Snyder Lecture:

Alice “Wendy” T. Gasch:  Gratuitous Eye Color Modification: An Overview

Purpose: To provide an overview, including the history, of means currently used for eye color modification of normal eyes. This topic is timely because it is trending on social media and because there is indication that modification of eye-color of normal eyes is trending upward in the U.S., particularly among individuals with brown eyes.

Methods: Review of material identified via multiple search engines, including PubMed, ResearchGate, and Google Scholar 

Results: Modification of eye color has been practiced since at least the second century CE, but until about 15 years ago, it typically was done to abnormal eyes – not normal eyes. Current means used to change the color of normal eyes are: eye drops, iris implants, laser depigmentation of the iris, pigmentation of the cornea (keratopigmentation) and contact lenses. All, except eye drops, are expensive and can change eye color, but all, including eye drops, are associated with potentially sight-threatening complications. Lack of FDA and CE approval is associated with all means, except contact lenses.

Conclusion: Presently, there is no risk-free means of changing eye color. Attempting to do so by any current means can change vision permanently for the worse.

The abstracts below were current at the time they were posted, March 26. Additional abstracts will be added as they are accepted; authors may edit them until close to the meeting dates.

Jennifer Arch:  Sight and Insight in Boethius's "Consolation of Philosophy"

During the house imprisonment that preceded his torture and execution in ca. 524 C.E., Anicius Manlius Severinus Boethius (b. ca. 480) wrote "De consolatione philosophiae." The "Consolation" was one of the most influential works in western Europe for more than a thousand years. In it, Lady Philosophy, an allegorical personification, explains to the prisoner Boethius why he is wrong to view himself as suffering in an orderly world designed by a just God. It may be of interest to ophthalmologists to hear just how much of this argument depends on vision: Boethius’ eyes are wet with tears; Philosophy’s eyes are burning and glowing; she fixes her gaze on him, and he on her; other “philosophers” believe they are looking at her when they really are not. Meanwhile, God—famously more Platonic than Christian, in a text written by an author who had also composed a treatise on the Trinity—gazes down at the orderly rotations of the heavens, and therefore human life, from the center on high. One of the best ways to see this order for themselves, the "Consolation" makes clear, is for human beings to look up into the heavens and to exercise reason in understanding what the stars and planets do and signify. Unlike some traditions in which vision and insight are gained through loss of physical sight, in the "Consolation" physical sight is an important means by which humans can think through their place in the universe. This paper, if delivered in 2025, will be in the 1500th anniversary year of the traditional date (524 C.E.) of the "Consolation," and of Boethius’s execution.

Barbara Arnold:  Retinal Hemorrhages in Battered Babies

The occasion of convening the Cogan Ophthalmic History Society meeting at the University of Colorado gives the opportunity to historically honor the Denver pediatrician who sensed the urgency to passionately become involved in teaching medical students, residents and colleagues about the life threatening injuries that deserved diagnostic identification. Kempe, with his wife Ruth, also a pediatrician persisted in making enormous strides in facing the disbelief of colleagues that parents could inflict injuries upon their family members and moreover accomplish the the next step of getting protective services involved. Within a professional lifetime, the collective descriptions of injury hallmarks, and now the community resources to help these families have been have been safeguarded by identifying the shaken baby syndrome (abusive head trauma) as a reportable condition in all fifty states.
In 1946 radiologists were discovering chronic subdural hemorrhages and cases of bone fractures in various stages of healing. Over time it became apparent that these babies had been abused. Further citations by radiologist John Caffey in the 60’s were consistent with the syndrome described by Kempe and added support to his description.

GT Giffney Jr published The Eye of the “Battered Child” in Arch Ophthalomol, 1964, August
British ophthalmologists MJ Gilkes and Trevor Mann published their recognition of retinal hemorrhages The Lancet in August of 1967.

Retinal hemorrhages are known to occur at the time of birth, with higher incidence of vacuum assisted vaginal birth. Several different prospective studies of fundi were documented at different institutions, some at 30 hours and others up to 90 hours after delivery. Most of these hemorrhages disappeared by two weeks and all cleared at 30 days. These were small hemorrhages in the posterior pole, in contrast to the diffuse hemorrhages in all layers of the retina and extending out to then ora serrata. as seen in infants with Shaken Baby Syndrome. Kempe’s early writings suggested that there may be a cyclical pattern to these injuries. Early intervention may prevent more life-threatening injuries. 

Documentation of fundus findings in infants suspected of having non-accidental trauma is the expectation. ER physicians have direct ophthalmoscopes, and examination by an ophthalmologist with a binocular indirect scope can offer better documentation to the observations in the peripheral retina.
In later years Kempe was nominated for the Nobel Peace Prize for his contributions to children’s safety.

Christopher Blodi:  Aces and Eights: How Wild Bill Hickock’s Vision Loss Led to the “Dead Man’s Hand”

Purpose: This presentation focuses on William “Wild Bill” Hickock’s (1837 -1876) life story, concentrating on his profession in law enforcement in frontier towns of the American West in the late 19th century. After developing an eye disease he was forced to find another occupation which led to his death while playing poker. 

Design/Methods: This retrospective project utilized primary and secondary written material.
Results: Hickock’s life was characterized by numerous law enforcement jobs in the American frontier. In these positions Hickock often used guns to deal with situations. When Hickock inadvertently shot a bystander questions arose as to his abilities and he lost his job. Hickock showed clear signs of vision problems that a visit to an eye physician did not cure. His inability to obtain work led him to move to Deadwood, SD to try to make a living playing cards. While playing he was shot in the back and died, holding “aces and eights”.  

Conclusion: Hickock’s visual deterioration led to his job loss. After unsuccessful attempts at various occupations, Hickock moved to Deadwood, SD where he was shot during a poker game. He died holding the now -iconic poker hand of “aces and eights” -the “Dead Man’s Hand”.

John D. Bullock:  Hassall and Henle - Their Corneal Bodies and Other Scientific Contributions

Hassall-Henle bodies (sometimes referred to as Hassall-Henle warts) are defined as small transparent growths on the posterior surface of Descemet's membrane at the periphery of the cornea. These bodies contain collagenous matter in which numerous cracks and fissures are filled with extrusions of the corneal endothelium. This condition is usually associated with the aging process. When similar changes are seen in the central cornea, they are pathologic and are termed cornea guttae. While keratologists, ophthalmic pathologists, and ophthalmology residents studying for their ABO examinations are highly familiar with these bodies, most other ophthalmologists have probably forgotten their anatomical details and are likely incognizant regarding other contributions by these two alliterative eponymous scientists.

The British physician Arthur Hill Hassall (1817–1894) made numerous other remarkable achievements which single him out as one of the great physician-scientists of the 19th century. He was a microscopist who produced many important discoveries in the fields of human histology, botany, and food/water safety. He published five classic works: The Microscopic Anatomy of the Human Body (the first English textbook on the subject); A Catalogue of Irish Zoophytes; A History of British Freshwater Algae; Food and its Adulterations; and A Microscopic Examination of the Water Supplied to the Inhabitants of London. His studies of Thames River water were predicate to John Snow’s seminal epidemiological discovery of cholera’s water-borne transmission. He also founded the first tuberculosis sanatorium in the UK, the Royal National Hospital, Ventnor, on the Isle of Wight.

The German physician, anatomist, pathologist, and microscopist Friedrich Gustav Jakob Henle (1809–1885) was an important figure in the development of scientific medicine. He was a student of the neurophysiologist/co-founder of modern ophthalmology, Johannes Müller. Henle is credited with numerous micro-anatomical discoveries, including Henle’s fiber layer, a layer of the retina that contains bundles of unmyelinated axons from rod and cone photoreceptors. His influence on the development of histology was comparable to the work on gross anatomy by the Renaissance master, Andreas Vesalius. Henle’s essay, On Miasma and Contagia, was an early argument for the germ theory of disease. He was Robert Koch’s professor at the University of Göttingen. “Henle’s postulates,” a set of criteria establishing a causal relationship between a pathogenic organism and a specific infectious disease, were later adapted and modified by Koch and are now known as the “Henle-Koch postulates.”  

The lives, careers, and numerous scientific discoveries of both Hassall and Henle are presented.

Edward De Sutter:  Jules Gonin 1934 His opus magnum le décollement de la rétine

Jules Gonin (1870–1935), a Swiss ophthalmologist, revolutionized the treatment of retinal detachments, making significant contributions to ophthalmology. His groundbreaking discovery identified retinal tears as the primary cause of retinal detachments, challenging the prevailing medical views of his time. He emphasized that successfully sealing these tears was essential for effective treatment, an idea that initially faced skepticism but was later universally accepted at the 1929 International Congress in Amsterdam.

Gonin’s most notable innovation was the development of the “Zündungstechnik,” a method for sealing retinal tears that significantly improved treatment outcomes. His insights also advanced understanding of the role of the vitreous in retinal detachment. These achievements culminated in his 1934 publication, Le Décollement de la Rétine, a comprehensive work summarizing forty years of research. This book remains a landmark in ophthalmology.

Between 1919 and 1934, Gonin published over forty articles and shared his findings at international conferences, establishing himself as a global authority. His work gained worldwide recognition at the 1933 International Congress in Madrid, and in 1937, the prestigious Gonin Medal was created in his honor. This award, presented every four years, celebrates exceptional contributions to ophthalmology. Additionally, a street and an eye hospital in Lausanne were named after him.

Gonin’s dedication and originality set him apart. He was known for his sharp observations and willingness to challenge traditional beliefs. He credited his mentor, Marc Dufour, and Dufour’s son Othmar for their influence, dedicating his magnum opus to them as a gesture of gratitude.

Jules Gonin’s legacy has had a profound and lasting impact on ophthalmology. His pioneering work not only advanced understanding of retinal detachments but also introduced groundbreaking treatments that have saved the vision of countless individuals. To this day, his contributions inspire ophthalmologists worldwide and underscore the importance of innovation and perseverance in medical science.

Leah Doro:  Happy Accidents in Ophthalmology

Some medical breakthroughs are hard-won, while others are stumbled upon. Penicillin, X-rays, and insulin are just a few cornerstones of modern medicine that were found entirely by accident. Ophthalmology’s happy accidents are less well known by the medical community and by the public, but they are no less interesting.

Probably the most well-known accidental discovery in ophthalmology is that polymethyl methacrylate in the eye is inert, which was observed by Sir Harold Ridley in the early 1940’s as he was examining the eyes of pilots who had this plastic lodged into their eyes during WWII. This discovery set off a chain of events that provided the foundation of modern lens implants as we know them today.

Neuro-ophthalmology and pediatric ophthalmology owe some of their early development to a slip of the hand during an experiment in cats by neuropsychologists Torsten Wiesel and David Hubel in the late 1950’s. The extra light that peeked out of a projector slide led to a greatly expanded knowledge of higher-order visual processing, and to a Nobel Prize for Wiesel and Hubel. 

Refractive surgery has multiple notable accidents to thank for innovations in the field, the first of which occurred in 1974 after Russian ophthalmologist Svyatsolov Fyodorov removed glass shards from a young boy’s eye and subsequently found him to have improved vision. This has been heralded as the birth of radial keratometry. Another occurred in 1993 when an accidental injury by a femtosecond laser to a graduate student’s eye sparked the inspiration for bladeless LASIK.

Honorable mentions for botulinum toxin (which ophthalmology cannot claim the accidental discovery of but can claim its origins for use in humans), ancient atropine for cosmetic use, almost-true carrot propaganda during WWII, and cocaine for ocular anesthesia.

Robert M. Feibel:  Sir William Bowman’s Contributions to the Operation of Needling of Posterior Capsular Opacity

Sir William Bowman was an iconic figure in the history of 19th century ophthalmology. This presentation will focus on his contributions to surgery for posterior capsular opacity. Many articles about Bowman mention his two- needle technique for opening such opacities, but do not fully relate or emphasize his other contributions to this operation. 

The development of posterior capsular opacity following extracapsular cataract extraction has always been a common complication. Prior to the invention of the Nd:YAG laser, capsular opacities were opened by surgical needling or discission. Although thin and uncomplicated membranes could easily be opened with a needle-knife, a thick capsule could resist a simple needling, and the resultant tearing and pulling of the membrane could cause complications. 

Bowman made several advances in needling such membranes. The first was the simultaneous use of two needles, cutting against each other and thus reducing trauma to the iris, ciliary body, and vitreous. This technique lasted well into the 20th century, until the YAG laser was introduced. Bowman was the first to teach that the hallmark of a good capsulotomy depended on the formation of the paracentesis. He emphasized that it was essential for the needle-knife to enter and exit the globe smoothly so as to avoid a prolonged leakage of aqueous Such leaks could result in bacterial infection through the paracentesis, or a flat anterior chamber with the formation of peripheral anterior synechia and secondary glaucoma. He designed a needle-knife with a guard on the needle shaft to prevent the needle from penetrating too deeply into the vitreous.

Bowman observed that the onset of acute glaucoma following needling was associated with an asymmetrical anterior bulging of the iris and a shallowing of the anterior chamber, from accumulation of aqueous behind the iris. Although he did not understand the syndrome of acute pupillary block glaucoma, he demonstrated that iris transfixion (without iridectomy) cured this glaucoma by opening a passage for the aqueous from the posterior chamber to the anterior chamber. This was the correct rationale for the use of iridectomy in acute glaucoma, in contrast to other current theories which were incorrect. 

In summary, Bowman’s two publications from 1853 and 1864 were landmarks in the historical development of needling capsular opacities, and several of his techniques were utilized until the development of YAG laser capsulotomy in the 1970s.

Margaret Greer and Alice “Wendy” T. Gasch: A Brief History of the Eye Exam: Vision, Intraocular Pressure, Visualization of the Eye

The comprehensive eye exam has a rich history that spans centuries. Each core component—visual acuity testing, intraocular pressure measurement, and visualization of the eye structures—was developed independently. Yet collectively, they play an essential role in assessing eye health. 

One of the earliest visual acuity tests, the two-star discrimination test, was believed to have originated in Ancient Persia. It was later adopted by the Arabs and aptly renamed the Arab Eye Test. If patients could visualize the two stars, Mizar and Alcor separately, they had roughly 20/20 vision. Anything less would result in the apparent merging of these stars. 

Other iterations of the visual acuity test included the use of mustard seeds and lines. It wasn’t until 1843 that the first optotype was invented. The Snellen chart is the most famous optotype and was released in 1862. Optotypes were critical because they allowed physicians to standardize visual acuity measurements across patients.

Devices that measure intraocular pressure were crucial additions to the comprehensive eye exam because they gave physicians the tools to screen patients for glaucoma. These tools used the Imbert-Fick principle and the equation: Pressure = Force/Area. Early intraocular pressure measurement devices included the weight-loaded plunger and spring-loaded scleral indentation tonometer (invented 1863 and 1865, respectively), which involved applying a known force to the sclera and measuring its indentation to estimate intraocular pressure. Later iterations of these devices included applanation tonometry and Goldmann tonometry, both of which are used today. 

The last component of the comprehensive eye exam involves visualizing the eye itself using contraptions that combine microscopes, mirrors, and external light sources. One of the earliest visualization devices was introduced in the 1820s by Johannes Purkinje, who studied the iris using an adjustable microscope plus light source. The direct ophthalmoscope, introduced in 1850 by Hermann von Helmholtz, let physicians view the posterior eye and retina in greater detail for the first time in living patients. This technology was continuously improved on, with the addition of more light sources, magnifying glasses, and lenses. The most famous visualization device, the slit lamp, was invented in 1911 by Allvar Gullstrand. It is still used today, albeit with some modern changes, and is a crucial addition to the comprehensive eye exam.

The comprehensive eye exam has continuously changed with the introduction of new technology. This presentation will dive into the components of the exam and discuss the inventions that revolutionized eye care.

Mark Greenwald:  Dr. Martin Urist and the Version Light Reflex Test

Martin J. Urist, MD, directed the ocular motility service at the Illinois Eye and Ear Infirmary (now University of Illinois Chicago) from the 1950s until his death in 1977, training countless residents in the art and science of strabismus and binocular vision. His somewhat idiosyncratic ideas and approach dominated in the Chicago ophthalmologic community during an era when nearly all eye muscle surgery was done by general ophthalmologists.

Among Dr. Urist’s contributions to ophthalmic knowledge were early appreciation of the significance of A- and V-patterns, and use of the margin-reflex distance measurement to help quantify the assessment of ptosis. Equally valuable usage of ocular surface light reflexes underlay Urist’s technique for quantification of eye rotations, which he termed the version light reflex test. This approach allowed the examiner to determine over- and under-rotation in the four secondary gaze directions, with reliable distinction between underaction of a rectus muscle and overaction of its yoke, and to compare exam findings between visits, between eyes, and between patients with considerably greater precision than is possible with most other clinical approaches. No equipment other than a standard muscle light is required.

Unfortunately the failure of Urist and his colleagues at IEEI to train a critical mass of ophthalmologists specializing pediatrics and strabismus led to the near disappearance of his influence over the past 40 years, even in Chicago. Resurrection of the version reflex test is hopefully still a possibility, and one that would greatly benefit the care of patients with abnormal ocular motility.

Hojin Han, Robert Enzenauer and Alan Beitler:  Ophthalmologist, Flight Surgeon, Five-year Prisoner of War: The Recollections of a True Survivor, Hal Kushner

An English-speaking Viet Cong officer said to Hal Kushner during his first days in captivity, “dying is very easy, living, living will be the difficult thing.” Kushner received his M.D. from the Medical College of Virginia in 1966. The very next year, he deployed to Vietnam as an Army Flight Surgeon in the 1st Air Cavalry Division. Only a few months in, he became the sole survivor of a disastrous helicopter crash that would mark the start of his time in captivity. Kushner was taken to the prison camps of the Viet Cong, where he lived in sub-human conditions, including near-starvation and constant threat of disease, for over five years. Only twelve of the original twenty-seven American prisoners in his camp survived; nine of them died in his arms. Yet, even without equipment, ravaged by disease and injury, and plagued by severe malnutrition, Dr. Kushner cared for and supported the other American prisoners—he even revived one man who suffered from a heart attack. Following his release in March 1973, Dr. Kushner trained in internal medicine and ophthalmology at Brooke Army Medical Center in San Antonio, Texas. He left active-duty service in 1977 and retired from the Army Reserve in 1986 as a colonel. His story as a medical officer, being taken as a prisoner of war and persevering in a desolate environment filled with unspeakable suffering, is a true tale of American patriotism and resilience.

Alison Hong:  The Origins of the Double Eyelid Blepharoplasty

South Korea is considered the mecca of plastic surgery, with the double eyelid blepharoplasty - known colloquially as the “Asian blepharoplasty” - amongst the most popular cosmetic procedures. The prevalence of the double eyelid surgery has socioeconomic, racial, and political motives that date back to the Korean War. This project aims to unveil the origins of the double eyelid blepharoplasty and how the United States’ intervention into the Korean War permanently changed Korean culture, life, and beauty standards. 

Dr. David Ralph Millard, hailed as the “the most brilliant and creative plastic surgeon of the twentieth century,” is often credited with popularizing the double eyelid blepharoplasty in South Korea during the war. Although he is most known for revolutionizing the cleft palate corrective surgery for children, his practice of the double eyelid surgery offered a permanent way for South Koreans to become more similar to the Americans living abroad. In his essay “Oriental Peregrinations,” Dr. Miller reflects on how plastic surgery during and after the war “constructed visible evidence of American goodwill in Asia.” His first patient, a Korean translator, asked for his eye to be “made into a round-eye,” as he felt that “because of the squint in his slant eyes, Americans could not tell what he was thinking and consequently did not trust him.” Dr. Miller learned of the surgeons across Asia, including Korea, already performing the double eyelid blepharoplasty for visual and cosmetic purposes. As Dr. Nadia Y. Kim writes, the yearning to appear more “Western” reveals the “Koreans’ sense of inferiority to their White racial bodies.” Perhaps by changing the shape of their eyes, the South Korean people could stray their identities away from the devastating war and begin to work towards a more prosperous life, with many of those aspects being influenced by American intervention. 

Today, around half of South Korean women aged between 19 to 29 have had plastic surgery, with blepharoplasties and rhinoplasties being the two most common procedures. With the international popularization of K-Pop music, Korean television and film, and South Korean medical tourism, South Korea is a leader in popular culture around the world. However, many, if not all, of the famous Korean faces we see on our screens have undergone cosmetic surgery. This acknowledgement begs us to wonder if the popularity of South Korean culture would remain without the embrace of Western beauty ideals.

Kenneth Hovland:  Historical Ophthalmic Exhibits at the University of Colorado

Initially two glass cases were purchased for the University of Colorado Department of Ophthalmology, to display a large variety of historical ophthalmic equipment used over the past 150+ years. Significant contributions were made from personal collections, of Leonard Swigert (father of Jack, one of the Apollo 13 astronauts, and co-resident of Phillips Thygeson at University of Colorado in 1930), Joel Goldstein, myself, and later from over 20 other interested ophthalmologists. Included are early ophthalmoscopes (Liebrich1855, Loring 1869, DeZeng 1914), Welch-Allyn (1915) and Keeler ophthalmoscopes, a Bailliart ophthalmodynamometer, ocular prostheses and orbital implants, Maklakov and Berens tonometers, and other glaucoma related devices. An empty bottle of Argyrol eye drop silver nitrate solution is shown. (Income from this in the 1920’s allowed Dr. Albert Barnes to collect numerous French Impressionist paintings, now on display in Philadelphia at the Barnes Foundation, valued at $30 billion!).

Two other display cases were obtained, the first entitled: Evolution of Cataract Surgery. Historical illustrations were created with the help of the Graphic Arts Department, starting with Egypt and India (600 BCE), through the Middle Ages with “couching”, up until Daviel’s extracapsular extraction technique in 1750. Instruments used in intracapsular extraction technique are shown, including a von Graefe knife and a razor-blade breaker to create the 180o incisions, and either capsule forceps, lens loupe, erisophake or cryoprobe to remove the lens. Post-operative +10 D “Aphakic glasses” were routine. In 1950 Harold Ridley introduced intraocular lenses (10 examples of explanted IOLs are displayed) and later YAG laser, phacoemulsification, foldable lenses and multifocal lenses were added.

The last display case entitled: Evolution of Retinal Detachment Surgery, with similar illustrations, describes the observations of Jules Gonin, the contributions of Charles Schepens, the usage of photocoagulation by Gerd Meyer-Schwickerath, and the development of vitrectomy by Robert Machemer. Included are an early (1930” s) hand-held perimeter used in estimating the external global location of retinal breaks for use at the time of surgery to apply cauterization (“ignipuncture”), indirect ophthalmoscopes, scleral depressors, diathermy and cryocoagulation units, silicone implants, and an array of vitrectomy cutters (1970’s to present).

These displays have been appreciated by faculty, staff, residents and fellows, patients and their families alike.

Jason Jo:  Books to Bacilli — The Legacy of Dr. John E. Weeks

Authors of autobiographies can rarely be described as humble. In the case of John Elmer Weeks and his autobiography, however, it would be the perfect descriptor. In spite of his many accomplishments — achieving a medical degree from having only “$1.75 in [his] possession and a scanty wardrobe” to becoming immortalized in medicine via the discovery of the Koch-Weeks bacillus — Weeks maintains an admirable sense of humility in both his writing and repute. David Baird, Dean of the University of Oregon Medical School wrote: “In each instance when a gift was made to the medical school, there was one request, ‘that there be no publicity’. This was typical of Dr. Weeks, a quiet, thoughtful, and unpretentious gentleman”.

John E. Weeks was born on August 9, 1853 in Painesville, Ohio. As a young man, Weeks committed to a career in medicine based on a New Year’s resolution and worked ten hours daily as a mechanic to support his studies. The field of ophthalmology and medicine at large have much to thank for that New Year’s resolution. In 1886, Weeks demonstrated that the culprit behind a series of mucopurulent conjunctivitis cases was a bacillus, later named the Koch-Weeks bacillus. Weeks went as far as to infect his left eye with the organism to better understand its course.

Perhaps just as impressive as his scientific achievements was Weeks’ investment in learning and teaching. These passions manifested themselves in his love for books and libraries. As a student, Weeks relied on books for his learning, whether on violin techniques or human anatomy. As such, in his later life, he devoted himself to making these resources available for future generations; in fact, in 1937, he contributed $100,000 for the construction of a medical library at the University of Oregon. He also left behind his autobiography, about which he wrote: “[My relatives and friends] had complimented me by insisting that a history of my life would be interesting and might lend inspiration to ambitious youth endeavoring to obtain some degree of successful or satisfactory living”.

Equally desiring of supporting future generations as undesiring of recognition, Weeks embodied humility through his contributions to patients, science, and literature. Given his investment in books and libraries, it feels only right to honor his legacy through writing, authored by one of the ‘youth’ who was — as aimed by his autobiography —inspired by the life of Dr. Weeks.

Christopher Leffler:  Casanova’s Truths: Tadini’s monocular cataract extraction, and Casaamata’s intraocular lens in the 1790s

Purpose. To determine which parts of the story told by Giacomo Casanova (1725–1798) about an Italian oculist who proposed placing a glass intraocular lens (IOL) after cataract surgery have a basis in reality.
Methods. Historical document review.

Results. Casanova wrote that Italian oculist Felice Tadini (fl. 1757-93) proposed the IOL in Warsaw in 1766, and then travelled through Krakow, Vienna, Munich, and Paris. That was actually Tadini’s planned itinerary in 1790, as Casanova wrote his memoris. In 1766 in Constantinople, Tadini operated on Esma Sultan (1726-1788), who had been treated by Regina Salomea Pilsztynowa in 1759-60, and for whom an oculist was subsequently sought within the Ottoman Empire in 1770-71. From 1766 to 1768, Tadini actually followed the itinerary Constantinople, Italy, Barcelona. Casanova wrote that upon arrival in Barcelona, Tadini refused examination in Latin, and was therefore drafted as a soldier. In fact, Tadini practiced in Barcelona (Apr-May 1768) before practicing as planned in Madrid (July 1768), as Casanova visited. In 1771, Tadini advocated monocular cataract extraction when the contralateral eye still had vision, and a 1772 editorialist rebutted Tadini’s position. Casanova wrote that a satirical article mocked Tadini’s advocacy of surgery for the one-eyed, and this satire was actually published in 1788. Casanova wrote that the Italian oculist who proposed the IOL was recommended by someone from Dresden. Dresden court oculist Johan Virgilius Casaamata (1741-1807), of Padua, had unsuccessfully placed an intraocular lens by 1796. Casaamata promoted vitreous loss, and did not preserve the capsule.

Conclusion. Casaamata had attempted to place an IOL by 1796, and possibly by 1790, shortly after Pellier’s 1789 proposal of a glass artificial cornea. Casanova probably heard about Casaamata’s attempt and falsely ascribed it to Tadini.

Robert Maloney:  Harold Ridley, Stewart Duke-Elder and Survivor Bias in the History of the Invention of the IOL

Purpose: 2025 is the 75th anniversary of the first implantation of an IOL by Harold Ridley. The widely accepted narrative is that Ridley and his invention received an irrationally hostile and narrow-minded reception from Stewart Duke-Elder and other ophthalmic thought leaders. 

Methods: I argue that this narrative is biased because it was told by Ridley himself and amplified by his biographer and close friend, David Apple. Our argument is based on archival research at the Institute of Ophthalmology in London, interviews with survivors who knew Harold Ridley and a review of the literature. 

Results: There were good reasons to be skeptical of Ridley’s invention. Ridley had not done pre-clinical studies, so his early patients suffered avoidable complications. His first patient had a postop spherical equivalent refraction of -21D because of an error in calculating the lens power. The implanted eyes developed severe inflammation from the sterilization chemical, cetramide. 21% of Ridley's patients suffered irreversible visual loss from glaucoma or corneal decompensation. He worked in secret at a time when openness was the norm. The cautious approach that Duke-Elder and others had towards IOLs is understandable. Duke-Elder died before IOLs were widely accepted, so his viewpoint was never recorded.

Conclusion: The story of the invention of the IOL is largely the unchallenged creation of Ridley and Apple. A more accurate history is a story of a clash of worldviews between an inventor who was focused on innovating quickly to solve a major clinical problem and established leaders who were concerned about the harm to patients from a flawed invention. The skepticism of established thought leaders remains a valuable check on overly aggressive innovation today.

Mark Mannis:  The Eye in Judaism: Myth, Metaphor, and Medicine

The eye and vision play prominent roles in the Old Testament, the Talmudic literature, and in contemporary Jewish life. 

In biblical times, there was little in the way of effective diagnostic and therapeutic techniques. The eye and vision were often employed in metaphorical terms, but vision was clearly appreciated for its importance.  

With the advent of the rabbinic literature as exemplified by the Talmud, eye disease was described more clinically and specific remedies were employed. The extramission theory of vision became the basis for a cultural view of the eye and its capabilities.  

In modern Jewish life, there is a strong tradition of assistance to the blind manifest as the establishment of organizations to aid the visually impaired. The primacy of vision and the scourge of blindness have retained their importance to Jewish life over many centuries.

Curtis Margo and Lynn E. Harman:  The Intriguing Blindness of Maria Paradis and the Instructive Potential of Medical Biography

Investigation of disorders affecting historical figures can shed light into medical conditions and medical practices seldom discussed in traditional curricula. We use the narrative of Maria Theresia Paradis (1759 - 1824), an accomplished Viennese musician, as a pedagogical tool to illustrate how medical biography can expose healthcare providers to important and interrelated topics that are often overlooked during training. Maria Paradis rose to fame early in life for having mastered the organ, harpsicord, and piano without the benefit of sight. Her reputation as a musical genius who overcame blindness has been questioned in modern times because of the improbability of having temporally regained vision as a teenager while under spurious medical care. This historical review prompts reflection on topics ranging from hysterical blindness and feigned vision loss, to the association of musical savant to autism, and how the medical profession deals with charlatans.

Michael Marmor:  Antisemitism in Ophthalmology and Art

Antisemitism is rising again in the world. What are implications for ophthalmology and the arts when discoveries or creations are made by people who espouse severe racial bias?  
Ophthalmology recognizes few diseases discovered by Nazi physicians, and their eponyms are easily erased. But the pathology still must be understood, and it harder to erase the memory of ocular experiments in Auschwitz. It is also hard to erase an antisemitic composer’s name from music, or an artist’s name from a painting. Some would argue that virulent beliefs should ban such works; others suggest that beauty in the arts stands on its own, independent of the creator’s bias. There is no perfect answer, and this presentation seeks only to raise awareness.
In music, Richard Wagner was an outspoken antisemite, and his writings were a model for Hitler’s tropes. Wagner’s works are loved by some and hated by others. They are still banned informally in Israel, in response to overwhelming public sentiment. The music of more ambivalent sympathizers, Richard Strauss and Carl Orff, is played in Israel, to mixed reception.
In art, Impressionism was a cohesive movement in France in the 1870s, but its integrity disintegrated toward the end of century, in large part because of the Dreyfus Affair that made antisemitic views politically acceptable and drove collegial artists apart. Monet, Pissarro and Cassatt were fervent Dreyfus supporters. In contrast, Renoir and probably Degas had been antisemitic before the Dreyfus affair, and these views became hardened. Renoir refused to show his art at an exhibit with Pissarro, who was of Jewish heritage, and Degas fired a model on the spot for expressing sympathy for Dreyfus. Neither would speak to Pissarro on the street, and Degas withdrew from the Jewish Halevy family who had been among his closest friends. Both spoke outwardly about the evils of Jews. The intensity of their bias may come as a surprise, since their racism was tempered before the Dreyfus Affair, by the practicality of finding commissions from wealthy Jewish collectors. Furthermore, their views cannot easily be recognized from their art. Cezanne did not support Dreyfus, but he was never overtly antisemitic.  
The paintings of Degas and Renoir are among the best known in Impressionism. Should the antisemitism of these painters alter one’s enjoyment or interpretation of their works? That is an individual decision.

Norman Medow:  From Papyrus to Parchment, From Paper to the Printing Press: The Evolution of Books and Some Ophthalmic History They Have Preserved

We have all learned from books and most of us still use them...at least from time to time! But, we take their origin for granted. This paper will explore how books were developed and the important role that they played in the preservation of Ophthalmic History.
In the beginning, there were Cave Paintings, the oldest from around 30,000 B.C.-The stone age or Paleolithic Era, used by Homo Sapiens to preserve what and how they hunted and possibly also for teaching purposes. As time evolved, and man moved from place to place, a more portable means of historic preservation became necessary. The Papyrus plant, grown easily, was found to be easily made to produce a surface for writing or painting. Its ease at being able to be rolled into a scroll for storage or for carrying, made it ideal. That is, until after time, it cracked, frayed and decayed causing Parchment to be developed as an alternative. Finally came paper from China and it was perfect. Smooth, easy to write or paint on but as only some people were literate, primarily the clergy, the dissemination of printed material was slow and tedious to make....Until the Printing Press was developed in the 15th Century. This discovery allowed for books to be produced and disseminated to more people and aided in the development of literacy. Most of the History of Ophthalmology has been preserved in book form. We will look at some of these important books including the 1st book of Ophthalmology printed in the vernacular, the 1st book of Ophthalmology printed in the USA. and the book discovering one of the 2 most important, easily portable, diagnostic instruments in all of medicine, The Ophthalmoscope. We will close the paper commenting on the role that Cyber Space has and will be playing in the future of books.

David Melanson and Stefano Cena: A Global Perspective on Ophthalmic History: The Narrative of Onchocerciasis

Onchocerciasis, commonly known as river blindness, is a major cause of preventable blindness and a defining challenge in global ophthalmology. The historical and scientific advancements in understanding and combating Onchocerca volvulus span from early observations to modern eradication efforts.
Clinical manifestations of Onchocerciasis were recognized in West Africa long before colonial medical documentation. Traditional healers observed the association between swollen nodules, intense itching, and visual impairment, highlighting the disease's impact on vision centuries before scientific identification. However, it was not until the late 19th century that European physicians, including Sir Patrick Manson and Rudolf Leuckart, identified the causative parasite and its transmission via Simulium blackflies. In 1917, Rodolfo Robles in Guatemala first established a direct link between the disease and visual impairment, coining the term “Robles disease.” Detailed ophthalmic studies in the mid-20th century revealed the pathophysiology of ocular involvement, particularly the migration of microfilariae into the cornea, anterior chamber, and retina, triggering inflammatory reactions such as punctate keratitis, sclerosing keratitis, and chorioretinitis. These findings provided crucial insights into the mechanisms of irreversible vision loss caused by the disease.
Efforts to address the ophthalmic burden of Onchocerciasis evolved significantly throughout the 20th century. Early interventions emphasized vector control, culminating in the establishment of the Onchocerciasis Control Programme (OCP) in 1974, which utilized aerial insecticide spraying in endemic regions of West Africa. The introduction of ivermectin in 1987 through the Mectizan Donation Program revolutionized treatment by not only reducing parasitic loads but also halting ocular complications such as keratitis and optic neuritis. Mass drug administration (MDA) campaigns, guided by studies on ocular pathology, led to the near-elimination of the disease in Latin America and substantial reductions in Africa under the African Programme for Onchocerciasis Control (APOC).
Despite remarkable progress, Onchocerciasis remains a public health challenge, particularly in conflict-affected regions and areas with low MDA coverage. Ongoing ophthalmic research into the disease’s impact on visual health continues to inform elimination strategies. The World Health Organization (WHO) sustains its efforts to eliminate Onchocerciasis through innovative vector control, targeted MDA, and studies to address residual blindness in endemic communities.
The historical trajectory of Onchocerciasis illustrates the intersection of ophthalmic disease, epidemiology, and global health policy. Efforts to control and eliminate the disease serve as a model for addressing other neglected tropical diseases, underscoring the critical role of interdisciplinary collaboration in the prevention of blindness worldwide.

Taylor Miller, Robert W. Enzenauer, and Craig A. McKeown: Dartmouth Eye Institute Led by Non-ophthalmologist Adelbert Ames, Jr.

Adelbert Ames, Jr. was born in Massachusetts on August 19, 1880, to Union Army General Adelbert Ames and Blanche Ames. Growing up in a military family fostered curiosity and adaptability that followed him throughout life. Despite struggling with exams, Ames enrolled at Harvard in 1899, graduating in 1903. Ames faced challenges with Harvard’s curriculum, but later attended Harvard School of Law, but was unfulfilled as an attorney. 
Influenced by his sister’s passion for painting, Ames quit law and pursued art with a scientific approach, believing paintings should resemble the physiology of the eye. His scientific approach led him to a physiological optics research fellowship at Clark University in 1914 with psychologist John Wallace Baird. Interrupted by Word War I, Ames enlisted in the Army as an aerial observer and pursued his interest in optical distortion, eventually becoming a commissioned officer responsible for leading the aerial photography reconnaissance schools. At the end of his service, he met Charles Proctor, a Dartmouth College professor of physics, who urged him to continue research at Dartmouth. 
Ames was attached to the Dartmouth faculty without agenda, and quickly published his first paper with Proctor and was placed on faculty in the Department of Research in Psychological Optics. His interest in binocular vision led to research on aniseikonia, a visual defect caused by retinal image asymmetry leading to an inability for the brain to form a single cohesive image. Ames studied the eyes of over 4,000 patients with aniseikonia, patenting 15 instruments for the diagnosis and treatment of aniseikonia. 
In 1936, Ames was appointed as Director of Research when the expanding research group became the Dartmouth Eye Institute (DEI). Ames was best known for the Ames Demonstrations, a series of optical illusions that were discussed in a manual published in 1955, most notably the Ames Room and Ames Door. These demonstrations notably influenced philosopher John Dewey, who thought they provided proof for his developing transactional theory. 
In his final years at the DEI, Ames shifted his focus to the intersection of psychology and scientific research that reflected Ames’ theoretical positions and sense of purpose. The DEI closed in 1947, and the Ames exhibits were relocated to Princeton. Ames passed in 1955, at 74. While Ames was not a physician, his intellectual curiosity led to significant contributions in physiological optics, ophthalmology, psychology, and philosophy that have carried influence beyond his life and the existence of the DEI.

George O'Hara and Alice “Wendy” T. Gasch:  The Slit Lamp Instrument: An Historical Overview

The invention and refinement of the slit lamp instrument is central to the modern practice of ophthalmology. This presentation is a concise narrative historical review of its invention and refinement over recent decades. We begin by discussing initial attempts to obtain an illuminated image of the eyes, followed by Allvar Gullstrand’s invention of the rudimentary slit lamp illuminator in 1911. We then discuss increments of improvement on this initial slit lamp model by Gullstrand’s contemporaries and successors in the early twentieth century. 

These advances include, among others, the combination of Gullstrand’s slit lamp with the binocular corneal microscope – which would support the then-budding practice of contact lens fitting – and the configuration of slit and microscope coaxial rotation about the object plane, which enabled retro-illumination of pathology and anatomical structures in the eye. Further, we describe the significance of these advances to the subsequent emergence of the Haag-Streit slit lamp in the 1950s, and of modern slit lamp fundus bio-microscopy in the 1980s. 

This historical overview attests to the innovation of the slit lamp instrument as a notable example of effective communication between practitioners of basic science and clinical medicine, from the physicists and physicians responsible for its invention and improvement to its continued application to present-day ophthalmology.

Mary Claire Schleck, Robert Enzenauer, and Grace Ambrose-Zaken:  Revisiting the Role of the White Cane for Congenitally Blind Children

This presentation aims to highlight the oversight in patient care that has consistently disadvantaged those with a congenital Mobility Visual Impairment or Blindness (MVI/B). MVI/B is a vision impairment that prevents visual anticipatory control, making walking inherently dangerous. In the 20th century, tools designed to reduce the danger of blind walking, such as the long cane (invented in 1945), were invented to assist newly blinded war veterans. The United States Army repurposed army surplus to create long canes for their blinded WWII veterans. 
In the 1950s, the reality of the Retinopathy of Prematurity (ROP) epidemic became unavoidable. Due to parents’ insistence that their blind children attend local public schools and an increase in academic publications on the subject, the significant developmental gap between sighted and blind children became apparent. In the 1960s, Orientation & Mobility (O&M) demonstration projects in high schools found that children with a congenital MVI/B were unable to travel independently and lacked the skills to learn how to use a long cane. Despite these findings, no new assistive safety devices were invented. The question becomes, why? If it is deemed unsafe for a blinded war hero to walk independently, does it not equally follow that it is unsafe for a blind child to do so? 
White Cane Safety Day, established in 1964, champions the long cane as a symbol of autonomy and empowerment for individuals with an MVI/B. Yet, the complexity of using a long white cane routinely causes it to fail more blind people than it helps. In response to this oversight, Dr. Ambrose-Zaken, the daughter of renowned WWII historian Stephen E. Ambrose, invented the Pediatric Belt Cane in 2014. The Pediatric Belt Cane is an assistive safety device for congenital MVI/B. Its lightweight rectangular frame attaches to a belt with magnets that is worn around the waist. Since Dr. Enzenauer attended Dr. Ambrose-Zaken’s motor research panel at Low Vision 2023, he has helped to bring this medically necessary tool to the awareness of fellow Pediatric Ophthalmologists and patients. In 2024, the American Academy of Pediatrics Uniformed Services Section recognized their work on improved gait outcomes in children with a cerebral/cortical visual impairment (CVI). 
In summary, this lecture will provide a historical review of the oversight in care for children with congenital MVI/B and address this gap by presenting the medical necessity of assistive safety devices for congenital MVI/B.

Isaias Torres and Robert W. Enzenauer:  Admiral Lewis H. Seaton, MD: An Ophthalmologist’s Journey to Surgeon General

Introduction:  The career of Vice Admiral Lewis H. Seaton, MD, represents a remarkable intersection of military service, ophthalmology, and medical leadership. As one of the few ophthalmologists to ascend to the rank of Surgeon General of the U.S. Navy, Seaton’s career was defined by clinical excellence, innovative medical leadership, and resilience in the face of adversity. His contributions spanned from nuclear submarine medicine to commanding Naval Medical Commands during pivotal moments in U.S. military history. This study highlights his career trajectory and the broader implications of ophthalmologists serving in high-level military leadership roles.

Methods: A comprehensive review of historical records, military service documentation, and ophthalmology training programs within the U.S. Navy was conducted to analyze Seaton’s career. His roles in submarine medicine, ophthalmic surgery, and executive medical leadership were examined to assess his impact on military medicine and ophthalmology. Special attention was given to his transition from clinical ophthalmology to administrative leadership following a cerebrovascular accident (CVA) that altered his surgical career.

Results: Seaton’s early career involved advanced medical training, including submarine and radiobiology programs, where he participated in nuclear weapons testing and served aboard the USS Seardragon and USS Enterprise. His transition to ophthalmology led him to leadership positions at the U.S. Naval Hospital in Jacksonville and later as Chairman of the Department of Ophthalmology at the National Naval Medical Center, Bethesda. After suffering a CVA in 1977, he adapted his career path and assumed command of the Naval Submarine Medical Center. In 1983, he was promoted to Vice Admiral and became the 29th Surgeon General of the Navy, overseeing military medical operations during the Beirut Marine Barracks bombing and the Grenada invasion. His tenure exemplified resilience, strategic leadership, and the broad impact an ophthalmologist can have in military medicine.

Conclusions: Vice Admiral Seaton’s career underscores the versatility of ophthalmologists in leadership beyond clinical practice. His ability to transition from surgical ophthalmology to high-level medical command demonstrates the adaptability and leadership potential inherent in the field. His legacy serves as an inspiration for future ophthalmologists considering careers in military medicine and executive healthcare leadership. Seaton’s journey reinforces the vital role of ophthalmologists not only in patient care but also in shaping military medical policies and global health initiatives.

Eric Wan, Arslon Humayun, Quinn Lysek, and Alice “Wendy” T. Gasch:  History of Space Exploration and Ophthalmology: Co-evolution of the Two Fields from the 1950’s to 2010’s

Introduction:  Colorado has a long history supporting space exploration, and the commercialization of spaceflight has reignited interest in space travel. It is important to recognize historically and clinically significant observations and events pertaining to the impact of spaceflight on human physiology in order to prepare humankind for longer space missions such as missions to Mars. From the 1950’s to the 2010’s (across American and Russian space programs), multiple stresses of spaceflight on the eye and visual system were recognized and studied. We describe the stressors and discuss how ophthalmology and spaceflight have shaped each other. We also discuss how ocular health was maintained in space. 

Methods:  To better understand significant observations and events pertaining to ocular health, we consulted primary sources (e.g., original manuscripts, recorded interviews, photographs). To contextualize our findings, we conducted a literature review and interviews with historians and subject matter experts at the National Aeronautics and Space Administration, the National Air and Space Museum, and the American Academy of Ophthalmology museum. We sought insights on: the challenges of spaceflight to the eyes; ophthalmic technologies revealing pathophysiology; and spaceflight technologies that shaped the field of ophthalmology.

Results:  From the outset of space exploration, multiple ocular challenges and phenomena were encountered. Environmental hazards (including UV radiation, dust, chemical burns, and trauma), photopsias, dry eyes, and retina changes were noted early in space exploration. Important for NASA’s top priorities for human health in space are neuro-ophthalmic changes observed during longer space shuttle missions and effects of radiation on the eye. During this time, an array of technologies were employed to investigate or address threats to ocular health in space: fundus camera, Krimsky testing, near point of convergence testing, eye patches, sunglasses, ultrasound, and tono-pens. Additionally, spaceflight has benefitted the field of ophthalmology, helping improve vision technologies including LASIK eye tracking and curvature, contact lenses, light-filtering lenses, and scratch-resistant lenses. 

Conclusions:  As humankind prepares for its next ‘giant leap’ in space exploration, it is important for us to consider the history of spaceflight and ophthalmology. Multiple risks and phenomena were identified in prior space programs, and several of these risks to ocular health persist today. Will we be able to adapt and protect vision during years-long interplanetary travel to Mars? Or will we be blinded by ambition during the journey?

Christine Xu:  A Change in Perspective: Stereopsis, Sightreading, and Cataract Surgery

Focusing on cases reported by Oliver Sacks in The Mind’s Eye, I will discuss two examples of the neuroplasticity of the human brain when faced with visual challenges. In addition, I will tie these concepts into my own experience of how learning cataract surgery has changed my perspective as a pianist. 

Lilian Kallir, born in Prague in 1931, was known as a child prodigy who made her debut as a pianist at the age of four, going on to become an expert in Mozart and Beethoven concertos. In her later career, she was about to perform one day when she suddenly discovered that she could not read the sheet music. Diagnosed with alexia without agraphia, she found herself unable to read words or music or recognize objects, although retained the ability to play music by ear and muscle memory. She subsequently demonstrated great resiliency in finding ways to compensate for her visual impairment. 

Although recovery of stereopsis was generally thought to be unlikely past the early critical period, multiple cases have occurred of adults who regained stereo vision later in life. Neuroscientist Susan Barry (b. 1954), also known as “Stereo Sue” as she was nicknamed by Oliver Sacks in his accounts, wrote about her surprise and excitement as she discovered 3D vision as an adult through vision therapy. Barry even contacted David Hubel (of the Hubel and Wiesel pair who performed foundational experiments on visual development, awarded the Nobel Prize in 1981), who expressed his fascination about her case.

Finally, I would like to relate these concepts of neuroplasticity to my experience as a classical pianist and surgeon-in-training. My musical style as a pianist was largely shaped by the lessons I took with a beloved mentor in childhood. To my surprise, as an adult I have recently begun to implement new motor and intellectual approaches to playing the piano, influenced by concepts I was learning in the ophthalmology OR. Starting residency I had hoped that my background in music would help in learning surgery; I was surprised to also discover an effect the other way around.

In summary, I hope that these cases will spark further discussion on neuroplasticity and the ability to change and adapt, relating to both our patients as well as ourselves.

Page last updated March 28, 2025