What You Need to Know about Four of History’s Greatest Ophthalmologists
Ancient physicians made a number of observations on the structure and function of the eye, as well as on the science of ophthalmology as it developed over time. After a number of ground-breaking discoveries and developments over the millennia of recorded history, the discipline of ophthalmology continues to flourish, making use of the most advanced technologies in diagnostics, treatment, and ongoing care. These advances all came about because of insights and hard work on the part of past practitioners.
Below is a brief summary of the contributions of four pioneers in the unfolding of the science of ophthalmology.
1. Sushruta, the First Known Cataract Surgeon
In ancient India, sometime from 1000 to 600 BCE, the surgeon Sushruta authored works detailing his knowledge of dozens of eye conditions and surgical procedures. Sushruta understood the disease we now know as cataracts, and historians often credit him with being the first known cataract surgeon.
He authored a major surgical text, Sushruta Samhita, which contained his detailed notes about surgical techniques and tools, and human anatomy. Included in the compendium is a step-by-step description of his cataract removal on a living person. According to a 2014 biographical article in Annals of Plastic Surgery, the multi-talented Sushruta was also the “father of plastic surgery” and an expert on nasal reconstruction as it existed in his time.
Sushruta also gained renown as a teacher of anatomy, the pathology of disease, and therapeutic medicine. He supported the ideas presented through his own first-hand knowledge of surgical techniques, breaking with the received wisdom of his time by advocating for objective experiment and observation.
2. Georg Joseph Beer Refines the Discipline of Ophthalmology
The discipline of ophthalmology became a well-defined area of practice and study due in part to the work of early 19th century Austrian physician Georg Joseph Beer. According to a 1988 paper by D. M. Albert and F. C. Blodi, published in the History of Ophthalmology series, Beer was a noted clinician, surgeon and teacher in the field. He established the first medical school and clinic dedicated to the treatment of eye disease.
Many medical historians consider the year 1812 a turning point in the acceptance of ophthalmology as a distinct and respectable discipline for physicians to pursue. It was the year in which a cohort of European medical students was required to attend lectures in the subject. Beer had already made his presence known in the field; in the 1780s, the self-taught ophthalmologist opened the first known privately-owned eye clinic, which offered its services free of charge to poor patients.
Beer invented a “flap method” procedure for sectioning the cornea to remove all or part of the lens as a treatment for cataracts. He created a special triangle-tipped instrument later known as “Beer’s cataract knife,” along with an accompanying needle. Beer’s treatment remained part of the ophthalmologist’s repertoire in to the 20th century.
3. Sir Harold Ridley Pioneers Intraocular Lens Implantation
British ophthalmologist Sir Harold Ridley performed implantation of the first intraocular lens in 1949. Some 30 years later, after decades in which Ridley’s contribution had not received the attention and respect it deserved, new improvements building on his original technique made widespread application possible. Thereafter, he was recognized for his major contribution to the field.
After Ridley’s death in 2001 at age 94, the Guardian newspaper noted his perseverance in overcoming the prejudices of the existing medical establishment and the post-war shortage of adequate surgical equipment to develop a treatment that would forever change the practice of eye surgery for the better.
During World War II, Ridley served as an officer in the Royal Army Medical Corps. A young pilot had a major influence on the trajectory of his work. The pilot had sustained severe damage to his eyes after a direct hit splintered the Perspex (similar to Plexiglas) cockpit canopy.
While treating the pilot, Ridley noted the inert Perspex particles did not induce an immune reaction in the eye tissue. Ridley was already contemplating how an artificial lens would function, and after observing the non-rejection of the plastic in the pilot’s eye, he had his answer.
After the war, Ridley worked to design an implantable lens, using a specially developed material named Transpex. Standard cataract treatment of the time involved removal of the entire eye lens, followed by minimal visual restoration through the use of thick lensed glasses. Ridley’s artificial lens opened new possibilities.
Late in life, the pilot Ridley had treated underwent removal of a cataract and implantation of an artificial lens in his working eye, giving him clear vision until his death in 1997.
Today, after further refinements of the original technique, Ridley’s work on the artificial lens has helped restore vision to about 200 million people worldwide.
4. Charles Kelman and the Development of Phacoemulsification
The New York Times 2004 obituary for American ophthalmologist Charles Kelman noted his pioneering work in developing a technique called phacoemulsification. The technique was used by surgeons in the removal of cataracts.
Kelman’s procedure debuted in 1967. It involved making a minute incision in the eye’s lens without removing it. Using a rapidly vibrating ultrasonic tip, a surgeon could emulsify the cataracts and extract them through the incision, while avoiding injury to the adjacent eye tissue. After Kelman’s innovation and the further development in the 1970s of Ridley’s wartime prototype for implanted lenses, a cataract patient no longer needed the thick eyeglasses previously prescribed after removal of their eyes’ own lenses.
Kelman’s innovation turned around the lengthy hospital stays and long recovery times previously typical for cataract removal operations. Because of phacoemulsification, the procedure is performed on an outpatient basis, a development hailed at the time by the American Academy of Ophthalmology as “revolutionary.”
