33rd Annual Meeting Abstracts 2021

There was no meeting in 2020; the 2021 meeting was held virtually

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. 

Snyder Lecture

The Unfinished History of Professionalism

George B. Bartley

Professionalism in medicine is easy to recognize but often difficult to define. This presentation will trace the ancient origins of professionalism and its relatively recent re-emergence; discuss what professionalism is (and is not) and its relationship to oaths; introduce early ophthalmic exemplars of professionalism; highlight consequences when the boundaries of professionalism are transgressed; and propose applications from the history of professionalism to the future of ophthalmology and medicine.

Dr. David W. Sime: The World’s Fastest Human

John Bullock

Dave Sime was born in Patterson, NJ on 07/25/1936. He was an outstanding, multi-sport athlete à la Jim Thorpe. After high school he rejected numerous professional bonus offers, preferring to attend Duke University on a baseball scholarship. He was soon recognized by Duke’s track coach for his blistering speed. During his career he set or tied 9 world records and appeared on the cover of Sports Illustrated. Because of an injury he was unable to make the 1956 Olympic track team. While a medical student at Duke he participated in the 1960 Rome Olympics, winning a silver medal in the 100 meter dash, losing gold by less than one inch. In Rome he served as a CIA operative attempting to facilitate the defection of a top Soviet athlete. He anchored the 4x100 meter relay; the team won in a world record time but was disqualified (allowing Great Britain the bronze medal) because their first exchange happened outside the changeover box. He concluded his athletic career and concentrated on his medical studies. He graduated in the top 10% of his medical school class and interned at Duke Hospital. His Duke mentor, J. Lawton Smith, steered him away from neurosurgery and into ophthalmology. He completed his residency at the Bascom Palmer Eye Institute in 1966. He practiced in Miami and his patients included Richard Nixon, Mickey Mantle, Don Shula, Sugar Ray Leonard, Ted Williams, and Bob Griese. He served as the team physician for the Miami Dolphins during their 1972 “perfect season.” Because of Griese’s amblyopia, diplopia, dizziness, and headaches, Sime designed new glasses for him which greatly improved his playing vision. Sime’s grandson, Christian McCaffrey (now a Carolina Panther) was runner-up for the 2015 Heisman Trophy. The personal characteristics making Sime a superior sprinter also made him a superior clinical ophthalmologist.

Feynman's Fascination with Vision and the Visual Arts

Chandra Chhetri

Dr. Richard Feynman, most renowned for his seminal contributions to the theory of quantum electrodynamics that would earn him the Nobel Prize in Physics in 1965, is less recognized for his keen interest in vision. Through consideration of his autobiographical texts, lectures, and artwork, this presentation depicts Feynman’s fascination with a world profoundly shaped by images, lending additional insight into a mind revered for mathematical brilliance.

Although the development of the Feynman diagrams in 1948 represents his most important foray into graphical output, Feynman was also a rather talented artist. After befriending the painter Jirayr Zorthian in 1962, the two began to exchange lessons in art and science on alternate Sundays. This presentation contains select pieces from The Art of Richard P. Feynman: Images by a Curious Character, a curated set of his works by his daughter Michelle.

His interest in vision does not stop there, however. In the three volume Feynman Lecture series, the eye remains the only organ that he has devoted not just one, but two entire chapters to (Ch 35: Color Vision and Ch 36: Mechanisms of Seeing). Here he discusses at length not just the physics of light and its relation to vision, but the anatomy, physiology, and evolutionary history of eyes. In his usual bold manner, he asserts making “no apologies for these excursions into other fields, because the separation of fields is merely a human convenience, and an unnatural thing. Nature is not interested in our separations, and many of the interesting phenomena bridge the gap between fields.”

The Quest for Snellen’s Dependable Optotypes

Paulus T.V.M. de Jong; Jan E.E.Keunen

Aim
To investigate how Herman Snellen happened upon his scientific approach to optotypes.

Methods
Literature search from the early 17th century on.

Results
The basis for reliable and reproducible visual acuity (VA) testing is determination of the separable minimum. Euclid theoretically described the smallest visual angle around 300 BC and that Robert Hooke determined in 1705 that two stars could be discerned when separated by 1 minute of arc is currently being contradicted. Daza de Valdes (1623) described how to put mustard seeds on a row, not to determine VA but to calculate the lens power that a person needed for sharply seeing them. In 1854, Jaeger published in Vienna his “Schrift-Scalen,” a collection of letters in haphazardly chosen sizes. Von Graefe and Donders discussed the necessity of an exact method to determine the VA and Donders asked Snellen to work on this. Snellen used some of Hooke’s observations to come upon the desired size of 5 minutes of arc for a whole letter, and one minute of arc for its legs. He published his optotypes in 1862 in a book “Letterproeven”. They were copied by Giraud-Toulon in France and Dyer in the US but these never got as popular as Snellen’s ones, if only because the British army ordered 1000 books from Snellen to use them worldwide. Landolt, a friend of Snellen, created in 1888 the ring with a gap, and only 100 years later letter charts were made that took crowding into account.

Conclusions: Despite some later improvements in his optotypes, Snellen was the founder of VA standardization worldwide to this day.

Henry R. Viets, MD, and the History of Myasthenia Gravis

Robert M. Feibel 

Henry R. Viets (1890-1969) was both a noted neurologist and medical historian.  While at Harvard Medical School, from which he graduated in 1916, he attracted the attention of Harvey Cushing who directed Viets into these disciplines. Cushing arranged for Viets to take a fellowship in Oxford, England in the year after his graduation. With Cushing’s recommendation, he lived with Sir William and Lady Osler and did research with the famous neurologist Sir Charles Sherrington, one of the founders of modern neurology.

Viets was in London in 1935 when he heard about the remarkable success of Mary Walker in treating myasthenia gravis, first with physostigmine and then with Prostigmin (neostigmine). Securing some ampoules of this drug, he took it to the Massachusetts General Hospital where he was an attending neurologist and in March 1935 injected it into a myasthenic patient with great success. He established the first Myasthenia Gravis Clinic in the world and was a pioneer in the diagnosis and treatment of this once obscure disease. With his colleagues, he evaluated hundreds of patients, and published many articles and edited several books on myasthenia. He continued this clinical practice for over 30 years.

Under the tutelage of Cushing and Osler, Viets became a medical historian and bibliophile, researching and writing hundreds of articles and several books on many different subjects in the history of medicine. He was a president of the American Association for the History of Medicine, and the librarian and curator of the Boston Medical Library that eventually joined with the Harvard Medical School Library. Viets served on the editorial board of the New England Journal of Medicine for 40 years, and was an editor of the Bulletin of the Medical Library Association. Published as: Feibel RM. Henry R. Viets, MD, and the History of Myasthenia Gravis. Neurology 2021; 96:322-6. PMID 33219137

Optography: Its Rise and Fall

Alice (Wendy) Gasch

Optography is the process of obtaining an optogram, which is an image seen on a retina after the retina has been exposed to the image and then chemically processed to make the image visible. In theory, optography is analogous to photography. Its popularity as a concept was prompted both by the invention of photography in the 1840’s and particularly by the discovery of the photosensitive pigment “visual purple” (rhodopsin) in the rods of the retina in 1876. In the late 1870’s, Wilhelm Kuhne popularized optography as a forensic tool when he demonstrated that images resembling windows with bars could be seen on rabbit retinas that had been exposed to such windows at the time of death and then chemically processed. The images consisted of white areas (bleached rhodopsin) on a purple or red background. Of note, a physician who assisted Kuhne in his laboratory and translated Kuhne’s papers into English dismissed optography as useless forensically. However, in the late 19th and early 20th centuries, it was widely believed that retinas, including human retinas, retained images of what was seen at the moment of death. Thus optography became a tool in the investigation of murder cases. It also became a plot device in published fiction. However, in 1975, optography underwent serious evaluation as a forensic tool and was conclusively deemed inappropriate as such. Nevertheless, as recently as 2008, optography was featured as a forensic tool in the television series Fringe. Thus optography has not entirely lost its appeal despite being debunked as useful forensically.

The Artist and the Eye

Frank Joseph Goes

People often call eyes the windows to the soul. But what exactly do we see when we gaze into the eyes of another person? In fact, the eyes do provide lots of information about another person’s emotional state. We can tell a true (or Duchenne) smile from a fake by looking at a person's eyes. 

This is also true when an artist paints the eye. The way an artist paints the eye may tell us something:
1. About the state of mood and the character of the artist;
2. About his artistic skills. Sometimes, the artist is unsuccessful in painting the eyes straight and symmetrical;
3. But sometimes the artist had a special message for us by painting eyes like he did -he wanted to tell us something.

Artists such as Pablo Picasso, Joan Miro, Eduard, Manet, Jean Michel Basquait, Rubens, Rembrandt, Dali, Dürer, and others pass the revue.

Tadeusz Krwawicz – The Man Who Invented Cataract Cryoextraction

Andrzej Grzybowski

 
Tadeusz Krwawicz (1910–1988), Polish ophthalmologist, pioneered the use of cryosurgery in ophthalmology. The idea arose in 1959 while experimenting because on lyophilization to store corneas and lenses for transplantation it was difficult to remove the lens without damage the capsule was usually torn. Subsequent experiments on rabbits revealed that touching the lens with a wire cooled to 203°K (–70°C) resulted in firm attachment of the lens capsule and subcapsular masses. A cryoextractor was developed and employed for clinical use in cataract extraction, likewise in intumescent cataracts and lens subluxation.

Cataract surgery utilizing cryoextraction led to substantial progress to ophthalmology by reducing the number of complications, particularly capsule rupture, and resulted in achieving better outcome compared to other methods. This surgery soon and for almost 20 years became a routine method used all around the world in cataract removal. It is worth underscoring, however, that cryotherapy found application in other fields of ophthalmology, such as the treatment of corneal inflammation, retinal detachment, and glaucoma. Cryotherapy and cryoretinopexy became effective treatment methods used till recent times. 

 Simultaneously, Krwawicz developed techniques for keratoplasty (intracorneal lamellar keratoplasty with a lyophilized graft) and certain refractive procedures, like stromectomia lamellaris in myopia (a precursor of LASIK) and by changing the corneal curvature through allogeneic intracorneal implants. Krwawicz presented other ophthalmic interests—his research concerned immunology, histology, histochemistry, biochemistry of ocular tissue, and mainly corneal and experimental surgery with a particular focus on the pathology of the cornea.

 Sir Stewart Duke-Elder, in his System of Ophthalmology, wrote: “He will be always remembered for introduction of cryosurgical techniques in 1959, especially cataract cryoextraction and cryotherapy of such diseases as viral infections of the cornea. These achievements made him well-known all over the world.”

The International Council of Ophthalmology awards Tadeusz Krwawicz’s Gold Medal every 4 years during the World Ophthalmology Congress. Medal recognizes significant contributions to ophthalmology, especially in diseases of the anterior segment and/or introduction of new technologies, and the advancement of international relationships among ophthalmologists.

The Frequency of Keratectasias and Staphylomas in the Course of the 19th Century up to Today - An Analysis Based on Rostock’s Artificial Eyes Collections

Rudolf F. Guthoff; Thomas Fuchsluger, Thomas Stahnke, Daniel Schubert

Purpose
The aim of this study is the analysis of time related changes in anterior segment pathology documentations exemplified in historical and contemporary collections of 3-D glass and acrylic eye-models.

Methods
In the collections there are:
1. 132 artificial glass eyes from around 1860
2. Atlas (A.P. Demour Paris 1818)
3. 60 acrylic “training models“ from about 2010
All items were reclassified including slit lamp examinations with special emphasis on keratectasias and staphylomas.

Results
The first collection of 132 items was most likely manifactured by Amadeus Müller Hipper Lauscha, Germany, acquired by Wilhelm v. Zehender, the first chairman of Rostock University Eye Department. Templates of 97 items were found in A.P. Demour’s Atlas with 9 staphylomas (9%). In the remaining 35 items there were 13 staphylomas (37%).
The second collection was made by Dr. Victor Ryzhov in Ufa an ophthalmologist and ocularist. Among these 60 items of there were 2 ectasias representing 3% of all samples.

Discussion
As the scientific interests of the acquirer are dedicated to the pathogenesis and therapy of keratoconus and keratoglobus as stimulated by Albrecht von Graefe. It could be hypothesized that most of pathologies which are not found in Demour’s atlas, are based on Zehender's suggestion and related to his own research interests.
The fact that the Russian collection includes only 2 mild ectasias most likely is explained by the fact that progress in conservative and surgical treatment (crosslinking, penetrating and lamellar corneal grafting) has influenced our present spectrum of disease presentations missing endstage pathology.

Discarded Eye Items: A Photograph and a Human Prosthetic Glass Eye Give Clues to the Past

Michael O. Hughes

Few people create grand legacies or make great gestures in society. Rather, most individuals live their lives within a small, quiet world. Many depart unnoticed, leaving behind no awards, estates, or monumental achievements.

When two items of seemingly small significance were separately happened upon, further analysis revealed their rather personal nature.

For this presentation, these relics will be discussed as they offer clues to the identities of the individuals who left them, and something of their lives. They also offer eye care professionals a useful perspective.

Two Stage Cataract Surgery...the Preliminary Iridectomy

Graham Kyle

Perusing the records of eye surgery in Wrexham Infirmary, North Wales, for the late 19th and early 20th century, I was struck initially by how infrequently my predecessors operated. (I worked in the successor of that hospital at the end of the 20th century.) They still had a considerable outpatient load, however.

More striking was the realisation that cataract extraction was routinely performed in two stages...the ‘preliminary iridectomy’ was performed six weeks before the lens was removed.

The rationale for this surgical approach was researched. Contemporary views, both for and against such a routine, as well as the need for an iridectomy at all in cataract extraction, will be presented.

American Notes, How Charles Dickens Changed the World of the Deaf-Blind

Linda Lawrence

A British tourist’s search for celebrities in America forever changed the way the deaf blind are educated. Charles Dickens traveled to the USA in 1842, with a priority to meet the already widely known Laura Bridgman, the first person who was deaf-blind to be educated in the United States, a pupil of Samuel Howe’s at the Perkins Institution (now Perkins School for the Blind). Years later, Helen Keller’s mother read "American Notes", written by Charles Dickens about this journey. Partly because of Dickens’ story, the Kellers sought out Perkins Institution leading them to Anne Sullivan. The amazing lives of three women: Laura Bridgman, Anne Sullivan, and Helen Keller were brought together by a chapter in a book.

Materials/Methods:
1. Review of Archives Perkin’s School for the Blind: Materials created by and about Laura Bridgman
2. Review of Charles Dickens American Notes
3. Personal correspondence with Library at Perkins’ School for the Blind

Results:
Charles Dickens’ infatuation with news and unusual circumstances brought him to Perkins Institution in 1842. He explored the clinical descriptions of Howe and personally met with Laura. His account in American Notes of his meeting with Laura Bridgman, and Dr. Howe’s details of her education are extensively documented, and how education for the deaf blind evolved. Understanding how communication and literacy, both important skills, can be achieved in the face of the loss of the two most important sensory inputs, vision and hearing, are the importance of this work. Three women’s lives were intertwined because of the novelist’s book chapter.

Bibliography
1. American Notes for General Circulation, London, June 22, 1850
2. Laura Bridgman Collection, Perkin’s Archives
3. Helen Keller, (1880-1968), The Story of My Life, 1903, (New York, Doubleday, Page, &Co.)

Highlights of the History of Iowa Eye 

 John C. Lee

C.S. O’Brien, M.D. was the first Head of the Department of Ophthalmology at the University of Iowa in 1925. He established the framework on which a remarkable department was developed. 

 Throughout the history of the Iowa Eye, many key faculty members have followed O’Brien’s lead and expanded the Department. 

 This paper will present some of the outstanding teachers and services that made the Department a “pride of the prairie.”

Cheselden’s 1728 Report of Eye Surgery in the Congenitally Blind: New Information

 Christopher Leffler; Stephen G. Schwartz; Natario L. Couser; Abdul-Rahman Salman

Purpose
To investigate the eye surgery performed by William Cheselden (1688-1752) in a previously unidentified 13-year-old boy, the report of which has contributed to extensive debates over the last 3 centuries among philosophers and scientists.

Design
Retrospective review.

Methods
Assessment of newspapers, books, journals, and letters.

Results
In 1728, a report signed “Chesselden” described recovery of vision following eye surgery for possibly congenital cataracts in a 13-year-old boy whom we have identified as Daniel Dolins (1713-1743). Philosopher George Berkeley (1685-1753) claimed that this report vindicated his theories about the perceptions of one suddenly made able to see for the first time. Daniel’s older brother had congenital cataracts, and was operated on by an oculist named Mrs. Jones twice in one eye. Daniel was still unable to read after his surgery, and there is no evidence that the procedure improved his ability to conduct visual tasks. Both Dolins brothers died prematurely. Daniel’s father was a professional associate of Berkeley, Daniel was presented to Berkeley’s royal patron (Caroline, the Princess of Wales), and the report uses concepts and language more characteristic of Berkeley's writing than of Cheselden's.

Conclusions
The Dolins brothers probably had hereditary cataracts. Despite the 1728 report, there is no evidence that Daniel’s vision improved. Berkeley is linked to the patient’s family and might have written the report said to validate his theories. Daniel’s case cannot reliably inform debates about perceptions after the sudden acquisition of vision.

Friedrich Best

Ian MacDonald

Introduction
Best disease is a common heritable macular dystrophy and is named after Friedrich Best, a distinguished German ophthalmologist whose training intersected many of Ophthalmology’s leading teachers of the time, including Professors Leber, Bruckner, Vossius and Hering. I recognized that I had virtually no understanding of “the person behind the syndrome” despite having provided clinical care for patients with Best disease, and so began my research of his career.

Methods
I reviewed Friedrich Best’s career from various sources. An initial personal search under the headings of Best and Ophthalmology generated little useful information except humorous suggestions. Three research librarians were separately consulted to provide direction and locate source documents. Searches also included the US National Library of Medicine and Sir Duke-Elder’s System of Ophthalmology. Personal contact was made with Christoph Frieburg from the Department of Ophthalmology at Giessen, Germany where Best was an assistant Professor under Vossius from 1896 until 1905, when he moved to Dresden.

Results
In Giessen, Best studied a family with a maculopathy and Vossius is reputed to have assigned the moniker, Best disease. The librarian from the Archives of the University of Heidelberg could not find a record for Best’s reputed training in Heidelberg with Leber. An attempt to contact one of Best’s family members failed. The best source of information came from The Person Behind the Syndrome by Peter Beighton and colleagues, published by Springer-Verlag in London, 1997.

Conclusions
While ophthalmologists can readily diagnose Best disease, they may not have learned much about Friedrich Best. The effects of WW2 with the fire-bombing of Dresden likely played a significant factor in the lack of information surrounding his career, as he was noted to have lost everything and had to re-start his career in his 70’s, an age when most ophthalmologists would have retired.

What's in a Name? A Short History of Ophthalmic Drug Nomenclature

Mark Mannis; Gary D. Novack

The history and development of the names given to ophthalmic drugs reflects the close association between physicians, pharmaceuticals, and the eye diseases that have afflicted patients over the centuries. The use of and naming of ophthalmic pharmaceuticals appears as early as Susruta in India and in the Ebers Papyrus in Egypt. In classical Greek and Roman medicine, the term “collyrium” stood for a range of medications for different diseases proffered by specific physicians or druggists. In the 18th century, the names of eye preparations were often linked with the name of the inventor/purveyor and were marketed to the public with his name. The 20th and 21st centuries have brought significantly more rigorous and scientific regulation of drug naming overall, largely in an attempt to ensure the safety and specificity of the medications. Throughout the history of the ophthalmic pharmacopeia, however, a common thread has been naming to address a specific problem and the linking of that name to the promoter. The modern naming process engages chemists, physicians, linguists, poets, and marketing experts and often provides a capsular history of the drug’s origin and utility.

This paper is based on sources including texts on the history of pharmaceuticals, historical research papers on ancient pharmacology, and United States FDA, European, and governmental regulatory policies.

Corneal Transplantation - A History, from Ancient Greece to Europe in the 21st Century

Bita Manzouri

The ability to restore sight has been a subject of intrigue for physicians and scientists for many years and one of the most fascinating histories relating to this subject is the history of corneal transplantation. The aim of this paper is to present to you the history of corneal transplantation, beginning with the Greek myths, touching upon the patrons saints of medicine and surgery and ending by relating the stories of the surgical pioneers of the 19th and 20th centuries and their experiments in corneal xenograft and allograft transplantation. An overview of modern corneal transplant surgery will be presented, highlighting not only some of the developments that have occurred in the last 20 years but the challenges that we still continue to face.

Did Edgar Degas have Stargardt Disease?

Michael Marmor; Zeynel Karcioglu; Edwin Stone

Purpose
Degas had vision loss from retinal disease that progressed over 40 years to legal blindness in old age, and likely had a maculopathy since he could easily walk around. Identification of that disorder might give insight into his disability. It is intriguing that Degas’ first cousin Estelle Musson had a similar affliction, leading us to ask whether Degas had hereditary disease. The most likely candidate would be Stargardt disease (ABCA4 gene).

Methods
Degas and Estelle had a common mother, but at best could share one copy of an abnormal recessive gene, with another coming from their fathers. Degas did not have children, but five of Estelle’s great grandchildren are still living in New Orleans. Assuming Estelle had recessive disease, there is a 76% likelihood that one of these would carry the same abnormality. Present tests for ABCA4 are about 75% successful, yielding a 57% likelihood of finding Stargardt disease if that was the family disorder.

Results
Gene testing was performed on five great grandchildren, but no disease-causing ABCA4 variants were found.

Discussion
This study exemplifies the value and limitations of scientific process in analyzing historical artists, and it reminds us of necessary perspective in assigning medical diagnoses. Knowing whether Degas had Stargardt disease would have helped to understand why his vision declined, but probably would not have changed judgments about his late art which simply showed effects of poor vision (well-documented) regardless of cause. It is easy to speculate about eye disease and aberrations in art, such as blur, weak color or distortion. However, without documentary evidence of the symptom or diagnosis, this often leads to error since artists have license to paint in many different ways for many different reasons.

The Discovery of the Aqueous Veins: Ascher versus Goldmann – A Dispute Between Two Pupils of Elschnig

Frances Meier-Gibbons

The beginning: In 1903, Leber showed for the first time histologically a connection between the canal of Schlemm and the episcleral venous network. He located the exit of intraocular fluid in these structures and had therefore an opposite view to Fischer et al, who postulated that a general metabolic exchange took place throughout the tissues of the eye.

The discovery of the first aqueous vein by Ascher in 1941 in the eye of an Alabaman miner confirmed the existence of these physiological and anatomical connections and supported Leber’s theory.

Ascher versus Goldmann: Ascher published his findings in 1942 and was very astonished when Goldmann, in 1946, declared that he made an independent discovery of the same facts. Ascher subsequently accused Goldmann of plagiarism. In response, Goldmann used in his second publication the term “Ascher’s veins” recognizing that Ascher was the first to discover these anatomical structures. The fact that Goldmann found these veins more often in normal humans than Ascher was explained by Goldmann as follows: He allocated all vessels with a laminar fragmentation to the aqueous veins and Ascher only the veins which contained the clear aqueous. Ascher had indirect methods to prove that the clear content was aqueous, Goldmann however could prove this fact by injecting fluorescein-sodium intravenously and looking at the fluorescence. Only the vessels, which contained blood particles besides aqueous, showed signs of fluorescence.

Summary:
Ascher and Goldmann, who had already worked together (and fought against each other) in younger years at Elschnig in Prag, started a fierce fighting about the discovery rights of the aqueous veins, a story which reminds the reader of a criminal story and is peppered with anecdotes.

My Dear Doctor Knapp, Cher Monsieur, Dear Colleague and Friend! - Letters to Hermann Knapp (1868-1911) at Columbia University, New York

Andreas Mettenleiter; Danny H. Kauffmann Jokl

The Edward S. Harkness Eye Institute at Columbia University in New York contains a collection of letters to the ophthalmologist Hermann Jacob Knapp (1832-1911), who moved from Heidelberg to New York in 1868. With one exception (a Hermann Helmholtz letter from 1859), the approximately 100 letters (originally around 135) in German, English, French, and Dutch are from the period between 1868 and 1911 and,   

impressively, document the network that Professor Knapp, now domiciled in New York, established with ophthalmologists from around the world. The content of these letters, to which the counter-letters are unfortunately missing, is of a professional, but also of a private nature and highlight the friendly, sometimes very friendly, relationship of Knapp with his international colleagues. As part of an ongoing project with the archivist of the Columbia Medical Library these remarkable sources are to be published together with  English translations in. The presentation will give an overview and some insights into this unique correspondence.

H.B. Stallard. More than just Chariots of Fire

Steven Newman

H.B. Stallard was one of the premiere British middle distance runners. He was a member of the World Record setting relay team in 1920. And participated in the 1924 Olympics finishing third in the 1500 meter (running on a broken foot).

Following his training in ophthalmology at St. Bartholomew’s, Stallard became interested in the treatment of intraocular tumors, particularly retinoblastoma. William Roengten discovered x-rays in 1895 and A. Henri Becquerel discovered that uranium spontaneously emitted rays that were similar to Roentgen’s x-rays. Pierre Curie (and Alexander Graham Bell) had recommended that radioactive isotopes might be a cancer treatment. Superficial treatment was begun in 1901 and in 1903 saw the first gynecological brachytherapy. By 1909 brachytherapy was being utilized to treat prostate cancer. Howard Kelly, established the “National Radium Institute” in 1913 to treat gynecologic cancers.

H.B. Stallard (with Dr. Foster Moore) participated in the first interstitial procedure for retinoblastoma (1929) and subsequently developed radioactive plaque applicators using radium (later cobalt 60). By 1961 he was able to report that 62 patients had been treated (preserving the globe). By the late 1990s plaque therapy had become mainstream and in 103 eyes there was a recurrence rate of 13%. Development of plaque therapy for melanomas came later initially in the 1950s in England and the 1970s in the United States.

During World War II Stallard took care of battle injuries and refused promotion above major so he continue to take care of patients. He authored Eye Surgery beginning in 1946 (with 4 subsequent editions), a standard reference for ophthalmology trainees in England. His CV includes anterior segment surgery, plastic and orbital surgery, strabismus, retina, and ocular oncology. He was also curator and member of staff at Moorefield’s and ophthalmic surgeon to St. Bartholomew’s.

Early Descriptions of Diabetic Retinopathy

Massimo Porta

The first description of retinal changes in a diabetic patient is accredited to Eduard Jäger Ritter von Jaxtthal, in his Beiträge zur Pathologie des Auges of 1855. Jäger was very good at reproducing the fundus, subjecting some of his patients to more than 20 sessions of up to 3 hours!

“With the pupil as dilated as possible…the central vessels are enveloped in a dense, reddish mist…the optic nerve contour is completely covered on all sides…irregularly shaped, elongated, blood-red spots of different size and almost uniform distribution… show a delicate striation, corresponding to the optic nerve fibres…In addition there are roundish areas at some distance from the vascular entrance, some surrounded by pigment…partly light yellow and partly orange yellow…The veins show a winding course and a definitely larger diameter”.

A less known description of retinopathy in diabetes was given by Charles Deval in his 1862 Traité Théorique et Pratique des Maladies des Yeux, the sum of an experience gained over 20,000 cases. Having stated that “l’Amaurose dans l’albuminurie et dans la diabète” are similar, Deval described a 33-year-old man he saw at the Ophthalmic Hospital in London. The patient, “had experienced considerable loss of vision…and urinated enormously. On ophthalmoscopy, I observed ecchymotic spots along the vessels; the retina was dirt-white and appeared edematous…The surgeon diagnosed glycosuric amblyopia. He stated…that this disease is so rare in London that only 2-3 cases are observed in their hospital”.

While Jäger was first to report fundus changes, probably central vein occlusion, in a diabetic patient neither he nor Deval may have described diabetic retinopathy. With hindsight, theirs were more likely reports of acute, rather than chronic, ocular conditions.

Phototherapy During the 20th Century: From Finsen (Nobel Prize, 1903) to Meyer-Schwickerath (Photocoagulation Mid-century) to Photodynamic Therapy, 1990

James Ravin

Finsen received the Nobel Prize in Medicine in 1903 for his work on light therapy of lupus vulgaris (TB). Modern analysis using his equipment has revealed he was actually using photodynamic therapy (PDT), which activated porphyrins in the TB organism to destroy them. Meyer-Schwickerath used sunlight and carbon and xenon arc light to coagulate the retina. PDT was introduced in 1990 and is now a second line therapy for AMD. It can be used to kill bacteria and much investigation is occurring now since many microorganisms have become resistant to antibiotics.

Columbus Discovered the LPS (But So Did Galen)!

David Reifler

The Renaissance discovery of the levator palpebrae superioris (LPS) by Realdo Colombo (1516–1559) – his description of the LPS recorded at least two years before that of Gabriele Falloppio (1523–1562) – was the subject of an undelivered presentation at the 2020 COHS meeting. This virtual 2021 meeting now provides an opportunity to discuss an expanded published version of that paper1 and a forthcoming corrigendum. The additional information focuses upon the partial description of the LPS – its most anterior portion – in a late work of Galen (129–210) entitled, On Anatomical Procedures [De Anatomicis Administrationibus/Περί Ανατομικών Εγχειρήσεων].2 That description, found in Book 10 of this fifteen-book treatise, only survived the Middle Ages in two very rare manuscripts of an Arabic translation by Ḥunayn ibn Isḥāq (809–873) that were finally translated into German and then English in the twentieth century. Julius Hirschberg (1843–1925) and Max Meyerhof (1874–1945) studied several other translations and original works of this famous Arabic physician.3 However, the specific ancient description of the LPS by Galen, in original form or in translation, was unavailable to these famous ophthalmic historians, as it had been unavailable to anatomists of the Renaissance and onward. Interrelated histories of the LPS, anatomy, and ophthalmology should be emended to include these contributions of Galen, Ḥunayn, and Colombo. 

1. Reifler DM. Milestones in oculofacial plastic and reconstructive surgery: The discovery of the levator palpebrae superioris and its subsequent history. Ophthalmic Plast Reconstr Surg (in press with open access; PAP version available upon request). PMID 33315840

2. Galen. On Anatomical Procedures, the Later Books… Duckworth WLH, trans. Lyons MC, Towers B, eds. New York: Cambridge University Press, 1962;46–50.

3. Meyerhof M, trans. The Book of the Ten Treatises on the Eye Ascribed to Hunain ibn Is-hâq (809-877 A.D.).Cairo, Government Press. 1928. https://wellcomelibrary.org/item/b31362370/.

Eye Healing at the Sanctuary of Our Lady of Lourdes

Markus Schulze Schwering

Purpose
Historical and medical classification of accounts of eyesight healings reported at the Sanctuary of Our Lady of Lourdes.

Method
Historical list of eyesight miracles was compiled. Attempt to medically assign a current ophthalmic diagnosis. Analysis of possible relationship between faith and the miracle.

Results
Between 1858 and 2018 (160 years), 70 miracles were performed, seven of which (7/70; 10%) concerned the eyes: A 54-year-old male regained sight after unilateral traumatic blinding. A 40-year-old female was healed from bilateral chronic blepharitis with ectropion. A 16-year-old girl able to see after 11 months of eye inflammation with limited vision/blindness. A 38-year-old female regained sight from bilateral descending optic atrophy. A 3-year-old boy experienced healing of sight and gained mobility after optic neuropathy and paraplegia post-meningitis. A 32-year-old female saw again after arachnoiditis with optic atrophy. A man recovered from bilateral hemianopsia with macular sparing after stroke. In 4 out of 7 cases, those suffering solely from eye conditions were completely cured suddenly. Those with multiple morbidities (3 out of 7 cases) were cured in due course. Healing was related to the people’s various acts of faith: washing oneself in Lourdes water (3/7); completely bathing oneself in Lourdes water (1/7), receiving Holy Communion (1/7); participating hopefully in the Lourdes pilgrimage (2/7).

Conclusion 
Seven people with diagnosed eye conditions, paralyses, and other illnesses participated in the pilgrimage to Lourdes in devout hope of a cure. All of them experienced their faith confirmed through the miracle.

Theiller, P. Lourdes, Wenn Man von Wundern Spricht. Sankt Ulrich Verlag; 2003.

Baustert, J.P. Die Großen Heilungen von Lourdes. Kommisionsverlog von R. van Acken zu Lingen a.d. Ems (Deutchland) und Benzinger Brothers zu Cincinnati (Amerika); 1902.

Mangiapan, Th. Les Guérisons de Lourdes. Édition Œuvre de la Grotte; 1994.

Läpple, A. Die Wunder von Lourdes. Pattloch; 1995.

In Search of Hunain’s Ten Treatises on the Eye

Ameenat Lola Solebo

Purpose
Hunain was a pre-eminent translator, physician, and surgeon, and his Ten Treatises on the Eye is thought to be one of the earliest ophthalmic text books from the Arabic Golden Age (c8th – c14th). This talk takes us through the detective work needed to piece together the chapters within this seminal text.

Method
May Meyerhof’s 1928 translation of the Ten Treatises, his accompanying texts and notes, as well as articles on Meyerhof’s life and work.

Results
In 1908, Julius Hirschberg, the German ophthalmologist and medical historian (1843-1925) published his History of Ophthalmology. It was an exhaustive, 11-volume strong collection, informed by his mastery of Greek, Latin and Arabic. One text eluded him: Hunain Ibn Is-haq’s 9th Century work, The Book of the Ten Treatises on the Eye, of which Hirschberg found only clumsy and incomplete medieval Latin translations. The Ten Treatises is not only the first robust attempt to present a systematic account of the eye and vision: it also stands as the bridge between Ancient Greek and Medieval medicine, and supported the 12th Century renaissance of medical knowledge. It took the work of another German ophthalmologist and historian, Max Meyerhof (1874–1945) to discover and connect the overlapping sections of Hunain’s Ten Treatises, hidden within private and institutional libraries across Egypt, Persia, and Russia. Max Meyerhof’s drive, vision and “archaeophilia” may have been influenced by his early adulthood journeys through Egypt, his love of Age of Enlightenment literature, or perhaps his necessary exile, as a German of Jewish origin, from 1920’s Germany.

Conclusion
Meyerhof’s achievements have allowed us to map the route taken by ophthalmic scholarship, from Galenic Ancient Rome to the Arabic Golden age, across medieval Europe, to turn of the (20th) century Germany and Egypt.

The Murky Story of Harold Ridley's First Lens Implant

David Spalton

It is widely thought that Harold Ridley did the first IOL procedure at St Thomas’ Hospital on 29 Nov 1949. In fact the contemporaneous theatre register from St Thomas’ shows that on the 29th November he did an extra capsular extraction on Emily Attfield going on to do a ‘lenticular graft’ on the same patient on 8 February 1950, taking the patient back to theatre 2 days later for the first dressing and repositioning of an iris prolapse. The procedure was therefore done as a secondary operation. The date correlates with the information he gave at the presentation to the Oxford Congress in 1951 and the other clinical information that we have. The patient was last seen in 1975 with a vision of counting fingers in the eye.

The fact that the operation was done as a secondary procedure is serendipitous as by then the posterior capsule would have fibrosed to support the implant – had it been done as a primary procedure as he later did – there would have been a strong possibility of irretrievable subluxation into the vitreous as subsequent experience showed - and IOL surgery may never have got off the ground.

At this time the only optical correction for unilateral aphakic would be a large PMMA scleral contact lens which most patients would find intolerable to wear for any period of time so the patient would have been an ideal candidate for the procedure and likely to be easy to persuade to have further surgery. One can speculate as to why HR never admitted the operation was done as a secondary procedure but intraocular surgery in those days carried a real risk of blindness and to operate again would be to put the patient in double jeopardy which he may have been reluctant to admit because of the brouhaha that was later aroused.

The Sad Story of Prof. Dr. Med. Speleers and the Katyn Massacre

Edward De Sutter

Prof. Dr. Speleers was a Flemish ophthalmologist. He was born in 1876. He received his education in high school and at the university in French as it was the rule at those times in the kingdom of Belgium. He attended the Hirschberg Clinic in Berlin in the beginning of his ophthalmological career. He was involved in the struggle for Flemish independence and use of the local language Flemish or Dutch in the education especially at the Ghent University. At the University of Ghent the teaching language was French and during the war, like in Poland, the Germans ruled that the teaching language has to be the language of the region. After the war he was sentenced for life and as Hirschberg, Axenfeld and others removed from the Belgian Ophthalmological Society as a member. In Holland he continued his ophthalmological career and his fight for his people. During the Second World War, he was appointed again at the State University of Ghent as ophthalmological Professor. He was a member of the European Red Cross commission als known as the Katyn Commission to investigate on the mass murder of Katyn in 1942 in Poland by the Soviet Army. He was imprisoned for life after the ww2 for taking part in that Commission by the Belgian justice.

Samuel Sharp and His Contribution to Early Cataract Surgery

Charles Pat Wilkinson

In contemplating a history of cataract surgery in England, primary attention might legitimately be directed to Sir Harold Ridley, the father of the intraocular lens. But an additional major contributor to that history was the Englishman Samuel Sharp, who 200 years earlier and only a year after the classic 1752 presentation of Jacques Daviel, introduced a knife that improved the production of a corneal incision and became an original model for the Graefe knife that ultimately became a classic tool for almost a century.

Samuel Sharp was born in about 1700 and became a prolific surgeon and writer regarding topics ranging from general surgery to ophthalmology. This presentation will briefly discuss Sharp’s career with a focus upon the history of the development of his knife, his operative results, and the modifications in instrument design that lead to von Graefe’s 1865 presentation regarding his modified knife and operative procedure.

Page last updated April 21, 2021