Cogan Ophthalmic History Society
2024 Meeting Abstracts
Charles Snyder Lecture:
Curtis Margo
Jonas Friedenwald, Eugene Wolff, and the Two Books that Helped Bridge the Specialty Gap
Eugene Wolff (1896 – 1954) and Jonas S. Friedenwald (1897 – 1955) were life-long students and educators of anatomic pathology and ophthalmology. Friedenwald in 1929 and Wolff in 1934 each published textbooks of ophthalmic pathology that influenced medical education for decades to come. These works─ The Pathology of the Eye and A Pathology of the Eye─ introduced ophthalmologists in training and in practice to anatomic pathology, while familiarizing pathologists with the nature of ocular disease. Both books appeared at the time when anatomic pathology was departing from its principal academic role in education and research to assume more functional participation in clinical care by establishing diagnoses through biopsy. This presentation provides perspective into the contributions of two men who dedicated their professional careers conveying the relevance of anatomic pathology to clinical ophthalmology. Often overlooked is the role that their textbooks on ophthalmic pathology played towards anchoring ophthalmology to the traditions of medicine.
Monique Barbour and Bria George
The Pioneering Contributions of 21st Century Black Women in Ophthalmology
Exploring the significant contributions of black women in the field of ophthalmology, highlighting their achievements, challenges faced and the impact of their work on the advancement of eye care is the focus of this initiative. Unquestionably, Patricia Era Bath was the pioneer that opened doors for those who are presently following in her footsteps. By examining the careers of these trailblazing individuals, Mildred Olivier, Leslie Jones, Tamara Fountain, Eve Higginbotham and Fasika Woreta, we aim to shed light on their remarkable journeys and the broader implications for diversity and inclusion with this medical profession. A comprehensive review of the literature, relevant society demographic data, institutional records and peer to peer interviews allowed us to construct this panel of the most influential black women in ophthalmology. In summary we found that despite facing systemic barriers these women have made groundbreaking contributions to the field, influencing not only patient care and leadership, but also research and medical education. Future research is warranted which will allow us to analyze the more profound impact that this will have on upcoming generations of black women and their decisions to pursue a career as an ophthalmologist. Improving visibility of African-American women ophthalmologists in digital, print and social media may positively influence underrepresented minorities pursuing a similar trail.
M.Tariq Bhatti
The Genesis and Rise of the Basic and Clinical Science Course (BCSC): A Unicorn Among Medical Textbooks
Dr. Russell LaFayette Cecil, the author of Cecil Textbook of Medicine, stated in 1960 that “medical books have a short life if they are not frequently revised…The modern medical textbook, in order to be of the greatest help to the student, must be authoritative and it will be so only when each field or subject is covered by an expert. In my opinion, the days of a textbook by a single author are over.”
The American Academy of Ophthalmology (AAO) Basic and Clinical Science Course (BCSC) was first introduced to the American ophthalmologist in 1970. The brainchild of Drs. Bradley Straatsma and Bruce Spivey, starting as just a series of booklets, is now a compilation of 13 volumes totaling approximately 5200 pages. But what makes the BCSC such a unicorn among all the other textbooks that exist in medicine? Arguably the most important aspect of the BCSC is its dynamic ability to keep up with the advancements in ophthalmology with a thoroughly vetted, well-written and high quality illustrated product with a strong digital component.
The process of a major revision for each BCSC volume is a comprehensive multi-step undertaking. Each volume is written by 7-8 committee members who are experts in their subspecialty. Each committee is led by a chairperson that oversees the entire process and assigns each member a primary editor role for a specific chapter. The primary editor is responsible for updating and adding new information to the chapter. Also, the primary editor is tasked with assuring the chapter content aligns with all the information in all the other volumes of the BCSC, as well as the other AAO educational products. A critical component in the major revision is a two day meeting in which each member of the committee presents his or her chapter to the entire group for additional review and verification. A medical editor finalizes the chapter for accuracy, syntax and grammar. At the time of publication of a major revision, each chapter of every volume has gone through an 8-step writing and editing process spanning nearly 24 months.
The BCSC is a dynamic medical textbook that has evolved and flourished for over a half century. A unicorn is a mythical being, but the BCSC is not mythical at all but thankfully a reality
Jeffrey Brosco
Social Authority of Modern Medicine
The history of modern medicine is often told as a simple tale of progress. In ancient times, people relied on magical thinking to explain disease and attempt cures. This continued until sometime in the 18th century, when physicians sought to understand illness using empirical science. By the end of the 19th century, the story concludes, the research laboratory began to offer therapies that actually worked. The technological triumphs of our modern hospitals and machines seem obvious: over the last two hundred years the infant mortality rate has declined nearly 100 fold and our average lifespan has more than doubled. Physicians today enjoy enormous social authority because what we do improve the health of the population. The story, however, is not that simple. In fact, Historians, sociologists and demographers have documented that the physicians’ social authority predates our ability to cure illness at a measurable level, and indeed our longer life spans owe little to modern medicine.
John D. Bullock
William Shakespeare: My Co-author, My Co-lecturer, and My Critic
William Shakespeare is considered the greatest writer in the English language and the world’s greatest dramatist. He is credited with 38± plays, encompassing three genres: history, comedy, and tragedy. Ben Johnson said that Shakespeare was “…not of an age, but for all time.” Seventy-five years ago, the prolific American composer and songwriter, Cole Porter, wrote "Kiss Me Kate," a modern play-within-a-play about William Shakespeare’s classic comedy, "The Taming of the Screw." In it is his beloved song "Brush up Your Shakespeare," to wit
“Brush up your Shakespeare,
Start quoting him now.
Brush up your Shakespeare
And the women you will wow…”
A tribute to Shakespeare’s unparalleled genius is the relevance and quotability of his words over four centuries later. Less frequently noted is Shakespeare’s prodigious breadth of medical knowledge. This talk will detail fifteen Shakespearean quotes from 11 of his plays that correlate with seven ophthalmological subjects on which I have published or lectured, thus making him my de facto “co-author” and “co-lecturer.” These include, among other topics: Shakespeare’s opinion of the validity of the miasma theory of disease transmission; an explanation of sensory compensation after blindness; the risks of opportunistic iatrogenic eye infections from advanced medical technology; and other references to optical devices, physiognomy, and medical malpractice. In addition, some years ago when I had submitted a paper for publication, the Editor of the journal used a Shakespearean title (from play # 12) to reject it based on his perceived exaggerated pomposity and irrelevance of our mathematical analysis, thus making Shakespeare my de facto “critic.” I have enjoyed collaborating with the Bard over the years, even though I did not always agree with him.
These include: (1) the origin of infectious agents; (2) Shakespeare’s opinion of the validity of the miasma theory of disease transmission; (3) explanations of sensory compensation after blindness; (4) the risks of opportunistic iatrogenic eye infections from advanced medical technology; (5) scientific dishonesty; (6) optical devices; (7) physiognomy; and (8) medical malpractice. In addition, some years ago when I had submitted a paper for publication, the editor of the journal used a Shakespearean title (from play #`12) to reject it based on his perceived exaggerated pomposity and irrelevance of our mathematical analysis, thus making Shakespeare my de facto “critic”. I have enjoyed collaborating with the Bard over the years, even though I did not always agree with him.
Pelin Celiker
The Origins and Evolution of Ptosis Repair (poster)
Ptosis repair has been performed for centuries. Per commonly cited records of ptosis surgery, Arab ophthalmologists were the first to perform surgery to treat ptosis, which involved resecting an ellipse of skin from the medial part of the eyelid, though there is limited information of cases or the specific period of time. Records by encyclopedist Aulus Cornelius Celsus document resection of skin eyelid around 100 AD in Ancient Rome.
Interestingly, there are not many records between 100 AD and the 19th century. In 1806, Italian anatomist and surgeon Antonio Scarpa publishes “Practical Observations on the Principle and Disease of the Eye”, where he describes the resection of tissue around the upper part of the eyelid with the purpose of elevating the eyelid. Other records of eyelid surgery around this time include C.F. von Graefe and Dzondi performing eyelid reconstruction in 1818 and Johann Karl Georg performing blepharoplasty in 1829. The early 19th century is also when surgeons start to perform different procedures based on the etiology of ptosis, including skin resection frontalis suspension, tarsus and/or levator resection, superior muscle suspension.
The interest in various surgical methods and their relative popularity changes significantly throughout these last 2 centuries. Earlier methods focus on cutting both the skin and orbicularis, in a similar manner to the ancient methods, to weaken the protraction. The focus then shifts on frontalis suspension, where materials ranging from cat gut suture to tensor fascia lata are used to suspend the eyelid to the functional frontalis muscle. Throughout this time, external approaches to advancing the levator palpebrae superioris gain traction.
In the 1950s, Berke describes a transconjunctival internal approach to resect the levator internally. In 1961, Fasanella and Servat describe the conjunctival-tarsal-Mullerectomy, where the eyelid is everted and the Muller muscle along with the tarsus and conjunctiva are resected. As this procedure increased in popularity, it is adjusted further to spare the tarsus and starts to be commonly called Muller muscle conjunctival resection (MMCR). The Putterman clamp is utilized to ensure accurate resection. Research has recently focused on how much to resect, closure methods and preoperative planning and testing.
The history of surgical techniques to treat a common ophthalmologic entity shows how much progress has been made and what was deemed impossible became possible. Given the rate of research on ptosis in the recent decades, there will no doubt be more discoveries and innovations to surgical approaches to ptosis.
William Culbertson
The Semmelweis Reflex in Ophthalmology: When you’re probably on the right track!
“Childbed fever” was claiming roughly 20% of mothers delivered in the private maternity floors in Vienna in the early 1840s. The cause was unknown but nevertheless the leading medical professors of the day authoritatively ascribed it variously to “miasma”, retained fecal material, misdirection of the mother’s milk into the abdomen and tight corsets. Oddly, the incidence of the mortal disease was very low when the mother was delivered either by midwives at the public hospital or at home. Young obstetrician Ignaz Semmelweis in Vienna gathered irrefutable evidence that obstetricians somehow carried the vector to the patient on their unwashed hands or clothing. Semmelweis showed conclusively that he could almost eradicate the disease in his hospital if the doctors washed their hands in a chlorine solution, changed clothes and refrained from performing autopsies before attending the mothers. When he alerted his medical superiors, he was roundly denounced by the medical establishment of the day. Semmelweis was demoted, fired and eventually died in a mental institution. The phenomenon of the entrenched medical establishment actively resisting a new idea, no matter how well founded in evidence and practice, has been termed the “Semmelweis Reflex”. Most often, it has been rooted in challenges to the rank or entrenched beliefs of authorities. In ophthalmology, we have examples of the Semmelweis reflex in Daviel’s cataract extraction, Binkhorst’s IOL, Kelman’s phacoemulsification; Forster’s intraocular antibiotics, Machemer’s vitrectomy, Puliafito’s OCT, Kelly and Wendel’s macular hole repair; and others. Years ago, in 1986, when I was personally confronted with Semmelweis Reflex-based opposition, Dr Edward Norton counseled me: “Buddy, when the establishment is against you, you know you’re on the right track. Only years later did I learn that it had a name, The Semmelweis Reflex
Philip Custer and Natalie Morales
The History of Entropion
Introduction
This presentation draws upon original manuscripts and images to explore the history and evolution of the treatment for various types of entropion, and how this condition helped define the specialty of Ophthalmology.
Methods
Publications were identified with PubMed searches and cross referencing. The staff at the Bernard Becker Medical Library and its Archives & Rare Books Division assisted in obtaining original manuscripts. Foreign language texts were translated with online services.
Results
The literature review included 877 publications published in English (n=546), French (n=156), German (n=122), other languages (n=53). These papers cross referenced the work of other surgeons. While many were not unique, descriptions of 1362 procedures were accessed, describing different methods to address involutional entropion, cicatricial entropion, and trichiasis.
Conclusions
The history of entropion began around 700BC and involves war and disease, fire and acid, clamps and agglutinins, alcohol, and women’s hair. The ravages of trachoma were a driving force in the constantly evolving nature of entropion surgery, and many procedures were used both for cicatricial and involutional disease.
Originally lids were everted through shortening eyelid skin and muscle with resection, cautery, caustics, and flaps. Orbicularis function was altered with myotomy, chemical denervation, or mobilization of flaps. Canthotomy was used to create marginal laxity in both involutional and cicatricial disease, and tarsorrhaphy employed to stabilize the margins. Sutures were placed to create anterior lamellar cicatrix, for rotational force, and to fixate the eyelid retractors. Retractor plication and horizontal shortening of the lid margin were performed separately and in combination. Various mechanical devices have been used to either redirect the lashes or reposition the lid margin.
Marginal blepharotomy, or performing posterior tarsal incision or excision, were often used in cicatricial entropion. Marginoplasty involved transposing skin or grafting different tissues onto the margin. Isolated trichiasis has been managed with epilation, lash cauterization (thermal, caustics), electrolysis, excision, radiation, and cryotherapy.
In 1883, Story commented “Probably more operations have been invented for the cure of inversion of the eyelids than for that of any other abnormal condition of the human frame…” For much of history, entropion surgery was likely the most frequent ophthalmic procedure performed. Treatment of trachoma and entropion contributed to the development of specialized eye hospitals and recognition of ophthalmology as a specialty.
Paulus T.V.M. de Jong
Robert Machemer. From a Difficult Childhood to High Excellence
In 1978, Bob Machemer hosted me for a week at his clinic in Durham. What a burdensome childhood he must have had.
In a documentary on German TV, titled “eine Familie unterm Hakenkreuz,” “A family under the swastika,” Bobs younger brother Hans discussed their childhood and home circumstances. The documentary was based on eight hours of film and photo material of Bob’s father Helmut, an ophthalmogist. During the period that Helmut was courting Erna Schwalbe, also studying medicine around 1930, she discovered that she was probably of Jewish descent and told Helmut that therefore they had better not get married. He convinced her that that was not important, and they married in 1932. Bob was born in 1933 and had two brothers. Erna was labeled as half-Jewish by the National Socialists who came to power and was not allowed to finish her study. Helmut had to leave his university position, could not set up his own practice and had to work as an assistant to an ophthalmologist. In order to erase the so-called family shame of mixed blood, Helmut volunteered in 1939 for the army as a junior doctor with sergeant’s rank. He fought in France and Russia and obtained the Iron Cross 1st Class in 1942. Four days later, he was killed by shrapnel. In March 1943, Erna and her children were granted "German-blood" status. Hans only heard his father's story from his mother when he was 25.
It was not until the end of the film that I saw a photo of Hans' elder brother and clearly recognized Bob. Most accounts of Bob's life have a gap between 1943 and 1966 when he left for Miami on a NATO fellowship. The remainder of my lecture will be about the difficult time for Bob after his father's death and during the chaos in post-war Germany, until about 1965 on which I received information from his brother Hans, a molecular biologist in Germany.
Edward De Sutter
Albrecht von Graefe and the Ophthalmology Congress of Brussels, September 13, 14, 15, & 16, 1857.
The first international congress for ophthalmology took place in Brussels in 1857. Albrecht von Graefe participated after organizing the first German ophthalmology conference in Heidelberg a week earlier with 12 colleagues. In Brussels, he discussed topics such as glaucoma and its treatment through iridectomy, including explanations to his friends Donders and Bowman. The congress was organized by Warlimont, the editor of Annales d'Oculistique.
Harry Flynn
Endophthalmitis: Then and Now
Endophthalmitis may be divided into three periods: pre-antimicrobials (before about 1940), systemic antimicrobials (about 1940-1974), and intravitreal antimicrobials (about 1974-present). In 1974, Peyman and Forster separately reported successful treatment of endophthalmitis patients with intravitreal antibiotics. During the early 1970s, Machemer first reported pars plana vitrectomy techniques. Further advances in intravitreal antimicrobials and vitrectomy led to the Endophthalmitis Vitrectomy Study (EVS), conducted 1990-1994 and first published in 1995. With relatively few exceptions, the recommendations from the EVS are widely followed today
Alice “Wendy” Gasch
The White Cane
For centuries sight-impaired individuals have used canes or their equivalent to facilitate mobility. However, it wasn’t until the period between the two World Wars that use of white canes became widespread. The time was ripe because poison gas that led to blindness was used for the first time during World War I. And, in general, horses and vehicles with loud iron wheels had been supplanted by cars with quiet rubber tires and higher speeds – making negotiating traffic more difficult for the visually impaired.
Three individuals are notable for instigating use of the white cane:
• Blinded Englishman James Biggs, who claimed to have invented the white cane in 1921, when he painted his walking stick white to increase his visibility when negotiating traffic.
• Normal-sighted French woman Guilly d’Herbemont, who recognized the dangers that blind individuals confront in traffic. In 1930, she contacted a French newspaper to support her efforts to supply white canes to the blind in France, and she, herself, donated over 5,000 white canes.
• George A. Bonham, President of the Peoria (Illinois) Lions Club, who, in 1930, advocated use of white canes with red bands to facilitate independent mobility by sight-impaired individuals. The Lions Club International approved the idea, and white canes were produced and distributed in Peoria in 1931. Lions Clubs throughout the U.S. soon followed suit.
Subsequently, there have been changes in the design of the white cane and facilitation of its use. Today white canes are available in many styles with various tips, and there are electronically-equipped versions that use ultrasound and other means to disclose the surrounding environment.
Moreover, worldwide, though not everywhere, there are laws that provide legal precedence in traffic to individuals using white canes.
Furthermore, in 1964, Congress passed a resolution (HR 753) authorizing the President of the United States to proclaim October 15 of each year as “White Cane Safety Day.” Within hours of passage of the resolution, President Lyndon B. Johnson did so. He noted that the white cane not only is a tool, but also is a symbol of the independence and self-reliance of its users.
It has been estimated that currently about 50 million individuals worldwide use a traditional white cane to facilitate their mobility.
This presentation will present a history of the white cane, including its evolution in design, use, and significance.
John Gittinger
"The Fundus Oculi and the Determination of Death"
Just 1 year after Helmholtz invented the ophthalmoscope, the first documented studies on mortal retinal changes were conducted by E. Bouchut…who, under the pseudonym of Pierre Durand, received a prize offer by the Marquis d’Ourches for the most nearly infallible sign of death.” Thus begins the “Historical Review” section of Dr. Jack Kevorkian’s 1956 paper in the American Journal of Pathology that is the title of this abstract. Dr. Kevorkian (1928-2011) was at that time a member of the Department of Pathology of the University of Michigan Medical School and had arranged to borrow a fundus camera from the Department of Ophthalmology to document the fundus appearance of several patients from 6 seconds to 4 minutes after “EKG death” and from 15 to 25 minutes after respirations ceased. He thought that the appearance of the venous blood columns and their “granularity” were reliable indices of death and allowed estimation of the time of death in minutes or hours. He subsequently achieved notoriety as a proponent of physician-assisted suicide and likely utilized his observations in this context. He eventually lost his medical license and then was convicted of second-degree murder in 1999 and spent over 8 years of a 10 to 25 year sentence in prison. He was released in 2007, 4 years before his death at age 83 of natural causes.
Frank Joseph Goes
The History of Gene Therapy in Ophthalmology
An overview of the history of gene therapy in ophthalmology will be given, starting with the discoveries leading to an understanding of genetic transmission –how does it work?
After speculations in ancient history concerning theories of heredity by Hippocrates and Aristoteles, the discovery of chromosomes carrying our genome in 1882, and the work of Gregor Mendel (1865) and Crick and Watson (1962) leading to a better understanding of genetic transmission, will be discussed.
Next step will be the analysis of the principles of gene therapy –how does it work?
Different approaches -the ex vivo and the in vivo therapy, gene editing--are possible: successes and setbacks ,leading to a temporary standstill are analyzed.
In 1972 gene therapy was proposed for the first time as a treatment for genetic disorders.
Further development of techniques went with “fall and rise”. The first therapeutic use of transfer as well as the first direct insertion of human DNA into the nuclear genome was performed by French Anderson(USA) in a trial starting in September 1990. In 1990, 4-year-old Ashanthi de Silva, born with a severe immunodeficiency (SCID) disease, became the first gene therapy success story .
Complications encountered through genetic treatment for other diseases, brought the treatment to a temporary standstill, but in the early 2010s gene therapy experienced a renaissance.
Since the eye is easily accessible for direct manipulation, the next step was the application of gene therapy in eye diseases, specifically in genetic eye disease leading towards blindness-Leber congenital amaurosis and retinitis pigmentosa.
In 2017, the FDA approved” Luxturna “as the first in vivo gene therapy, directly administered to the eye, targeting diseases caused by mutation in the gene RPE producing potentially blinding diseases.
Treatments were highly successful and movie fragments of the behavior of Briard dogs with Leber disease treated with gene therapy, as well as humans will be presented.
The present and future application possibilities of gene therapy in ophthalmology and in medicine, as well as the socio-economic and ethical aspects will be discussed.
Jace Jo
The Musical Ophthalmologist, Henri Parinaud
The ophthalmological and neurological work of Henri Parinaud (c. 1844–1905) is well known and celebrated in texts and through his eponymous syndromes; conversely, the musical work of Parinaud is less known and certainly, less celebrated than is deserved.
Parinaud was a French ophthalmologist and neurologist who, during the course of his life, wore many hats. In a loosely chronological order, Parinaud was — the eldest son in a working-class family; a distinguished officer in the Red Cross field ambulance service during the Franco-Prussian war; an ophthalmologist and mentor who established a free-of-charge clinic near the slaughterhouses and markets, a notably lower-class region of Paris; a founding member of La Societé Française d’Ophtalmologie and council member of La Societé de Neurologie; the recipient of one of the highest distinctions in France, the Ordre national de la Légion d’honneur; and likely most importantly to Parinaud, a husband and father of three daughters.
Through all these roles, Parinaud was known for his character. After his passing in 1905, his obituary read: “a reliable and devoted friend so perfectly sound and professionally correct that one could not find a better example. He was for all his confrères the kindest and most respected adviser.”1
Perhaps his kind, humanistic character was related to his involvement in the arts. Parinaud, known by his musician pseudonym, Pierre Erick was a pianist, organist, and composer. Only four of his pieces, all published in 1904 by Ricordi Paris, are currently accessible through the Bibliothèque nationale de France. The four are: Légende d'une Marionnette (piano concerto with three movements Marche de la Noce, Valse, and Marche funèbre), Océana (waltz for piano and orchestra), Rêverie (three-part piece with piano alone, piano with violin, and piano with voice), and Soiur D’Automne (waltz for piano and orchestra) [recordings performed by my mother and pianist Hea Yoon Jo be shared at the Cogan meeting].
In 2019, I was admitted to the Icahn School of Medicine at Mount Sinai through the Donald and Vera Blinken FlexMed Program, which encourages applicants from non-traditional science backgrounds, including the arts, to join the medical field. As a musician in medicine myself, I admire Parinaud’s ability to marry the two seemingly disparate fields. And as mentioned prior, I hypothesize that his participation in the arts and the humanities may have contributed to his much-admired humanistic character. Undoubtably, a young Parinaud would have been the quintessential FlexMed admit.
Hadi Joud and Curtis E. Margo
Lorenz E. Zimmerman: The Right Pathologist at the Right Time
Born and raised in Washington, DC, Lorenz Eugene Zimmerman became the most renowned ophthalmic pathologist of the 20th century, serving as the Chief of the Division of Ophthalmic Pathology and Registrar of the Registry of Ophthalmic Pathology at the Armed Forces Institute of Pathology (AFIP). After graduating from medical school when World War II ended, Zimmerman had contemplated a career in internal medicine. By the end of his internship, however, his interest had shifted to pathology. Upon returning from a tour of duty in Korea, during which he was awarded the Legion of Merit, he was assigned to the division of pulmonary pathology at the AFIP. When the head of the AFIP informed him of the vacancy in ophthalmic pathology created by the retirement of Helenor Wilder in 1953, Zimmerman accepted the position. In his own words, this opportunity was a “gold mine”, as it came with a backlog of over 5,000 pathology cases! For over 32 years, Zimmerman led one of the most productive ophthalmic pathology laboratories and training centers in the world. His skills as a diagnostic pathologist and his formulation of systems of disease classification are the focus of this review. The presentation will also explore how his professional knowledge and insights into the biology of retinoblastoma became intertwined with his personal family battle with the disease.
Christopher Kaler
Ophthalmic References in Emily Wilson’s Translation of Homer’s The Iliad
A new translation of Homer’s epic poem, The Iliad, by Emily Wilson, provides fresh historical context to the eye in literature and the predilection for serious eye injuries during military battles. First produced in written form in the 6th Century BCE, the epic poems attributed to Homer were originally chanted as oral traditions and the poet’s precise identity remains obscure. The Iliad relates the saga of a ten-year war between Greek and Trojan forces and is rich in the mythology of ancient Greece in which divine entities controlled the destinies of humans.
The eye figures prominently in the poet’s description of gods, goddesses, and mortal men and women, and The Iliad appears to contain the first use of the root “ophthalmos.” Several oft-repeated Homeric epithets refer to eyes, e.g., in the case of two immortals: “bright-eyed Athena,” and “wide-eyed,” or “ox-eyed” Hera. Descriptions of the eyes also reflect characters’ emotion, e.g., the anger of Agamemnon: “his eyes shone bright as fire,” and the shock and fear of Aeneas: “with infinite sadness swelling in his eyes.” Eyes are frequently referenced in death as well: “darkness covered up his victim’s eyes,” “darkness covered his eyes,” and “black night veiled his sight.”
Injuries to warriors’ eyes are highly descriptive in Wilson’s translation, e.g., the death of Hector’s chariot driver by a stone: “It struck… right on his forehead as he held the reins. It crushed both brows and broke his skull. His eyes fell on the dusty ground before his feet,” the death of Pisander by Menelaus, who “stabbed his forehead above his nose, right at the bridge, and broke his skull, and popped his eyeballs out,” and the death of Ilioneus by Peneleus, who “stabbed him underneath his brow, drove deep into the socket of his eye and popped the shiny eyeball out.”
The latter description of direct ocular trauma was recapitulated in Homer’s The Odyssey (also translated by Wilson), in which Odysseus and colleagues impaled the single globe of the Cyclops, Polyphemus: “They took the olive spear, its tip all sharp, and shoved it in his eye,” and “whirled the fire-sharp weapon.”
Wilson’s translations reinforce the eye as a vulnerable body site during man-to-man conflicts, which remains true in modernity, as recently described in association with the Russian invasion of Ukraine (Pavlenko et al., Am J Ophthalmol. 2022;242:A1-A3).
Zeynel A. Karcioglu
How do the Blind Painters Paint?
This presentation reviews the basic and applied differences in painting essentials between sighted and blind painters. Furthermore, the personal and artistic characteristics of a congenitally blind painter are detailed.
The conventional approach to painting by sighted painters is based on perceiving a 3-dimensional object through the sense of vision and its conversion into a mental representation. Then, a personal representation of the image is formed in the artists’ mind depending on their background, training, genre, style, etc. The artist later adapts the 3-D perception into a 2-D form and applies this on the canvas using creative tools, including perspective, coloring, highlighting, shadowing, etc. Precision and beauty of the rendition are based upon the individual artist’s ability to observe the object in the visual cortex, then construct, manipulate, and translate the contents of his/her insight and place them onto the medium at hand.
How do blind artists paint? The widely held hypothesis for the blind artist’s ability to paint is that the visual sensory stimulus to collect perceptions is replaced with haptic exploration, the purposeful fingertip action that perceivers execute to encode properties of surfaces and objects to optimize the information uptake. But many other facets of the sightless painting process, such as perspective, color and shade utilization etc. are big unknowns to this day.
A unique way scientists address cross-modal sensory transformations is to study early blind people with no prior conscious visual experiences or memories. A case model for this research is EA, a 69 y/o male, a congenitally anophthalmic painter, whom physicians and basic scientists have exhaustively studied for decades. The presentation will cover the life and times of this blind artist based on my interviews with him, his agent, and medical researchers who have been studying his case for years. EA’s astonishing ability to learn to paint in perspective and employ vivid colors in his art will be presented, and samples of his masterworks will be reviewed.
Zeki, S: Essays on science and society. Artistic creativity and the brain. Science 2001: 293, 51
Begley S: Train your mind, change your brain. Ballantine Books, New York, 2007.
John Lee
Sohan S. Hayreh, M.D., Ph.D., D.Sc. (1927-2022)
Sohan S. Hayreh, M.D. was best known for his contributions on the vascular circulation of the visual system, vascular diseases of the eye and optic nerve. He was awarded many high honors for these contributions.
Originally from a small farming village in Punjab, India, he completed medical school in India. After serving in the Indian Army Medical Corps., Dr. Hayreh obtained a faculty position at the Government Medical College in India where he began his lifelong extensive research in the blood circulation of the eye.
His dedication to research was the incentive to apply and receive the Beit Memorial Research Fellowship in Medical Sciences at the University of London. During this fellowship, he was mentored by Sit Stewart Duke-Elder.
Through his research, Dr. Hayreh received academic positions and high honors in England and Scotland. At ophthalmology meetings in Europe, he met Frederick C. Blodi, M.D., which led to Dr. Hayreh joining the Department of Ophthalmology at the University of Iowa in Iowa City, Iowa in 1973.
Dr. Hayreh worked with Edward S. Perkins, M.D. at the Institute of Ophthalmology in London and became close friends. Dr. Hayreh recommended Dr. Perkins to Dr. Fred Blodi. In 1979, Dr. Perkins was invited to join the faculty as a Professor in the Department of Ophthalmology at the University of Iowa.
For twenty-six years, Dr. Hayreh continued his research, teaching, and clinical services at the University of Iowa. He received many awards and accolades. He assumed emeritus professor status at the University of Iowa in 1999 until his death in 2022.
Sohan S. Hayreh, M.D. continues to be regarded as a world authority on ocular and optic nerve circulation, vascular disorders of the eye, giant cell arteritis, and many other topics.
Christopher Leffler and Stephen Schwartz
How Charles Kelman Invented Phacoemulsification in the 1960s: a Reappraisal
Background: Charles Kelman developed phacoemulsification by modifying an ultrasonic dental tool (Cavitron, NY) to emulsify cataracts so that they could be removed through small incisions. Kelman wrote that he first learned of the dental tool just as his research grant was about to run out.
Methods: We reviewed the John A. Hartford Foundation files related to Kelman, and interviewed his first wife, two people who worked in his lab (a dentist and an assistant), and family of his dentist (Larry Kuhn) and of the engineer (Anton Banko) who built the device.
Results: By January 1962, Kelman learned of the Cavitron instrument from his then-fiancée, who worked in Larry Kuhn’s dental office. Kelman initially pursued other ideas for cataract surgery, including cryoextraction in 1962. His first grant, which covered small-incision cataract surgery, became active in Jan. 1964. Kelman and Kuhn were together when the idea for using the Cavitron device for cataract surgery was formulated. Kelman and Kuhn tested the Cavitron device on a previously-extracted cataract without obvious efficacy at Kuhn’s office. In February 1965, when Kelman’s grant had 2 years remaining, he began devoting resources to studying the Cavitron instrument. The first time the Cavitron instrument was able to remove a cataract in any species in a manner deemed a success was in a cat’s eye on March 23, 1966. The first two phacoemulsifications in human patients took place between April and June of 1967.
Conclusion: By all accounts, Kelman and Kuhn collaborated in at least several important steps in early phacoemulsification development. Kelman probably became aware of the Cavitron ultrasonic instrument earlier than is generally recognized, but multiple modifications of this device were required to permit its use for cataract surgery.
Grace Levy-Clarke
From Bleeding to Biologics: Granulomatous Uveitis: Sympathetic Ophthalmia and Ocular Sarcoidosis: Informative Role in The Historical Understanding of Autoimmune Diseases.
Autoimmune diseases, also referred to as immune-mediated disorders have been described in the eye dating back to writings from Hippocrates, we can also find informative writings from early American physicians. Sir Hans Sloane (1660-1753), based on his early writings demonstrated a clinical understanding that a unilateral traumatic ocular injury could result in contralateral blindness. The documented early treatment of this condition included bleeding. Additional writings in 1778 by John Jay, an attorney, reporting on an ophthalmic case from James Jay, his physician brother, and in 1808 by Peter Foissin, both used the term “sympathy” in their clinical understanding and description of the possible relationship between the two diseased eyes. Sympathetic Ophthalmia is now a well-defined but still poorly understood autoimmune, granulomatous uveitic entity. The complete clinical description of sympathetic ophthalmia was in 1840 by Sir William Mackenzie, with confirmatory histopathology described in 1905 by Ernst Fuch.
Ocular sarcoidosis has been described since the early 1900’s and is often the initial manifestation of a multi systemic, autoimmune, granulomatous disease that is immunologically well described but etiologically still obscure. From an historical perspective the multidisciplinary nature of sarcoidosis spans many decades across multiple subspecialties. The descriptions by dermatologists 1798-1900 (Hutchinson, Besnier and Boeck), and culminating with description of Heerfordt’s syndrome in 1909, by the Danish ophthalmologist. Like other ocular inflammatory syndromes bleeding was on the invasive armamentarium prior to the use of steroids in the mid-20th century.
The inflammatory cytokine, tumor necrosis factor (TNF) is believed to play an important role in the formation of granulomas. Currently our therapeutic armamentarium for granulomatous uveitis includes biologics such as TNF antagonists.
Jaime D. Martinez, Juan Carlos Navia, Christopher T. Leffler, Dennis Bermudez, Harry W Flynn Jr, and Stephen G Schwartz
Cystoid Macular Edema: The History of Its Diagnosis and Treatment
Cystoid macular edema (CME) is the most frequent cause of decreased vision after uneventful cataract surgery. The introduction of the direct ophthalmoscope in 1851 allowed for further understanding of macular disease. What followed in the decades after made descriptions increasingly more detailed.
In 1950, Karl Hruby (Vienna) reported on maculopathy post-cataract surgery. Three years later, S. Rodman Irvine (Beverly Hills) published the text of his Proctor Lecture, describing “prolapse of the vitreous into the anterior chamber with late rupture of the hyaloid face following uncomplicated intracapsular cataract extraction” potentially leading to “development of postoperative macular changes” and “macular degeneration.” In 1954, Paul Chandler (Boston) and John Nicholls (Montreal) described “macular edema in association with cataract extraction.” In 1957, Edward Maumenee (Baltimore) described postoperative “changes in the macula.”
The introduction of fluorescein angiography (FA) revolutionized our understanding of pathophysiology. First described by Harold Novotny and David Alvis (Indianapolis) in 1961, FA was further modified by investigators in Miami, including Noble David, Raymond Sever, and Johnny Justice, Jr. In 1966, J. Donald Gass and Edward Norton (Miami) used FA to report on 44-patients with “CME” with-or-without disc edema. They concluded that “the pathogenesis…involves leakage of serous exudate from the retinal and optic nerve head capillaries.”
In the late 1960s, McGuinness Myers, a medical illustrator, worked with physicians at Bascom Palmer to create detailed paintings of ophthalmologic diseases. Included were pictures of the clinical and angiographic features of CME.
In 1995, Puliafito reported a series of 74 patients with macular edema of various causes, including a patient with pseudophakic CME. Using OCT, Puliafito provided quantitative measurements of retinal thickness, contributing greatly to the utility of OCT for both diagnosis of CME and assessment of treatment response.
Treatment for CME post-cataract surgery has improved tremendously over the past several decades. In 1964, H. Wyatt Laws (Montreal) reported on the treatment of 8 patients with postoperative CME using oral vasodilators. He concluded, “visual acuity was improved or maintained in 87%” and “excellent results were obtained in the treatment of macular edema following cataract surgery.”
In 1968, John Gehring (Boston) reported use of oral prednisone on 17 patients with post-operative CME. He found “76% responded to systemic steroids…83% achieved 20/30 vision or better.”
Finally, in 1977, Kensaku Miyake (Japan) investigated the use of prostaglandins and other inflammatory mediators to treat CME. Amongst 30 patient eyes treated with topical indomethacin, significantly lower rates of CME were observed.
Norman Medow
Crime and Punishment: The Evolution of Medical Malpractice and Ophthalmology's position within !
Primum non nocere......First, do no harm...This doctrine, a major tenet of medicine, although not explicit in the Hippocratic oath, stands at the base of our medical practice and education. What happens when a wrong occurs, a harm or a complication. Our laws have evolved to provide for a patient to seek redress, through the court system, for a medical act that caused him harm.
The origins of redress for grievances dates back into early history. The earliest record that we have of rules and regulations regarding both the fees for medical care as well as the punishment for medical failure, are to be found in Babylonian writings dating back to 1750 B.C.E. Following this, the Magna Carta (1215), The Petition of Rights(1628) and The Bill of Petition(1689) in England , laid the foundation for our American system of Medical Malpractice. The 1st book on medical malpractice was written in the United States in 1860 by John Elwell
This paper will discuss these origins of medical payment and punishment for medical failure bringing us to the modern era of law and medicine. Where Ophthalmology fits into the overall picture of contemporary malpractice will be discussed, using statistics already in the literature as well as new statistics from one of the largest indemnity companies in the United States
Nolite Timere..Fear Not !..Illegitimus non carborundum...do not let the bastards get you down..This WWII Aphorism had it correct...Do not allow the enemy to dampen your resolve.....in modern Medical Malpractice, 75% of all of cases are won by the defendant !..Keep your head held high!
Natalia Morales and Phillip Custer
The influence of trachoma on the establishment of modern ophthalmology – a “worldwind” tour
Trachoma, caused by Chlamydia trachomatis, is a non-sexually transmitted conjunctivitis that results in blinding sequelae due to scarring. While there is evidence of trachoma impacting Ancient Roman and Greek societies, references to the disease can be traced back as early as the 27th century BC. The disease became endemic in the Middle East and was spread throughout modern Europe during the Napoleonic Wars. The London Dispensary for Curing Diseases of the Eye and Ear, now known as Moorfields Eye Hospital, was established in 1805 in great part to treat the influx of trachoma cases.
The spread of trachoma to the US was often attributed to immigrants. During the late 19th century in the US, fear of trachoma was weaponized for anti-immigration rhetoric and trachoma was the first disease classified as a dangerous contagious disease by the US government. However, the work of Drs. John McMullen and Joseph Stucky helped bring attention to the impact trachoma had on non-immigrant American communities, which ultimately led to public health investments. Trachoma became widespread in the mid-South (coined the Trachoma Belt) and specialized trachoma hospitals, clinics, and schools were opened to help manage the condition.
Nearly in parallel, awareness of high trachoma rates in Native American communities began to grow. Indian boarding schools, originally designed to assimilate Native American children, were known to have some of the highest trachoma rates.
Dr. Webster Fox, an ophthalmologist, advocated for aggressive surgical approaches in the management of trachoma for Native Americans, including radical grattage and tarsectomies. Due to various factors, surgically driven treatment was widely adopted in this population. The American Medical Association ultimately investigated these practices and subsequently cautioned against their use due to poor success rates.
Drs. Phillips Thygeson, Polk Richards, and Francis Proctor headed the Fort Apache Trachoma Research Laboratory, located next to a Native American trachoma school.
In the 1930s, sulfanilamide was discovered by Dr. Fred Loe, a friend of Dr. Thygeson, as an effective treatment of trachoma. At the time, it was thought to be caused by a virus, but Chlamydia trachomatis was ultimately isolated in 1956.
Although rarely encountered in daily ophthalmology practice in the US, trachoma continues to be the most common infectious cause of blindness worldwide. Individual treatment is theoretically simple but the approach to treating communities is complex
James Ravin
Marat - Radical Politician and Scientific Writer
Jean Paul Marat (1743-1793) had a medical career for more than ten years in France and England. He received his MD degree from the University of St Andrews in 1775. He translated Newton’s Optiks into French in 1786 and wrote treatises on light, fire, and electricity. One of his publications is of particular ophthalmological interest for therapeutics more than two centuries ago: An Enquiry into the Nature, Cause, and Cure of a Singular Disease of the Eyes, Hitherto Unknown, and yet common, produced by the use of certain mercurial preparations.
Tracy Ravin
The Optical Art of Bridget Riley
Bridget Riley (April 24, 1931-present) is an English artist and important figure of the Optical (Op) art movement of the 1960s. Descriptions of her work frequently reference the eye, visual function and perception. Riley gained international attention with the 1965 exhibit at the Museum of Modern Art titled “The Responsive Eye.” Her work in the early 1960s focused on black and white patterns often creating the effect of movement. In the later 1960s she transitioned to working with vibrant, often contrasting colors.
The complex effects created in her art arise from both the physiology of our retinas and the visual processing that occurs in our brains. Some well described illusions appear regularly in her work. Our retinal cells are exquisitely sensitive to contrast. The exaggerated contrast between edges of different shades, known as Mach bands, has been used in art since ancient times. This effect is frequently visible in Riley’s work. Other illusions that appear in her work include the Zollner and Hering illusions which involve additional patterns around parallel lines that create the effect of curving. By varying the frequency of lines and scale of her paintings she can alter some of the effects and create new visual experiences.
Despite creating optical effects in her art, Riley denies ever studying optics. She cites Seurat and pointillism as the inspiration for her unique style. Closely approximated lines of color can create a blending of colors much like the optical mixture effect created with pointillism. Using her empirical method, Riley creates complex visual effects. Her works challenge the senses and invite interaction from the viewer. They continue to provoke diverse reactions from viewers and stimulate discussions of perception.
Stephen Schwartz, Christopher Leffler, Andrzej Grzybowski
Dorothy Tiffany Burlingham and the Psychology of the Blind Child
Dorothy Tiffany Burlingham (1891–1979) was a child psychoanalyst with a particular interest in blind children. She was a daughter of the artist Louis Comfort Tiffany (1848-1933) and a granddaughter of Charles Lewis Tiffany (1812-1902), founder of the jewelry retailer. An unhappy marriage to a psychiatrically ill husband and a sick child led her to emigrate to Europe with her four children seeking psychoanalysis. She became a lay psychoanalyst and a lifelong partner—both professional and personal—of Anna Freud (1895–1982), youngest daughter of Sigmund Freud (1856-1939). Burlingham, at age 67, founded a day nursery for congenitally blind children in London. She wrote extensively on the psychological problems facing these children. These included an impaired ego development, the need to remain still (both for safety concerns and to better employ their hearing), and their anomalous relations with their parents and their sighted peers. Her unusual life journey led to many important contributions to this field.
Eric Wan, Elizabeth Schexnyder, and Alice “Wendy” Gasch
Margaret Brand, MBBS: A Pioneer for the Prevention of Blindness in Leprosy
Purpose: Ophthalmologist Margaret Brand, MBBS (1919-2014) had a tremendous impact on the treatment of ocular leprosy (Hansen’s Disease) during a time when over half a million new cases were diagnosed each year. Her contributions are underappreciated despite a continued need for ophthalmic care for leprosy. We describe first-hand accounts from Dr. Brand and her colleagues, presented for the first time.
Methods: We analyzed Dr. Brand’s publications, biography/autobiography, instructive videos, and 35mm slides. We consulted publications from her peers for a contemporary understanding of her work, and “The Star” magazine produced by leprosy patients.
Results: Dr. Brand is regarded as the world’s “best ocular leprologist” and was a medical pioneer, becoming Chief of the Ophthalmology Department at the National Hansen’s Disease Center in Carville, Louisiana, and Assistant Professor of Ophthalmology at Tulane. Her thorough descriptions of the pathophysiology and diagnosis of ocular leprosy paved the way for standards of care. For example, she was the first to explain why so many leprosy patients had corneal ulcers. Prior to Dr. Brand, there was little guidance about approaching ocular leprosy; she created treatment and surveillance guidelines and patient education materials. She wrote “Care of the Eye in Hansen’s Disease,” the seminal text used for training not only field workers, but also ophthalmologists.
Dr. Brand was creative in applying ophthalmic principles and techniques to meet leprosy patients’ unique needs in resource-poor settings. An experimentalist, she brought in new techniques, such as corneal transplants and reconstructive plastic surgery techniques in which she transferred the temporalis muscle tendon to the eyelid in order to restore blinking. She was also a prolific surgeon. In rural eye camps her surgical teams performed 100 to 150 cataract surgeries a day. Her destitute patients, many with horrific deformities and ulcers, regarded her as the “closest thing to Jesus Christ.”
Dr. Brand is credited with greatly improving the visual prognosis of leprosy patients, and her impact continues through the leprosy research and treatment facilities in China, Ethiopia, and India that she helped establish, and the countless occupational therapists, nurses, and physicians she trained.
Conclusions: Over 100 years ago, Bull and Hansen remarked that “there is no disease which so frequently gives rise to disorders of the eye, as leprosy does.” Today, ocular involvement continues to occur in 75% of leprosy cases. Knowledge about ocular leprosy must be maintained in order to prevent its devastating consequences. Dr. Brand gave us the knowledge and tools.
Christine Xu
A Story of Seeing and Hearing from Bach to Stevie Wonder
Oliver Sacks writes in Musicophilia, “Professional musicians…possess what most of us would regard as remarkable powers of musical imagery.” As a classically trained musician myself who also has synesthesia, I have appreciated that music often requires synthesizing both auditory and visual input. In this talk, I will tell the story of musicians throughout history who have had some form of visual impairment, whether later in life or as a condition present since childhood.
This story will touch on some notable musicians from the 1600s to the present day, featuring recordings of their works, including brief live performances if I am able to secure the necessary instruments. Two famous composers of the Baroque era, Johann Sebastian Bach and George Frederic Handel, likely had cataracts and underwent a “cataract couching” procedure performed by a surgeon of questionable training; in Bach’s case, complications including endophthalmitis likely led to his death. Maria Theresia von Paradis was an Austrian performer and composer of the Classical era, who was friends with notable figures such as the Mozarts, and was blind before the age of 5 and used a special board to write out her compositions. Manuel de Falla, a Spanish musician of the late Romantic era who was known for his interpretations of Spanish folk music, suffered from a mysterious eye condition that may have been recurrent iridocyclitis; the severe discomfort of his eyes likely affected his musical style.
But the story does not end with classical music. To highlight a few famous musicians of more contemporary times, Andrea Bocelli is a singer of worldwide fame who lost vision in childhood due to congenital glaucoma as well as eye trauma. Ray Charles was a pioneer of the genre of soul music who became blind likely from childhood glaucoma. Both of these musicians taught themselves to play piano and read music in Braille at an early age. The iconic musician Stevie Wonder likely lost vision due to retinopathy of prematurity. As he stated in an interview, “It's played a part in that I'm able to use my imagination to go places, to write words about things I've heard people talk about.” Indeed, one could argue that music allows the imagination to create vision from sound and vice versa, a remarkable synergy.
Page last modified March 22 , 2024