraged and became popular once more; Chairman Mao demanded to remove his cataracts using this technique in 1975. However, in the past 15-20 years, ‘couching for cataract’ has slowly faded away as China has opened its door to the Western world and various modern surgical techniques of cataract extraction have been brought and practiced in China. 

Summary or conclusions: The history and use of ‘couching for cataract’ in China reflects the country’s history, culture, and political transformation.

Published as: Chan CC. Couching for cataract in China. Survey of Ophthalmology 2010; 55:393-8. PMID 20451942

Tuberculosis and Ocular Disease in the Life of Stonewall Jackson
Pamela S. Chavis*

Introduction or purpose: Tuberculosis and ocular disease may have affected one of the great generals of the Civil War. 

Historical approach or resources: Review of medical history of Stonewall Jackson through existing biographical material. 

Body of paper: Medical history will be detailed with link to personal environmental situations and outcome of Civil War. 

Summary or conclusions: Tuberculosis and ocular disease may have affected one of the great southern generals and his death deprived Robert E Lee of his balanced view and may have led to the decision to cross the Mason-Dixon Line into Gettysburg, Pennsylvania

*Flight was canceled at the last minute due to inclement weather

Emanuel Krimsky (1898-1992), A Prism, and a Full Spectrum Life
Ira Eliasoph

Introduction or purpose: More light on an interesting Ophthalmologist

Historical approach or resources: Published papers, personal documents and recollections

Body of paper: Doctor Krimsky is widely known for the test bearing his name, and was a multitalented man. He wrote extensively on the corneal light reflex and binocular function. He also devised many instruments for use in ophthalmology. I had the good fortune to meet him at the start of my career. He was a musician, artist, photographer, physician, teacher and inventor. He and George Bernard Shaw disagreed about vaccination. He served in the army in World War II. His oldest daughter holds many of his papers and instrument prototypes. He was liked and respected by one and all. 

Summary or conclusions: This man and his work should be remembered.

"A Mesolithic (Middle Stone Age!) Spanish Artificial Eye"
Please Realize This Technology Is About 7000 Years Old!
Jay M. Enoch

Abstract: Last year, the writer presented a paper on an amazing ancient artificial eye found in Iran! That artificial eye is 5000 years old. A reader spotted this report, and called the speaker's attention to a similar, artificial eye, but 2000 years older (about 7000 years B.P. [before the present]). It was manufactured during the mesolithic period = Middle Stone Age!). It was recently unearthed in Spain. Incredible! 
This eye was found in situ in the right orbit of the scull of a man who died at age 40-45 years. He also had a deformed pelvis. He was tall, and apparently was relatively well-to-do (based upon other goods found in this and neighboring graves). The artificial eye was made of ocher (or ochre). An incised cornea (or iris) can be identified, and possibly a pupil. On the rear surface of “the eye”, there was found an inscribed large letter “X”. This eye-structure precedes known written language. 
This artificial eye was much more primitive in shape, design, and finish than the one found at “The Burnt City” in Eastern Iran. The man’s body (containing the eye in situ) was found at an archaeological site in Spain known as Cingle del Mas Nou i Cava Fosca, Ares del Maestro, Castellón Province. The body was exhumed at Cingle del Mas Nou. 
The two early manufactured artificial eyes will be compared.

Simon Pollak, MD *P
Robert M. Feibel

Introduction: Simon Pollak was the first physician in St. Louis to specialize in ophthalmology. He played a key role in the development of education for the blind and visually impaired by founding the Missouri School for the Blind in 1850. He introduced the use of the Braille system at this school where the blind children first learned to read with Braille in the Western hemisphere. He also established the first eye and ear clinic at the St. Louis Mullanphy Hospital, the charitable city hospital at this time. He attended this clinic for over 40 years, and was the first to teach ophthalmoloscopy to physicians in St. Louis. 

Historical Resources: The details of his life are mostly known from his own perspective as related in The Autobiography and Reminiscences of S. Pollak MD. But many details of Pollak’s life and achievements can be verified from other local sources. 

Body of paper: In 1859,at age 45, Pollak decided to stop his general medical and surgical practice and to specialize in ophthalmology. The most interesting part of his autobiography is his description of his twenty-two month he spent travelling across Europe where he learned ophthalmology at the greatest centers of medical education, including London, Paris, Berlin, and Vienna. This grand tour, including study with many of the most famous physicians of his time, was also accompanied by many cultural and sightseeing activities. 

Summary: Pollak’s narrative of his travels is a valuable insight into the training for the budding ophthalmologist at the time when, with invention of the ophthalmoscope in 1851, ophthalmology was becoming a true specialty. Published as: Feibel, RM. Simon Pollak, MD.  Gateway: The Magazine of the Missouri Historical Society.  2013;33:63-71

Cyclopia I : Congenital Malformations from Homer to the Enlightenment
Ronald Fishman

Congenital malformations were known to ancient peoples and entered their folklore long before poets elaborated them into legend and mythology. The legend of the Cyclops was handled differently by the two ancient Greek poets Hesiod and Homer. The figure of the Cyclops as a malevolent monster continued through medieval folklore and became blended with the themes of the evil eye and "the blinded ogre." It persists even today. 

Meanwhile, birth defects generally entered the superstitions revolving around mythological creatures and monsters of all sorts. They were a popular theme in 15th and 16th Century European literature. They finally achieved rational explanation in the Enlightenment, largely through the writings of the French naturalist Ettienne Geoffroy St. Hilaire (1772-1844), whose other ideas included a precursor to evolution.

Ludwik Zamenhof – One the Most Famous Ophthalmologists in the World’s Culture.
A. Grzybowski

Introduction or purpose: Although Zamenhof was a physician and ophthalmologist, and some of his relatives also were educated in the same field, there is not much of reliable information already published on this subject. One of the reasons for that is that majority of original information are deposited in the 19th century Russian documents or the 20th century Esperanto language studies. Consequently, very often non-reliable data related to Zamenhof’s and his family’s life are presented, mainly because these articles are not based on original sources. 

Historical approach or resources: The original documents related to Zamenhof life and work written in Polish, Russian and Esperanto were analysed. Body of paper: Ludwik Lazarus Zamenhof was born into a Jewish family on Dec 15th, 1859 in Bialystok, Poland. The question of Zamenhof’s nationality often comes up. Encyclopedias seem to be uncertain. For example in the 1991 Encyclopedia Britannica it is stated that he was a “Russian physician and oculist” (p. 891, vol 12, Micropaedia), and also that he was a “Polish Oculist” (p.560, vol 4, Micropaedia), and also “a Polish-Russian doctor” (p. 583, vol 22, Macropaedia). It would be more accurate to say that Zamenhof was a Jewish physician living in a Polish city that had been occupied by Russians for nearly 100 years. 
Ludwik Zamenhof started his professional training in Ophthalmology at the Jewish Hospital in Warsaw Among his teachers were Zygmunt Kramsztyk (1849-1920), Edward Flatau (1868-1932) and Samuel Goldflam (1852-1932). Zamenhof then spent a semester in Vienna. He then worked as an ophthalmologist in various places, Lithuania, Ukraine, Bialorus, and Poland, and finally he started a private ophthalmology practice in Warsaw where he remained for most of his life. 
Two of his three children, Adam and Zofia, became medical doctors. Adam (1888-1840) earned a PhD at Lausanne (Corneal astigmatism) and became a prominent ophthalmologist. He was an associate professor of Ophthalmology at the University of Warsaw and head of the Jewish Hospital at Cyste, which was the biggest and most up-to-date hospital in Warsaw at the time. In 1940 he was arrested and murdered by Nazis in occupied Warsaw. It was clear that all of mankind might have been helped by his father's universal language. 

Summary or conclusions: The less known aspects of Ludwik Zamenhof and his family medical life were studied and presented.

The History of Presbyopia
David Harper

Introduction or purpose: This paper details the centuries-long human struggle to understand and cope with presbyopia. 

Historical approach or resources: Literature Review

Body of paper: Presbyopia has bedeviled mankind from the time of Aristotle and before to the time of the Renaissance, when corrective lenses became more readily available. However, its true nature as a refractive problem, separate from hyperopia, was not understood until late in the 19th century. Then and now, however, many unanswered questions have remained concerning its etiology. Currently, research continues unabated, not only to find better methods of correction and possibly reversal or prevention, but to gain a more complete understanding of this long process of decline that is so remarkably uniform in all humans. This paper discuses the evolution of our understanding of presbyopia from ancient times to the present.

Summary or conclusions: Presbyopia remains an incompletely understood phenomenon. After many hundreds of years, possibilities for better treatment still continue to excite the imagination.

The History of CT at Mayo Clinic
Jacqueline A. Leavitt, M.D.

Introduction or purpose: Outline the history behind the first CT scanner in the US and it’s affect on medical practices at Mayo Clinic. Historical approach or resources: (see references below) 

Body of paper: Sir Godfrey Hounsfield developed the CT scan while working at EMI, Ltd in England. Dr. James Ambrose, a neuro-radiologist, utilized the CT scan clinically at Atkinson Morley’s Hospital. At a the Neuro-radiology Postgraduate Course at Albert Einstein in May 1972, Hounsfield and Ambrose were last minute fill-in speakers and showed some of their results with the EMI CT. Colin Holman from Mayo Clinic attended the meeting and was so excited that he borrowed the slides and brought them back to share with his Mayo colleagues: Hillier “Bud” Baker Jr, Wayne Houser, John Hodgson and John Gisvold. These images were the first to show structures within the brain including bone, blood, brain and ventricles. Bud Baker went to England to learn more about the machine. He met with Hounsfield and Ambrose and the administrators of EMI and made an offer on an EMI scanner. The scanner was all ready as it was supposed to go in a British hospital but the hospital was 150 years old and couldn’t support the machine’s weight. That scanner was the first outside the UK and was used on June 19, 1973 for the first clinical CT scan at Mayo. This presentation will discuss the development of the neuro-radiology practice at Mayo, compare diagnostic testing before and after the advent of the CT scan, discuss CT safety issues, original reports on CT, insurance coverage for CT and the impact on the practice of CT. 

Summary or conclusions: The advent of the CT scan influenced the practice of medicine and specifically ophthalmology, neurology and neuro-ophthalmology, more than any other diagnostic tool since x-rays. In recognition of this, the Nobel committee awarded the 1979 Nobel Prize in physiology or medicine to Hounsfield and Alan Cormack. 
 

References:

Ambrose J. Computerized transverse axial scanning (tomography): Part 2. Clinical application. Br J Radiology 46, 1023-1047, 1973.

Baker HL JR, Kearns TP, Campbell JK, Henderson JW. Computerized tomography in neuro-ophthalmology. Am J Ophthalmol 78: 285-294. 1974

Baker HL Jr, Campbell JK, Houser OW et al. Computer assisted tomography of the head: An early evaluation. Mayo Clin Proc 49: 17-27, 1974.

Baker HL Jr. The impact of computed tomography on neuroradiologic practice. Radiology 116: 637-640, 1975.

Baker HL, Jr., Houser OW, Campbell JK. National cancer institute study: Evaluation of computed tomography in the diagnosis of intracranial neoplasms. Radiology 136: 91-96, 1980.

Computed tomographic scanning of the brain. NIH Consensus Conference Statement, November 4-6, 1981.

Hodgson JR. Hillier L. Baker, Jr. M.D., President, Radiological Society of North America. Radiology 134 (2): 547-548, 1980

Hounsfeld GN. Computerized transverse axial scanning (tomography): Part 1. Description of system. Br J Radiology 46, 1016-1022, 1973.

Houser OW, Smith JB, Gomez MR, Baker HL, Jr. Evaluation of intracranial disorders in children by computerized transaxial tomography: A preliminary report. Neurology 25: 607-613, 1975.

Kennedy RH, Baker HL, Jr, Houser OW, Whisnant JP, Kennedy MA. Neurologic computed tomography in a defined population group. Radiology 130: 153-158, 1979.

McCullough EC, Baker HL Jr, Houser OW, Rees DF. An evaluation of the quantitative and radiation features of a scanning x-ray transverse axial tomograph: the EMI scanner. Radiology 111: 709-715, 1974.

Ommaya AK. Computerized axial tomography of the head: The EMI-scanner, a new device for direct examination of the brain “in vivo.” Surg Neurol 1:217-222, 1973.

Technology review: X-ray diagnosis peers inside the brain. New Scientist 54:207, 1972.

DVD - 30th Anniversary of the Introduction of the CT at the Mayo Clinic, filmed at the Mayo Foundation House, Rochester, MN, May, 2003

DVD- EMI Scanner produced at Atkinson Morley Hospital London, England, 1972.

Interviews with Ed McCullough, Frank Earnest, Glenn Forbes

Early Glaucoma History: Buphthalmos.
Harry H Mark

The disease we know as glaucoma is subdivided into several categories, such as acute and chronic, primary and secondary, etc., so much so that Saul Sugar suggested the term ‘The Glaucomas’. Buphthalmos manifests itself mostly, but not exclusively, at birth or soon thereafter, by a visible enlargement of the globe. It was therefore easily diagnosed since early times.
     After glaucoma was clearly defined in the 1850s, the historian encountered two hurdles. First was the name itself, understood to mean green/blue, which drove scholars to search for early diseases manifested by this eye discoloration. Secondly was the discovery that the disease was manifested mainly by increased intraocular tension, which lead to search of who first described hard eyes. Actually the history of glaucoma, its diagnosis, pathogenesis, and treatment, at least in the Buphthalmos (Hydrophthalmos) category, goes farther back than usually told.
     The paper explores the evolution over the centuries of the terminology of Buphthalmos, its signs and symptoms, and its treatment.

Did Rembrandt Have Strabismus?
Michael F. Marmor

Introduction or purpose: Rembrandt is not known from historical record to have had any ocular difficulties. However, several authors have observed an appearance of mild ocular divergence in some self-portraits and portraits. The allegation of strabismus raises interesting ophthalmologic and historical issues: Can one reliably judge ocular position from paintings? Can one reliably judge ocular deviation from images in general? Would strabismus be a problem—or perhaps an advantage—for an artist? 

Historical approach or resources: Articles addressing Rembrandt’s ocular position have been reviewed, as well as his corpus of self-portraits (from an authoritative text). Photographs were taken of volunteer subjects in a variety of head and gaze positions, to assess the appearance of straightness or deviation, and a number of experts (including Cogan members) have been queried about these images. Literature on ocular and facial cues for judging gaze has been selectively reviewed. 

Body of paper: Analysis of Rembrandt’s self-portraits was found to be ambiguous at best, as it is hard to judge exact lid and eye margins when there is poor imagery, rough paint (impasto), etc. Furthermore, artists may “adjust” images (even portraits) for many reasons. Mild divergence is indeed suggested by many portraits, and seems partly stylistic and partly a result of facial direction and gaze. A portrait of Rembrandt by his student Bol seems to show the master with divergent eyes—but Bol paints himself exactly the same way. The photographs revealed that similar illusions of ocular divergence occur, and elicit inconsistent judgments from skilled ophthalmic observers. Literature back to the 1800s shows how much our sense of ocular direction and position is influenced by facial cues. Since both judgment and portrayal of depth involve a variety of monocular as well as binocular cues, and it is doubtful that strabismus would confer any advantage to an artist. 

Summary or conclusions: It is very unlikely that Rembrandt had strabismus, from the evidence gathered. If he did, the same would be true for a large percentage of painters and portrait subjects, which is unlikely. This investigation points out some of the difficulties of retrospective diagnosis from paintings. The complexity of gaze appearance has been recognized for centuries, which may in part be why ophthalmologists use cover tests and not casual observation.

An Eye for an Eye: Review of Medical Legal Ophthalmology
Steven A. Newman

Introduction or purpose: Visual complaints and ophthalmology have been front and center in the inter-action between the law and medicine since the earliest recorded legal references (code of Hammurabi and the Bible). Although less a part of classical forensic medicine, ophthalmology has been critical in the development of industrial compensation. Many of the legal aspects of compensation and disability law have started with ophthalmic pathology. Hysteria, malingering and feigned medical problems for compensation and service-avoidance have also involved ophthalmic complaints. In view of the importance of the visual system, it is not surprising that ophthalmology has played a central role in development of medical malpractice law. 

Historical approach or resources: This talk will be based on literature at the end of the 19th and beginning of the 20th century which outlined medical legal ophthalmology through the works of van Arlt and Baudry. Through the early and mid 20th century, writings by Snell and others have outlined measurement of visual disability and traced the development of compensation law, and in the later part of the 20th century, Bettman and other authors writing in individual sub-specialties writing in the framework of Fields in 1897 have outlined the role of the expert witness as well as characterizing malpractice, its occurrence and avoidance. 

Body of paper: This paper will outline the various aspects of the interaction between ophthalmology and the legal profession, its development and future changes. 

Summary and conclusions: Ophthalmology, of all medical subspecialties has the longest track record of interaction with law. Understanding and appreciation of the interaction between ophthalmologists and the legal profession provides a model for understanding the evolving status of medicine and the law.

Surgical Treatment of Astigmatism. Louis Borsch’s MD Thesis, 1900
James G. Ravin

Introduction or purpose: To explore the understanding of surgical treatment of astigmatism at the beginning of the 20th century. 

Historical approach or resources: Thesis for the Doctorate in Medicine from the Faculté de Medécine de Paris (The University of Paris). 

Body of paper: (John) Louis Borsch, Jr., (1893-1926) was born in Philadelphia, PA, the son of a famous optician who had invented rimless spectacles and the first cemented countersunk bifocal. He received his first MD degree from Jefferson Medical College in 1893. Borsch successfully defended his second MD degree in Paris in 1900, after having been Chief of de Wecker’s Clinic, a member of the French Ophthalmological Society and an Officer of the Academy. His thesis summarizes clinical reports on the surgical treatment of astigmatism and contains data accumulated from rabbit experiments.
Later Borsch practiced in Paris and was on the staff of the American Hospital of Paris. He treated some very famous patients, including the author James Joyce and the artist Mary Cassatt. On the recommendation of the International Congress of Ophthalmology the Italian government decorated him in 1909. He was the first American to fire a shot at the enemy after the US entered the First World War. He served as eye surgeon at the French military hospital of the Grand Palais in Paris and traveled to the front with the American consul general to examine conditions for treating ocular casualties. The French government made him a Chevalier of the French Legion of Honor in 1918 and promoted him to Commander in 1929. Borsch published articles on optics as well as lacrimal and ophthalmic plastic surgery. 

Summary or conclusions: Progress in medicine is not always linear or even remembered. Borsch’s thesis deserves recognition.

Published as: Ravin JG. The multifaceted career of Louis Borsch. Archives of Ophthalmology 2009; 127:1534-7. PMID 19901225

Anne Sullivan Macy: Blind Teacher
Joseph W. Sassani

Introduction or purpose: The paper presents multiple challenges in the life of Anne Sullivan Macy, the teacher of Helen Keller, and how these episodes both prepared her for the role that she would come to play in Helen’s life, and helped shape the composite being that was Anne and Helen. The paper documents why Anne surely deserves the title, “Blind Teacher”. 

Historical approach or resources: The paper is presented in narrative form, and relies on published and web-based resources. 

Body of paper: Anne Sullivan Macy (baptismal certificate: Johanna Mansfield) was born to impoverished Irish immigrant parents on April 14, 1866 in Feeding Hills, Massachusetts. She became “Teacher” to Helen Keller, and their story was popularized in the movie, “The Miracle Worker”. Anne’s early life was Dickensonian. This impoverished environment, no doubt, contributed to her contracting trachoma that was to haunt and challenge her throughout her life. In many ways, her vision challenges were to define her own life as much as did her work with Helen Keller. In Anne Sullivan Macy: The Story Behind Helen Keller, Nella Braddy, Anne’s biographer, states that the first words that Anne could remember were, “She would be so pretty if it were not for her eyes” (p.1). 
After her tubercular mother (Alice Cloesy Sullivan) died when Anne was eight years old, her alcoholic father, Thomas Sullivan, eventually abandoned his children. Anne and her younger brother, Jimmie, were sent to live at the Tewksbury almshouse. Jimmie, who had tuberculosis of the hip, died there a short time later. It was a devastating loss for Anne. 
By the time she was at Tewksbury, Anne already was having severe vision disability from trachoma, and surgery did not result in significant visual improvement. Yet, Anne desperately wanted an education. At Tewksbury, the illiterate Anne learned that there were schools for the blind, such as the Perkins school, which under the leadership of Dr. Samuel Gridley Howe had successfully taught a blind-deaf girl, Laura Bridgman, to understand and to “speak” using the manual alphabet, sign language. While at Tewksbury, Anne learned the manual alphabet in order to communicate with Laura . Thus, ironically, it was Anne’s experience at Tewksbury that prepared her for her life’s work with Helen Keller. Although these experiences would have tested any adult, Anne was still a child. 
Anne had a quick temper and a steel backbone. Throughout her life, these characteristics were to thrust her into controversies, and sustain her through her subsequent redemption. This paper discusses some of the most important of these episodes and their impact on the composite individual represented by Anne and Helen. Realistically, Helen Keller, as the public has come to know her, would not have existed without the strengths and foibles of Anne Sullivan Macy. As Helen Keller stated in Teacher: Anne Sullivan Macy: A Tribute by the Foster-Child of Her Mind, when summarizing Anne’s continuing impact on Helen’s life even after Anne’s death, “There was such virtue and such power of communication in Teacher’s personality that after her death they nerved me to endure and persevere. I was gripped by the might of the destiny she had mapped out for me, it lifted me out of myself to wage God’s war against darkness “ (p. 247). 

Summary or conclusions: This paper presents key episodes paralleling the lives of Anne Sullivan Macy and Helen Keller with an emphasis on Anne’s perspective. It documents that, in many ways, they comprised a composite individual, with Anne Sullivan Macy being, to many, the invisible half. Furthermore, I will demonstrate that Anne truly could be called “Blind Teacher”, and possessed multiple characteristics of that title.

Reflections on OCT
Joel S. Schuman
Co-authors: Gadi Wollstein, Hiroshi Ishikawa, James G. Fujimoto

Introduction or purpose: To review the invention, development, adoption and applications of optical coherence tomography (OCT) 

Historical approach or resources: Primary sources, medical literature

Body of paper: Optical coherence tomography (OCT) has become an important diagnostic tool in the clinical practice of ophthalmology. The development of this technology and its rapid adoption occurred over a relatively short 15 year period. The first retinal imaging was performed in 1989 in the laboratory of James G. Fujimoto, PhD, by David Huang, MD, PhD, then a Harvard Medical School, Cambridge, Massachusetts, and Massachusetts Institute of Technology, Cambridge, Massachusetts, Health Sciences Technology (HST) MD, PhD candidate, and Joel S. Schuman, MD, then a fellow in ophthalmic research and glaucoma at Harvard University and Massachusetts Eye and Ear Infirmary, Boston, Massachusetts. The first prototype ophthalmic OCT was placed at the New England Eye Center, Tufts-New England Medical Center, Tufts University School of Medicine in Boston, Massachusetts, and in vivo ocular imaging of subjects began in 1994. In 1994 the technology was patented and transferred to Carl Zeiss Meditec, Inc (Dublin, California), and the first commercially available OCT, called OCT 1000, was marketed in 1996. The technology went through 2 iterations, resulting in OCT 2000 in the year 2000 and then OCT 3 (Stratus OCT), which became commercially available in 2002. More than 10,000 of OCT units are in clinical use worldwide, and many consider OCT 3 the current “gold standard” for retinal imaging. In 2006, the first high-speed, high-resolution OCTs, known variously as Fourier domain OCT, SD-OCT, or hsHR-OCT (all describing the same technology), became commercially available. 

Summary or conclusions: OCT is a robust, high impact technology in ophthalmology, rapidly adopted and continuing to evolve.

O Christmas Tree: A History of ‘Christbaum’ and ‘Christbaumschmuck’ Cataracts
Pamela C. Sieving

Introduction or purpose: Research and clinical studies on Christmas tree (“Christbaum”) cataracts and Christmas tree decoration (“Christbaumschmuck”) cataracts regularly cite earlier publications as though these two conditions were variations on a single entity. This paper disentangles the reference trail to align the evidence on anatomy and etiology with the appropriate presentation. 

Historical approach or resources: Bibliographic- and historical research. 

Body of paper: For nearly 100 years, ophthalmologists, optometrists and vision researchers have written about unusual cataracts in which needle-shaped structures have been described as “Christmas tree” cataracts, (“Christbaum”). A parallel series of studies examines “Christmas tree decoration” (“Christbaumschmuck”) lens crystal cataracts; at least one paper describes opacities with the ‘appearance of coloured lights decorating…a Christmas tree.’ Some authors suggest these are age-related changes; others that they occur in young children, particularly with systemic disease. This paper traces descriptions, theories and laboratory studies on these conditions, and teases out the reference trails. 

Summary or conclusions: The etiology and clinical significance of these two conditions are still unsettled. While definite findings are awaited, illustrations of the two conditions continue to delight, and future reports are anticipated.

2008 Snyder Lecture
Meyer Schwickerath
William Tasman

Meyer Schwickerath was born in the Rhineland not far from Cologne on July 10, 1920. he was affectionately known as M-S by his friends, colleagues, and students and in his lifetime was one of the giants of the 20th century in ophthalmology. 

M-S after working in the eye clinic in Hamburg, Germany under Professor O. Marchesani, moved to Bonn under Professor Mueller in 1952. He stayed in Bonn until 1959 when he become Professor and Director of the University Eye Clinic in Essen, Germany. 

His idea to develop a light coagulator came to him after an eclipse on July 10, 1945, his birthday. It went through several phases starting with a basic attempt to use the sun as a light source focused through a Galilean type telescope and utilizing a heliostat to compensate for the rotation of the earth. The ultimate Xenon photocoagulator became used worldwide and led to the use of present day lasers which have done so much to help in the treatment of blinding eye diseases. 

M-S was one of the founders of the Club Jules Gonin in 1959 and was fluent in English, German and French. He was nominated for the Nobel Prize. At one point he said to me that he knew he wouldn’t get it because he was German and it was too close to the end of the Second World War. Regrettably I agreed with him, but clearly he deserved it.

A Very, Very Negative Book Review
H. Stanley Thompson

Introduction or purpose: A colorful story that illuminates the beginnings of periodic ophthalmic journals in English

Historical approach or resources: Both the journal that published the book review in 1863, (The Ophthalmic Review) and the book that was reviewed, (A Manual of Ohthalmoscopic Surgery) were examined, and biographical information about the principal characters was collected. 

Body of paper: The scene is set. The review is reviewed

Summary or conclusions: The publishing of this devastating review accomplished little for the reviewer or for the reviewers new Journal. 

Page last updated February 26, 2021