29th Annual Meeting Abstracts 2016 - St. Louis, Missouri
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.
Presenter: Donald L. Blanchard, MD
Title: Henry Gray's (Eye) Anatomy
Abstract: Henry Gray published his world famous text "Anatomy: Descriptive and Surgical" in 1858 and it has never been out of print since. A decade earlier he wrote “An Essay on the Origin, Connections, and Distribution of the Nerves of the Human Eye, and its Appendages; illustrated by Comparative Dissections of the Eye, of other Vertebrate Animals.”. This nearly 400 page text was the Triennial Prize winning essay of the Royal College of Surgeons in 1849, and earned him 50 guineas. It was deposited in the Royal College of Surgeon’s Library where it has languished: unpublished, virtually unknown, and not reproduced until I requested a copy. “An Essay” is a detailed work about the comparative anatomy of the eye and ocular appendages. His dissection work included invertebrates and vertebrates, emphasizing chickens, snakes, and humans. He studied the sympathetic, parasympathetic, and pertinent cranial nerves associated with the eyes. His work is well referenced for previous findings and work by others, especially William Bowman.
Gray used the Royal College of Surgeon’s Museum collection specimens but did most of the dissections himself. He stated his purpose to be beyond merely tracing the nerves, but rather putting forth ideas of functions too. His thoughts and findings about the retina will be the focus of this presentation. He made great strides in increasing the accurate knowledge of the anatomy of the retina, but much more needed to be done, especially with better fixation and staining techniques. That will be the topic of a presentation at a later date.
Presenter: George Bohigian, MD
Title: History and Folklore of Plant - Based Ophthalmic Medications
Abstract: For millennia, humans have looked to nature for remedies to alleviate pain and cure disease, including ophthalmic diseases. Today, people continue to use medicinal plants in traditional ways, as complementary medicine, or as resources for research and innovation. Many of the ocular medications of the past, still in use today, are extracted from plants.This paper will discuss the history, folklore and etymology of ophthalmic medications such as cocaine, atropine, pilocarpine, scopolamine and marijuana. P*
Presenter: Elisabeth Brander
Title: Historical Aspects of the Bernard Becker Collection in Ophthalmology and Optics
Abstract: In addition to being a well-respected ophthalmologist and member of the Washington University faculty, Doctor Bernard Becker was an avid bibliophile. A love of reading and interest in history led him to purchase books that he found intriguing, and these purchases gradually grew into an exceptionally fine rare book collection dedicated to the history of ophthalmology and optics. He generously donated his collection to the Washington University School of Medicine in 1975, where it is available for researchers to consult.
The collection is not only a valuable resource for those studying the history of ophthalmology. It also reveals much about the history of the book as a physical object. This talk will examine some of the collection’s highlights in order to illustrate how Doctor Becker’s books not only depict the history of a medical specialty, but also show important developments in the history of print.
Attendees will be able to view a selection of books from the Becker collection following the presentation.
Presenter: Pamela Chavis
Second Author: James Farmer
Title: Symbolism of the Eye in the Ancient World
Abstract: In prehistoric and ancient times the Eye has had symbolic representation for the supernatural. This is a parallel phenomena in several ancient periods; it occurred in independent and noncontact cultures. Representation of the Eye can be seen in Rock Art, statuary, and pictographs and other evolving art forms. It is a stronger occurrence then that was not mirrored in other body parts; it is both unique and interesting. Eastern, Egyptian, north American, south American and Mesoamerican cultures will be reviewed.
The Eye also has been used to signify general body status; i.e., transformative trance, life and death. The representation of the eye has been a useful tool for interpretation by modern scholars.
Presenter: Robert M. Feibel, MD
Title: James Moores Ball: St. Louis Ophthalmologist, Medical Historian, and Bibliophile P*
Abstract: James Moores Ball (1862-1929) was an ophthalmologist in St. Louis who excelled as a medical historian and collector of rare and historic books about the history of anatomy. During his lifetime, he was best known as the author of a comprehensive and authoritative textbook entitled Modern Ophthalmology. First published in 1904 with 820 pages, the text was well received, sold well, and the publishers desired further editions. The sixth and last edition was published in 1927 and had grown to 1513 pages, 648 illustrations, and hundreds of medical references. He also acquired a collection of ophthalmic items consisting of photographs, drawings, and photomicrographs of various ocular diseases. This collection of about 960 items formed his museum which he carefully labeled and inventoried. In 1922, he donated this collection to the Army Medical Museum; they are now archived at the National Museum of Health and Medicine in Silver Spring, MD where they are neatly curated and collected in 45 boxes.
Ball was very interested in the history of anatomy and wrote two books on this subject, the first being a short biography of Andreas Vesalius and the second a history of the resurrection men or grave robbers who sold corpses to professors of anatomy and surgery for teaching purposes. His legacy today is the approximately 480 volumes of his personal library which he donated to the St. Louis Medical Society. They are now in the Archives and Rare Books department of the Becker Medical Library of Washington University School of Medicine and form one of their major collections, concentrating of the history of anatomy, beginning with a first edition of Vesalius’s Fabrica and holding many important and beautiful landmark volumes.
Presenter: Ronald Fishman
Title: Obsolescence
Abstract: Obsolescence is the reverse of the coin of innovation, a virtue embedded in our culture and usually considered an unalloyed virtue of medical practice, something we all know is not always true. I will discuss only two features of this complex subject: 1. obsolescence in basic concepts of the life sciences. Examples include the supplanting of the humoral theory of disease by a better understanding of physiology and the germ theory of disease, and the near-extinction of vitalism by cellular and molecular biology.2. Obsolescence in technology, wherein diagnostic and therapeutic instruments are replaced by better ones as far as ease of use, accuracy, surgical benefits, expense, etc. but understanding of the disease entity itself may or may not be much enhanced.
Presenter: Leonard Flom, MD
Title: The Role of the Iris Biometric in the Pairing of Mothers to Newborns and for Infants for Lifetime Identification
Abstract: The chaotic, sometimes nonexistent identification of newborns and infants has historically resulted in mother/child mismatches at birth, hospital kidnappings, abandonment after discharge, and ethnic slayings of children in certain societies. The Chinese introduced footprint identification 4000 years ago to identify all individuals. While an anachronism, this historic biometric is still ubiquitous, but mostly ignored in practice.
While developed nations have proposed more advanced identification technologies in recent years, accurate identification in underdeveloped areas remains a crucial need.
After years of attempting to create an unique biometric with the reliability and extreme accuracy to confidently identify these neglected children, success was achieved with an algorithm incorporating three biometric methods: iris, ear and fingerprint. This unusual algorithm recognizes newborns through non-contact imaging that can be taken using inexpensive image capture devices. Previously piloted in Israel in an ethnically homogenous population, this algorithm, only incorporating photographs of newborns’ ears and photographs of birth-mothers’ irides, has proven successfully matched newborns to their birth-mothers 100% of the time. However, this algorithm has not been tested in a more diverse population, requiring further investigation.
As a result, this biometric innovation now anticipates TWO research projects:
1. Matching newborns’ ears with birth-mothers’ irides with 4 unique data bases; thus, defying mismatches.
We hypothesize that, when replicating this study in a more diverse population, this algorithm will further serve to match newborns to their mothers with 100% accuracy.
2. A longitudinal iris biometric study in infants to determine the earliest month (between birth-9 months) when the iris can be unquestionably relied upon as a measurement tool for lifetime identification.
Presenter: Alice (“Wendy”) Gasch, MS, MD
Title: Onchocerciasis and Its Control
Abstract: Purpose: to provide an overview of onchocerciasis and its control. This topic is timely because recipients of the most recent Nobel Prize in medicine included two scientists who developed a drug, avermectin, which has led to a dramatic decline in onchocerciasis incidence.
Methods: review of material on the internet and in print
Results: First reported in 1875, onchocerciasis is a potentially-blinding eye and skin disease caused by the filarial nematode Onchocerca volvulus. Simulium flies transmit O. volvulus between humans, the only host. Because the flies breed in fast-flowing rivers and streams, onchocerciasis also is called “river blindness.” It is the second leading cause of infectious blindness wordwide. The following factors regarding onchocerciasis will be presented: historical background, clinical manifestations and their pathogenesis, diagnosis, geographic distribution and differences, determination of endemicity, socioeconomic impact, treatment, prevention, control, and elimination. Ninety-nine percent of infected people reside in 31 African countries, and disease foci also exist in Latin America and Yemen. Ivermectin, a derivative of avermectin, is a microfilaricide and the current mainstay of treatment, but it is not an ideal treatment because it does not kill adult worms (macrofilariae). Nevertheless, in 2013, Columbia, after decades of intervention, primarily with ivermectin, became the first country to eliminate onchocerciasis. A new approach being investigated to eliminate the disease is use of antibiotics to kill Wolbachia. This intracellular bacterium is an obligate, mutualistic endosymbiont of O. volvulus. It is present throughout the worm’s life cycle and is essential for the worm’s viability.
Conclusion: Onchocerciasis remains a significant cause of preventable blindness and thus a significant public health issue in affected areas. Measures are diminishing the scourge, and more efficient methods to eliminate the disease are being sought.
Presenter: David Harper
Title: Accommodation and the Nucleus: The Lens Within
Abstract: First reported by Listing in 1846, the focusing power of the human lens, calculated from the curvatures of its external surfaces, is not adequate to sharply focus an image on the retinal surface. Helmholtz and others noted that even if the whole lens had a refractive index equal to the refractive index of the nucleus, it would still fail to provide enough focusing power. However, none made any attempt to explain the responsible mechanism. Allvar Gullstrand, working during the first decade of the 20th century, pointed to the nucleus as the source of this extra focusing power. After 1870, when Adamük and Woinow first suggested nuclear sclerosis (tissue hardening with water loss) as the cause of presbyopia, many researchers have studied this problem.
In 1972 R. F. Fisher demonstrated that presbyopia was not secondary to nuclear sclerosis but instead corresponded to an ever increasing adhesion of the nuclear fibers to each other by a process which occurs without water loss and excludes the lens cortex. In 2010, Robert C Augusteyn noted that the lens cortex is unique in that it grows throughout life by the addition of new cortical cells inside the surrounding capsule. He also described their ongoing compaction, noting that electron micrographs show their membranes to be extensively folded with complex interdigitations.
Gullstrand, a century earlier, had described a similar interpenetration of individual cortical fibers. This relentless cortical cell growth throughout life appears to be similar to the growth of hair and nails and may deprive the nucleus of adequate space to respond to accommodative stimuli. This process appears likely to be one factor in the inexorable decline in the total accommodative range that begins at about age 10 and afflicts every human on the planet at a similar rate.
Presenter: Richard Keeler
Title: St. Dunstan’s Hostel for Blinded Soldiers and Sailors in the First World War
Abstract: Introduction or Purpose: Much has been written about the First World War that started just over 100 years ago. British servicemen who were wounded in the trenches of this cruel war returned home to find that little had been prepared for them in their new plight. The exception however was for those who were blinded and this was due to one man. This talk records the life of an extraordinary entrepreneur and philanthropist, Sir Arthur Pearson, who founded St Dunstan's in 1915 to look after the welfare of blinded servicemen.
Historical approach or resources: The request for a photograph of Sir Arnold Lawson, an ophthalmologist, who worked voluntarily at St Dunstan's during and after the war, came from the author of a biography, Father of the Blind, on Sir Arthur Pearson published in 2009. The introduction to this book and Lawson's own retrospective account in 1922 of St Dunstan's proved a rich source of material for the subject of this paper.
Body of paper: The book recounts how Pearson built up a newspaper and publishing empire only to lose his sight at the age of 48 at the peak of his career. Not to be daunted he devoted his considerable talents to found a hostel where blinded servicemen, mainly soldiers, would be welcomed and learn to be blind. That hostel was St Dunstan's. It was here that the servicemen were trained in Braille and a whole range of occupations.
Summary or conclusion: Without the drive and brilliant administration of Sir Arthur Pearson in his second career, many young blinded servicemen would have faced a dismal future. St Dunstan's thrives today and is now called Blind Veterans UK.
Presenter: Jacqueline A. Leavitt
Second Author: Susan Pepin, MD
Title: Traumatic Nerve Palsy and History: The Influence of Ophthalmic Care on C. Everett Koop, MD
Abstract: C. Everett Koop entered Dartmouth College in 1933. The football coach was enthusiastic about Koop based on his high school records. The team had been undefeated and Koop had played both offense and defense. One game, he jumped up to catch a pass and was hit on both sides by opposing players. When he woke up he had diplopia and a headache.
Days later, Koop saw Alfred Bielschowsky who questioned him about his background. Bielschowsky proceeded to “strongly advise” Koop NOT to play football. He told him that “another injury like this and he may not be able to practice medicine”. Bielschowsky diagnosed a “right hypophoria” and prescribed 6 prism diopters which he kept until the 1950s. He took the advice Dr. Bielschowsky gave him and quit football because he was serious about medicine.
Koop graduated from Dartmouth with a degree in zoology, graduated from Cornell Medical School and did his surgery residency at Penn. After a year of pediatric surgery in Boston he returned to Children’s Hospital of Philadelphia for his career.
Once he had eye inflammation requiring care and was told by the chairman in Iowa (while there to give a speech) it was surprising he had never had surgery. Koop felt he managed very well with prisms. He described his increasing success as a surgeon and that no one ever knew that he had diplopia.
In 1981, Koop was appointed Surgeon General. He ended up seeing Marshall Parks as a patient when he was 70 years old. His prism needs had jumped from 6 to 11. As Koop was leaving the office, Marshall Parks told him that he was the first patient he had examined that had also been examined by Bielschowsky and acknowledged the significance of that for Marshall Parks.
Presenter: John C. Lee
Second Author: H. Stanley Thompson
Title: Charles D. Phelps, MD (1937-1985): Short Life, Big Impact
Abstract: Introduction: Charles D. Phelps, MD was a rising “star” in ophthalmology whose life was cut short. Although his number of years was limited, he produced extensive research in glaucoma, educated many residents and fellows, and began his legacy as Department Head at the University of Iowa.Methods: biographical notes, historical records, video recorded interviews of his contemporary faculty at the University of Iowa, internetResults: Charles Phelps, son of an ophthalmologist, was carefully raised by his parents. He was an excellent student. His educational path included the University of Iowa for undergraduate and medical school. He interned at Boston City Hospital. Then, after two years of service as a Captain in the United States Air Force, he returned to the University of Iowa for residency in ophthalmology.
Phelps joined the Iowa faculty in 1971as an instructor. He went to St. Louis in 1972 for an NIH Special Fellowship in Glaucoma under Bernard Becker, MD at Washington University School of Medicine. He then returned to the University of Iowa as Assistant Professor in Glaucoma. In 1984 and until the time of his death in 1985, Phelps served as Department Head at the University of Iowa. Conclusions: It has been said by other ophthalmologists that he would have made a great Head of the Department. In his short life, Charles D. Phelps, MD impacted many ophthalmologists, patients, and research in glaucoma.
Presenter: Christopher Leffler, MD
Additional Authors: Tamer Hadi, Akrithi Udupa, Stephen G. Schwartz and Daniel Schwartz
Title: A Medieval Fallacy: the Crystalline Lens in the Center of the Eye.
Abstract: Objective. To determine whether, as most modern historians have written, ancient Greco-Roman authors believed the crystalline lens is positioned in the center of the eye.Background. Historians have written that statements about cataract couching by Celsus, or perhaps Galen of Pergamon, suggested a centrally-located lens. Celsus specifically wrote that a couching needle placed intermediate between the corneal limbus and the lateral canthus enters an empty space, presumed to represent the posterior chamber.Methods. Ancient ophthalmic literature was analyzed to understand where these authors believed the crystalline lens was positioned.
In order to estimate where Celsus proposed entering the eye during couching, we prospectively measured the distance from the temporal corneal limbus to the lateral canthus in 30 healthy adults.Results. Rufus of Ephesus and Galen wrote that the lens is anterior enough to contact the iris. Galen wrote that the lens equator joins other ocular structures at the corneoscleral junction. In 30 subjects, half the distance from the temporal corneal limbus to the lateral canthus was a mean of 4.5 mm (range 3.3 to 5.3 mm).
Descriptions of couching by Celsus and by others are consistent with pars plana entry of the couching needle. Anterior angulation of the needle would permit contact of the needle with the lens. Conclusions. Ancient descriptions of anatomy and couching do not establish the micro-anatomic relationships of the ciliary region with any modern degree of accuracy. Nonetheless, ancient authors, such as Galen and Rufus, clearly understood that the lens is located anteriorly. There is no reason to believe that Celsus or other ancient authors held a variant understanding of the anatomy of a healthy eye. The notion of the central location of the lens seems to have arisen with Arabic authors in 9th century Mesopotamia, and lasted for over 7 centuries.
Published as: Leffler CT, Had TM, Udupa A, Schwartz SG, Schwartz D. A medieval fallacy: the crystalline lens in the center of the eye. Clinical Ophthalmology 2016; 10:649-62. PMID 27114699
Presenter: Maurice Luntz, MD
Title: Selected Luminaries of Yesteryear
Abstract: Purpose: To present photographs of a few of the many stalwarts in Ophthalmology active in the second half of the 20th century with a short review of some of their work.They were in their time role models for young Ophthalmologists. The audience will be asked to identify the individuals in the photographs; how many are remembered?
Methods: Searching my slide collection, some borrowed photographs, publications from that period and my memories from personal contact. Selected for mention are those aspects of their extensive contributions that seemed to best illustrate their qualities as physicians and individuals.
Conclusions: The second half of the 20th century was no less noted for Giants in Ophthalmology than previous or present times. They were productive as surgeons, researches, teachers, administrators and moved Ophthalmology forward as a science and an art. They introduced technological advances which has led to better patient care. To be well acquainted with them was a privilege.
Presenter: Curtis E. Margo, MD
Second Author: Lynn E. Harman, MD
Title: Conceptual History of Autoimmunity. Perspectives on the Contributions of Ocular Immunology
Abstract: Background: Medical historians identify the mid-20th century as when the scientific and medical communities accepted the validity of autoimmune disease, yet several disorders were suspected of being autoimmune decades earlier, specifically sympathetic ophthalmia and phacoanaphylaxis. Why did it take so long to recognize the basic pathogenesis of such a conspicuous group of diseases, and what role did ocular immunology play in forming these concepts?
Methods: Review of relevant literature and period textbooks.
Results: The notion of horror autotoxicus, proposed by Paul Ehrlich in 1901, considered pathologic autoantibodies as dysteleologic. Early 20th century investigators learned that the immune system could inflict harm on the host in the form of allergy and anaphylaxis. Exogenous antigens were responsible for these injuries, however. Ocular immunologists described phacoanaphylaxis and sympathetic ophthalmia as autoimmune disorders but couched in terms of allergic disease. A variety of discoveries made the concept of autoimmune disease possible, but the most important was immune tolerance. This avenue of research began with animal transplant experiments involving the anterior chamber of the eye.
Conclusions: Two unique inflammatory disorders of the eye and experiments with the anterior chamber exploring immune tolerance played important roles in the conceptual evolution of autoimmune disease. Ironically, sympathetic ophthalmia and phacoanaphylaxis, two conditions which seemed best poised to invalidate horror autotoxicus did not, probably because immunology at the time lacked the tools and understanding to decipher their complex pathways.
Presenter: Harry H. Mark, M.D.
Title: Emerging ideas about the lens and cataract in the 17th century
Abstract: The explosive growth in the number of scientific publications is often lamented today as being overwhelming. Five centuries ago Johannes Kepler already said that it was doubtful whether knowledge suffered more from the scarcity of good papers in the old days or from the abundance of bad ones at his time. The wide gap between new discoveries and their wider recognition and application is well illustrated by the nature of the lens and cataract. In 1604 the physicist Kepler demonstrated clearly that the human lens was an optical device rather than the site of vision. It formed an inverted image on the perceptive retina. Kepler's ideas were proven in fact by Scheiner in 1619.
On the other hand Benito Daca de Valdes in 1623 reported the need for very strong convex corrective spectacles after depressing the "cataract", still widely believed to be an opacity in front of the light perceiving lens. This belief was printed again by Riverius as late as 1672. Pierre Brisseau in 1706 finally demonstrated that a cataract was actually the opaque lens, as did Antoine Matre-Jan at the same time period.
Similar slow recognition occurred, for instance, to new ideas reported by Gregor Mendel on heredity, discovered 34 years after publication, or the centuries old optical laws of reflection and refraction already shown erroneous some 34 years ago but not yet acknowledged.
Presenter: Mark J. Mannis, M.D., 2016 Snyder Lecturer
Title: Shakespeare's Eye
This year, we commemorate the 400th anniversary of the death of William Shakespeare, arguably the greatest dramatist of all times. While much of his life remains shrouded in a great deal of mystery, the works imputed to him remain timeless and enduring in the depth of their human understanding. The eye, vision, and blindness play significant roles in both the plays and the sonnets of the great Bard, and this presentation will review the important role of the eye as a metaphor in the Shakespearean theatrical opus.
The Backdrop
It is important to note that Shakespeare’s career developed on the backdrop of tumultuous times in politics, medicine, and the theater. In the realm of politics, Elizabeth I died heirless in 1603, with the throne passing to James VI of Scotland (James I of England). With this transition from the Tudor dynasty to a Scottish king, there came renewed religious unrest culminating in the aborted Gunpowder Plot of 1605 and a string of grisly public executions thereafter. Added to this political turmoil were recurrent seasons of the plague that recurred periodically. In 1606, over 30,000 died (approximately 1000/week) from bubonic plague in London, a city of 200,000, further destabilizing the political structure.
The medical institutions in England were also in turmoil. Well behind the European continent, where progressive Islamic medicine was pervasive, England was rife with quacks and empirics. Surgeon/barbers were only loosely regulated and were completely separate from the physicks (the “internists”, as it were). Apothecaries were regulated by yet another governing body. This structure, in which there was no cohesion or true regulation of medical science, served to produce a chaotic medical backdrop to the dramatic expressions of Shakespeare. The world of the theatre was also in some degree of turmoil, bobbing and swaying, with the rapidly changing socio-political scene.
Shakespeare and Medicine
Many essays and books have been written on the subject of medicine in Shakespeare’s works. It is clear that the Bard was very familiar with both current medical institutions as well as the diseases they managed. There are over 700 references to medicine in the plays, and the playwright cites many disease entities accurately as well as their treatments by physicks and surgeons who appear or are alluded to in the plays. For the most part, physicians are portrayed sympathetically, while surgeons never appear on stage.
The Eye in Shakespeare
Ophthalmology at the turn of the 16th Century was also in transition. Pre-eminent was the work of Georg Bartisch (1535-1607) who established ophthalmology as a specialty in medicine in his vernacular tome, Oftalmodouleia: Das ist Augendienst. In addition, Richard Banister (1570-1625), considered the father of British ophthalmology, became the leading exponent of ophthalmology, with excellent descriptions of disease entities, medical and surgical therapies, and critiques of quackery and empiricism.
The understanding of ocular physiology was in flux, transitioning between the earlier Aristotelian concept of the eye primarily as a receiver to the neo-Platonic/Galenic concept of the eye as an active projector sending the pneuma or the “spiritus visibilis” into the world to produce vision.
In the Shakespearean opus, there are 519 references to the eye. Some of these refer to the physical eye in disease and others to the eye as a metaphor in the context of a dramatic setting. Among the specific eye diseases that are mentioned in the plays are pin and web (cataract), raw eyes (conjunctivitis), sand or gravel blindness (? trachoma), the parted eye (diplopia), and traumatic blindness. Yet, as with all medical entities appearing in his works, disease is usually employed as a metaphor.
The Eye as a Metaphor
In the course of a lecture on this subject, the broad range of allusions to the eye, vision and blindness is impossible to cover. Therefore, only a few examples of the way in which the eye is used as a metaphor can be addressed here.
The eye was often seen as an expression of character:
• “Yet he looks like a king! Behold his eye, as bright as the eagle’s, lightens forth controlling majesty.” (Richard II)
• Let me see his eyes, that when I note another man like him, I may avoid him.” (Much Ado About Nothing)
• “Alack, there lies more peril in thine eye than twenty of their swords! (Romeo and Juliet)
The eye also portrayed human emotion:
· “Uncle, even in the glasses of thine eyes, I see thy grieved heart.” (Richard II)
· “I see a strange confession in thine eye” (Henry IV)
1606 was a landmark year for Shakespeare in which he wrote two of his most visual plays, Macbeth and King Lear.
As is demonstrated clearly in the dagger scene just before Macbeth kills King Duncan, the eye (and its vision) becomes the expression of Macbeth’s recognition and emerging guilt over the impending regicide, which he knows is wrong. The guilt is transmuted into the hallucination of the dagger covered with gouts of blood. Similarly, in the famous sleepwalking scene after the murder, Lady Macbeth, having driven her husband to commit murder, is now consumed with remorse over the deed and hallucinates the sight and smell of blood on her hands—the visual manifestation of her profound and disabling guilt.
In King Lear, vision is tantamount to power and virility. And the loss of sight is equated with the lost of power and induced physical helplessness. The grisly onstage blinding of the Duke of Gloucester for his loyalty to Lear, is designed to make him helpless and dependent. But at the same time, his blindness coincides with a new understanding of his sons, one of whom is faithful and the other disloyal. This parallels the madness of Lear that is accompanied by the recognition of the true character of his three daughters.
Shakespeare favored the understanding of the eye as did Galen, as a projector of light, and by extension, of emotion and love. As such, in Shakespeare’s work, the eye and vision symbolize power, become the manifestations of guilt and remorse, serve as an active projector of love and hate, and represent the mind and intellect.
Shakespeare’s contribution to the lexicon of the eye.
William Shakespeare coined over 2000 words and phrases in the English language. Among these, is the concept of the “mind’s eye” (oculus imaginationis) as well as the word “eyeball” which first appears in the English language in Midsummer Night’s Dream.
Shakespeare’s Death
Even in death, there is a connection, albeit tenuous, between the Bard and the eye. Hildegard Hammerschmidt-Hummel, a German Shakespeare scholar, has used medical and forensic techniques to examine the likenesses of Shakespeare in portrait and sculpture that are presumed to be authentic and contemporary. Among these, she and her team have discovered periocular swelling suggestive of dacryosialoadenopathy (Mickulicz Syndrome), a distinctive ocular finding often associated with underlying systemic diseases particularly hematologic malignancies. She hypothesizes that these findings reveal the likely cause of Shakespeare’s demise. Although the genuine nature of the images on which she bases her theory, as well as the methodology itself, is highly contested, it is an intriguing coda to the life of a playwright and poet in whose works the eye has figured so prominently.
Presenter: Michael F. Marmor, MD
Title: The Ophthalmic Sleuth: Unfinished Paintings in the Pitti Palace
Abstract: Purpose: In the Pitti Palace in Florence are a set of four paintings credited to Andrea del Minga, of which two are well colored, while the other two are pale except for a select regions. Are these unfinished, and why?
Background: According to the historian Vasari, these four works were designed by Baccio Bandinelli, but painted by Andrea del Minga. Is this merely a tale of art history, or is there a deeper meaning? Vasari noted repeatedly that Bandinelli could not paint well in color, and I have argued previously that he was probably red-green color-blind.
Results: The flesh tones of the two unfinished paintings are drab, and there are curious demarcations where a hand or foot is colored. This suggests that they were being colored in steps. The pale main figures resemble those in paintings attributed to Bandinelli, and are consistent with color-blind perception. Thus, these four works might actually be full oil paintings by Bandinelli, with only highlights of color by del Minga.
Comment: Almost 500 years after the fact, we cannot be certain how these paintings were generated. Conceivably, Del Minga made uncolored under-paintings routinely before adding color. But it is attractive to consider that Bandinelli originally executed these works, rather than merely doing drawings. Vasari notes several instances where Bandinelli hired a colorist, and these partly unfinished paintings in the Pitti Palace add confirmation. Color blindness was unknown in the Renaissance, of course, and Bandinelli would not have understood the criticism of his oil paintings. He was famous for ill temper and a vindictive personality, which was undoubtedly reinforced by the insult of having his paintings completed by others.
Presenter: J. Fraser Muirhead
Title: Joseph LeConte: Geologist and Vision Scientist
Abstract: A graduate of the College of Physicians and Surgeons in New York City, Joseph LeConte, is known primarily as a revered professor of geology at the University of California, and as a charter member of the Sierra Club. His geology textbook was extraordinarily popular; its 5th edition appeared ten years after his death. The amazing volume and variety of subjects of his publications include evolution, race relations, art, religion, liberal education, instinct, liver function, amphibian respiration, flying machines, feminism, and the origins of sex.
My presentation describes his early years, his youthful interest in vision, his training with Louis Agassiz, his abbreviated medical practice, and his Civil War experiences. Reconstruction’s inadequate university funding forced a shift from geology to less expensive vision research. Continued problems ultimately compelled a move to the University of California, where his very successful career centered on geology, but included work on vision.
I discuss his interest in vision, his 27 articles on vision and his very popular textbook, "Sight: An Exposition on the Principles of Monocular and Binocular Vision". The first English textbook on the subject, it containes clearly described, easily performed experiments and elegant illustrations. William James was impressed by the second edition. Julius Hirschberg lauded the German edition, "Lehre von Sehen".
Interest in his vision work waned in mid-20th century. Recent articles have described the role he and two other neglected researchers played in the development of the concept of the “cyclopian eye”. The widespread use of the first edition of “Sight” as a textbook in United States colleges supports the contention that Joseph LeConte be considered the father of physiologic optics in the United States.
Presenter: Steven A. Newman
Additional Authors: Samuel Yun and Robert L. Lesser
Title: Harvey Cushing and the Practical Evolution of Visual Field Testing and Its Role in the Development of Neurosurgery
Abstract: Introduction: Although the Greeks were familiar with homonymous visual field defects, it was not until Wollaston in 1824 corrected the inaccuracy of Galen’s gratuitous statement about fibers not crossing in the chiasm. It was William McKenzie in 1835 who first recognized the potential localizing value of a bitemporal visual field defect. The development of neurosurgery was predicated on intracranial localization. Although plain films could recognize bony abnormalities most intracranial pathology was invisible to roentgen diagnosis. Cushing early on recognized the important value of clinical localization by visual field testing.
Materials & Methods: A review of a series of seven articles authored or co-authored by Harvey Cushing demonstrates the development of the use of visual field testing for localizing intracranial pathology.
Results: Early papers often echo previous statements (eminence based medicine) of authors who are often incorrect. With increasing experience, one can see how Cushing abandoned those statements that were incorrect, and emphasized the usefulness of quantitative assessment of the visual fields.
Conclusions: Although the advent of imaging (CT and later MRI scan) now plays a primary role in intracranial localization, visual field testing, as described and emphasized by Harvey Cushing, still plays a critical role in the functional assessment, even when imaging does not show change.
Presenter: Rolando Neri-Vela
Additional Author: Lizbeth Espiosa-Miguel
Title: Badianus Codex and Ophthalmology
Abstract: In 1551 was elaborated the Badianus Codex on the Santa Cruz School in Tlatelolco; it is the most important Indian herbolary manuscript. This Codex was ordered by Francisco de Mendoza, son of the Viceroy Juan Antonio de Mendoza as a present for King Phillip II of Spain. It was discovered in the 20th Century inside the library of Cardinal Barberini on the Vatican City. The Codex is ordered in thirteen chapters describing diseases from head to toes as used at those times. It was written in Náhuatl and Latin and was illustrated with drawings of medical plants made by the tlacuilo indians (painters) and were made of vegetable paint.Among the ophthalmologic diseases included in the Codex are pterygium, conjunctivitis, cataracts, blindness and the so called "glaucoma”.
Presenter: James Ravin
Title: Iris Recognition Technology
Abstract: Iris recognition technology is a means of identifying individuals based on the appearance of the iris stroma and is widely used in security for airlines, industry, the military and even as a means of identity for governmental benefits. A photographic image of the iris is taken using infrared light and stored electronically in a data base that can be compared with other images. Although our irises are identical genetically, they differ morphologically, even for identical twins. A reliable method of identifying people has been a long term goal, and this form of biometry is very useful. Photographs obtained with visible light have been used since the 1840s. Alphonse Bertillon, a French pioneer in biometry, standardized the mug shot and created a table of iris morphology early in the 20th Century. At the middle of the 20th Century, James Doggart, an English ophthalmologist, noted the uniqueness of the iris, and Francis Heed Adler agreed. Two American ophthalmologists, Leonard Flom and Aran Safir were familiar with Doggart's work, and obtained a patent for iris biometry in 1987. They were inducted into the National Inventors Hall of Fame for their work. Their patent has since expired, but techniques and applications have advanced rapidly.
Published as: Ravin JG. Iris recognition technology (or, musings while going through airport security). Ophthalmology 2016; 123:2054-5. PMID 27664909
Presenter: David Reifler
Title: A Footnote in Hirschberg’s History of Ophthalmology ‒ The Rothschildsand Ophthalmologist Dr. Edouard Meyer
Abstract: The massive, multivolume tome, Geschichte der Augenheilkunde [History of Ophthalmology] by Julius Hirschberg (1843‒1925), contains a generous and flattering section about Professor Hirschberg’s Parisian colleague and fellow von Graefe disciple, Dr. Edouard Meyer (1838‒1902). Recent research at the Bibliothèque nationale de France and elsewhere in Paris has revealed a small but important error in Hirschberg’s history concerning the personal life and financial fortunes of Dr. Meyer ‒ particularly his purported connections to the Rothschild family by marriage. This paper will dispel the Meyer-Rothschild genealogic myth while reviewing Dr. Meyer’s career and his importance to the history of ophthalmology and medicine. Verifiable connections between Dr. Meyer, the Rothschilds, and one of Meyer’s most important protégés will be described. This particular protégé is the Zurich-educated Dr. Aharon Meir Mazie (1858‒1930) ‒ a polymath physician, engineer, linguist, agronomist, and Zionist ‒ who emigrated from Paris to Ottoman Palestine in 1888 and who became one of the most important figures of the so-called First Aliyah. During the late nineteenth century ‒ a quarter-century before Albert Ticho and the “Days of Ticho,” Dr. Mazie provided important ophthalmologic and general medical services to the Jewish population of Palestine on behalf of Baron Edmond de Rothschild.
Presenter: Gill Roper-Hall
Title: Henri Parinaud: An Update on his Syndrome
Abstract: Henri Parinaud was a French ophthalmologist with a great interest in neuroophthalmology and was one of the first physicians to practice in that specialty. He is well known for his eponymic syndrome with features including upgaze palsy, convergence retraction nystagmus and pupillary light/near dissociation.Parinaud was born and raised in France. During his medical training in Paris at the Salpêtrière, the legendary teaching hospital, he wrote a doctoral thesis on papilledema in children with meningitis. This attracted the attention of Professor Jean-Martin Charcot, considered by many to be the founding father of neurology. He was appointed by Charcot as chief of ophthalmology of the neurology service at the hospital and this setting allowed him to develop and establish the discipline of neuroophthalmology.Parinaud was a modest man and did not assign his name to the well known syndrome. Although he described vertical gaze paresis among his findings, not all the features now known to be part of this syndrome were reported by him in his early description. Parinaud’s body of work and its influence on modern day clinical neuroophthalmology will be described. A current understanding of his supranuclear vertical gaze syndrome, as it is now accepted, will be presented from an anatomic and clinical standpoint with a description of the examination techniques used to elicit the features of this eye movement disorder.
Presenter: Ivan Schwab
Title: Why Is It Pronounced Fresnel?
Abstract: In 1822, Augustine Fresnel, an optical engineer, is credited with discovering and developing the principle of his eponymous lens. Fresnel had published on the wave theory of light, as well as manuscripts on diffraction, interference, and polarization, when he was made the French Commissioner of Lighthouses in 1819. He was charged with improving lighthouse beacons with this appointment. He was aware of previous work by Count de Buffon in 1748 to reduce the thickness of convex lenses and combined that knowledge with his own research to develop the formulae and understanding of light manipulation to produce the Fresnel lens for lighthouse beacons. The Fresnel lens principle led to the projection of light over the watery horizon 20 miles or more and was the greatest advance in lighthouse technology in 3000 years.
This brilliant invention reduced the weight of large, powerful convex lenses by two-thirds allowing the lenses that produced the focused light column to be turned more easily. Importantly, this invention permitted the huge lenses to be shipped in pieces and assembled in the lantern room of lighthouses despite a total weight of some of the larger lenses to be over six tons. The discovery was so technologically advanced for its time and so optically important that these lenses remain in use today at many lighthouses.
Over the ensuing nearly 200 years, Fresnel lenses have been used in a variety of other optical devices. Interestingly, about 150 years after its discovery, the principle of Fresnel prism lenses came to Ophthalmology in 1970 when Jampolsky introduced the membrane Fresnel lens for use in strabismus. It is surprising that it took so long.
Presenter: Sriram Sonty
Title: Ophthalmology in the 19th Century America: Evolution and Eminence.
Abstract: Purpose: To provide insight into how ophthalmology developed as a separate surgical specialty, an dits impact on eye operations in the 19th century.
Introduction: Although ophthalmology was established as an independent specialty in Europe in the late 18th century, ophthalmology as an independent surgical specialty was a new phenomenon in America. 18th century advancements in ophthalmology include the understanding of the nature of cataracts by Maitre-Jan, and Daviel’s development of cataract extraction. American ophthalmology progressed with visits to European institutions by Frick and Williams. The first surgeons to make Ophthalmology an independent specialty were Drs. George Frick, Isaac HaysandLittell. In ophthalmology, they stood above all others in the extent of their practice, with their self-sacrificing devotion to their work.
Methods: Ophthalmic Institutions which emerged in this time frame include New York Eye Infirmary (1820), Massachusetts Charitable Eye and Ear Infirmary (1824), Baltimore Dispensary for Diseases of the Eye(1823), Wills Eye Hospital (1830), and Illinois Eye Infirmary (1858). The three pioneers were Frick, Hays & Littell, modest and conservative by nature, and endowed with literary tastes. Other prominent eye surgeons of the time includeMcClellan, Gibson, Rodgers, Smith and Gross. The first American book on Ophthalmology was published: A Treatise on the Diseases of the Eye by George Frick. Other books were On the Anatomy, Surgical Operations and Treatment of Diseases of the EyebyGibson and A Manual of Diseases of the Eye by Littell. Among the most significant surgical operation advancements of the time were the operation for Strabismus, Gibson’s scissors for absorbing Cataract Surgery, andHorner's operation for Ectropion.
Conclusion: The 19th century produced many eye institutions, independent ophthalmologists, and technological innovations matchedEurope, and brought America to the forefront of international ophthalmology .
Presenter: Bradley R. Straatsma
Second Author: David F. Weeks
Title: Jules Stein: Ophthalmologist, Entertainment Magnate, and Advocate for Vision
Abstract: Purpose: To describe the lifetime activities and accomplishments of Jules Stein
Methods: Retrospective review of published and unpublished biographical material.
Results: Jules Stein combined his love of music and medicine with organizational and business skills to achieve successive careers as a musician, an ophthalmologist, an entertainment magnate, and an advocate for vision. To improve and preserve vision, he founded Research to Prevent Blindness, founded the Jules Stein Eye Institute at the University of California, Los Angeles, and led a multiyear campaign to establish the National Eye Institute.
Conclusions: With successive careers and extraordinary achievements, Jules Stein created an enduring legacy of benefits to ophthalmology, vision research, and the preservation of vision.
Last updated March 25, 2021