21st Annual Meeting Abstracts - 2008
History of the International Intraocular Lens Club (IIIC)
David J. Apple, M.D.
Introduction or purpose: In this report I will discuss the efforts of the leading eye surgeons of the time, including Harold Ridley himself, in establishing this Club. During the period between Ridley’s invention of the Intraocular Lens (IOL) – 1949 to the early 1960’s there was extreme hostility to this invention. Several ophthalmologists, the majority in the U.K., realized that the best way to try to establish a liaison between the surgeons and the ophthalmic establishment would be to establish a “society or Club” and do presentations at various meetings.
Historical approach or resources: Resources that this author has utilized to prepare this report were obtained during a 23 year period between 1985 and 2008 as the author prepared a biography of Sir Harold Ridley (Slack, 2006).
Body of paper: To accomplish the goal of establishing a Club various meetings, including a 1951 meeting in Chicago, an international meeting in London, a 1966 international meeting in Munich extending to the 1974 meeting in Paris were attended. The leadership of these meetings, in particular the 1966 meeting, were very much against these surgeon’s attempts and these movements were thwarted. However, a decision was made by a small group of 12 ophthalmologists to “fight rather than join” the leaders and on July 14, 1966, rather than attending the Munich meeting, they remained in London and formed the Club, naming Harold Ridley the first president. In this report I will detail a few interesting occurrences that occurred up to and including the 1974 meeting in Paris, including “interesting testimony” by the great actor Robert Young, and a very interesting effort by one of our present members of the Cogan Society, Dr. Bob Drews.
Summary or conclusions: This Club was important in bringing “legitimacy” to this specialty of IOLs. Its membership has increased from the original 12 to over 300.
The Eye Injury That Changed Western Civilization
Darron Bacal, M.D.
Introduction: The Bayeaux Tapestry depicts the major events that occurred in the year 1066 in northern France and England. This year was important because there was a shift away from Scandanavian influence on the culture and society of England towards that of continental Europe. Was the final catalyst for this conversion an eye injury?
Historical approach or resources: This summer, I traveled to Bayeaux, France to personally examine the Bayeaux Tapestry. Texts that discuss the overt and covert messages found in the Tapestry, as well as other texts that review the events of this historical time period and the life of William the Conqueror will be referenced.
Body of paper: Upon the death of Edward, King of England in early 1066, there was some dispute as to who was the rightful successor. Harold Godwinson assumed the throne but Duke William of Normandy felt that he had been promised the position by Edward years before. William amassed a large army and fleet and sailed across the English Channel to conquer England and become king. A number of fortuitous events unfolded in succession which allowed William to defeat Harold. The final event which assured victory for the Normans occurred when King Harold was struck in the eye by an arrow during the battle and died. The ruling class of England became dominated by Normans. This produced a major shift in many aspects of English life for centuries to come.
The Bayeaux Tapestry is one of the greatest historical and artistic works in the world. It depicts almost all of the major events that transpired during 1066 on both sides of the Channel. The battle between King Harold's men and those of Duke William is vividly portrayed, as is the eye injury that felled the King.
However controversy exists between different historical sources as to whether or not King Harold actually sustained an eye injury. We will explore the various historical sources available to us and discuss their validity on this topic.
Summary: Prior to 1066, England was within the cultural sphere of Scandanavian countries because of frequent Viking raids. When Duke William of Normandy invaded England in 1066 and defeated King Harold, English society became more European. A series of unlikely events had to occur for King Harold to be defeated by Duke William. The last and most significant of these events was an eye injury to King Harold during the battle. As a resultof the Norman conquest of England, the course of English history and that of Western civilization was permanently altered
Ophthalmic History—New Techniques for Looking at the Past
George M. Bohigian M.D.
Introduction or purpose: The classic method of library research has been supplemented by the Internet. This paper explores current methods of researching our ophthalmic heritage.
Historical approach or resources:
Bernard Becker Archives & Rare Book Library, Washington University School of Medicine, St. Louis , Mo.
Library of Congress
Internet: Pub Med, Google, Wikipedia, ATT Global Network
Body of paper: Library research is still the accepted standard in obtaining solid information. Rare books, archival libraries, hospital librarians and personal communications were some of the only techniques for exploring the past. Although the Internet has changed this process dramatically, the ability to communicate with experts who are strangers is difficult and personal contact is necessary. A researcher must carefully consider the credibility of on-line material. How to use these resources effectively will be discussed.
Summary or conclusions: Since the founding of the Cogan Ophthalmic History Society, the methods of research on our ophthalmic heritage have changed. The Internet has profoundly enhanced our ability to obtain information. However, reading the original archives is still the bedrock of historical research.
Eugene Chan: Pioneer of Modern Ophthalmology & Visual Sciences in China
Chi-Chao Cha, M.D.
Introduction or purpose: Prof. Eugene Chan (1899-1986) is a pioneer of modern ophthalmology in China. This presentation describes his life and contribution to Chinese ophthalmology and ophthalmic history.
Historical approach or resources: Highlighted Eugene Chan’s publications related to his philosophy and of Chinese ophthalmic histories in glaucoma, cataracts, trachoma, and ocular trauma.
Body of paper: After completion of his higher education in the US, including a post-doctoral fellowship with Prof. William Holland Wilmer at the Johns Hopkins, Eugene Chan dreamed and determined to change the picture of blindness in China. He returned to China in 1934. He knew to make a difference in due course by teaching medical students and training residents and fellows in Ophthalmology. He taught in 5 medical schools and founded 4 local ophthalmologic societies. He emphasized on the work of mobile medical teams that travel deep into urban and rural areas to educate the masses on eye care and heal the sick. Together with his beloved wife, Prof. Winifred Mao, they received the energetic support from the Chinese government, and built the first, largest, and best Eye Center including an eye hospital, a research institute, and an office of prevention of blindness in China, in 1983.
Ophthalmic history, particularly the Chinese ophthalmic history, was a great passion of Eugene Chan. He learned ancient Chinese language, conducted research in eye disorders in ancient China and studied eye diseases suffered by prominent people (nobles, poets, historian, monks, etc.) in China. Examples of these articles are introduced.
Summary or conclusions: Profs. Eugene Chan and Winifred Mao left a dramatic positive imprint on Ophthalmology in China that has led the Chinese ophthalmologists and visual researchers to participate in and contribute to the world stage. Most common ocular diseases and disorders had been well recognized and documented in China during the Tang Dynasty (618-907 AD).
A View of the history of Ophthalmology in Saudi Arabia 1983-2008
Pamela S. Chavis, MD
Co-author: Khalid F. Tabbara M.D.
Introduction or purpose: A historical perspective on the evolution of ophthalmology in Saudi Arabia over the last 25 years.
Historical approach or resources: World Health Organization Survey, direct patient care by the physicians involved
Body of paper: A review of case material, i.e., pertinent diseases and training of ophthalmic physicians over a 25 year period with changes in disease entities and resources.
Summary or conclusions: With the aid of current technology and a country-wide survey of eye problems, resources were directed to resolve some diseases, identify others and establish indigenous physicians for follow through.
Kritzer, Kestenbaum, and Koller, Something about each
Ira Eliasoph, M.D.
Introduction or purpose: Three very different slants on eye care.
Historical approach or resources: Letters and personal recollections.
Body of paper: An iridology diagram with a letter to my uncle from the iridologist Oscar Kritzer. A personal story from a friend of Freud, Alfred Kestenbaum, and his mistaken cure. A letter tells how Koller practiced and his New York life.
Summary or conclusions: Documents and personal recollections shape our science and our lives.
The First Known Artificial Eye Unearthed at “The Burnt City” in Iran
Jay M. Enoch Ph.D., D.Sc.
Introduction or purpose: In far-eastern Iran, in a recently excavated grave (#6705) in “The Burnt City” cemetery, the oldest-known artificial eye was found within the left orbit of a very tall woman (ca. 5’10”- 6’00” tall). Her height was exceptional for that population and place. She had a rather Africanoid skull, and was 25-30 years old at the time of death. A quality, decorated brass hand mirror was also found within her grave. The remains were dated, 2900-2800 B.C. or almost 5000 years ago.
Historical approach or resources: Near the Iranian border with Afghanistan, not far from the city of Zabul/Zabol, and a modest distance north of the Iran-Pakistan border, lie ruins of a major early city/civilization called Shahr-i Sokhte (there are other trans-literations). The translation of this appellation, “The Burnt City” (ca 3200-2100 BC), will be used to describe this center, and the true name of this center is unknown. It became a major trade, manufacturing, and commercial center. Interestingly, this city didn’t have any defensive walls for protection! The city burned at least three times prior to being deserted by its people(s).
John Dalton: Though in Error, He Still Impacted Upon Our Understanding of Color Deficiencies
Gerald A. Fishman, M.D.
Introduction or purpose: John Dalton was a multi-talented scientific investigator with unalloyed curiosity. He made meaningful contributions in chemistry and meteorology, and in addition provided a detailed description of his own color vision defect. He is most remembered for his enunciation of the Atomic Theory.
Historical approach or resources: Review of numerous original articles and text.
Body of paper: The Quaker, John Dalton, was already in his twenties when he first suspected that his color perceptions were faulty. Consequently, he embarked on a vigorous analytical journey to explain the etiology of his impairment. While thorough, his analyses led him to an erroneous conclusion as to origin of his affliction. Nevertheless, his investigations ignited an interest in future scientists to pursue more in-depth studies on the topic of color deficiencies.
Summary or conclusions: John Dalton was an innovative thinker. His scientific interests ranged widely. While his crowning achievement was the enunciation of the chemical atomic theory, he was also responsible for the first full description of color deficiency (Daltonism) as well as major advances in the physics of gases, and various insights on meteorological phenomenon.
Martha, Sigmund and Karl: A Love Story
Ronald Fishman, M.D
Introduction or purpose: To retell from a different perspective the discovery by Karl Koller of the use of cocaine as an anesthetic in eye surgery.
Historical approach or resources:
The private letters of Sigmund Freud and Karl Koller
Display material from the Medical Museum of the Allgemeine Krankenhaus in Vienna.
Body of paper: When Freud one day introduced Koller to the cocaine and planned joint experiments with him, he then left on vacation to see his fiancé. Koller promptly by himself used cocaine to anesthetize the cornea and reported it at two medical meetings, gaining all the credit.
Summary or conclusions: Both Freud and Koller profited by this affair.
The Charles Coutela Medal – Paul Richer’s Last Medallic Artwork
Jay M. Galst, M.D.
Introduction or purpose: The Coutela medal appeared in an E-Bay auction sale in 2007. Because of the inscription “Ophtalmologiste Des Hopitaux” on the medal I wanted to find out more about Coutela the ophthalmologist and the reason that the medal was struck.
Historical approach or resources: Secondary sources including internet sources were used, as well as Coutela’s obituaries which were in French ophthalmology journals. This medal was not in the numismatic literature but the artist, Richer, was listed as a known medallist in Forrer. Much information was found in the book, “The Eye of the Artist” by fellow Cogan members, M. Marmor and J. Ravin.
Body of paper: A short biography of Coutela will be presented. His place in history as Clemencau’s friend who performed cataract surgery on Claude Monet will be discussed. Related through his wife’s family to the physician, artist Paul Richer, known for his book “Artistic Anatomy” which to this day is used by art students painting the human body. Richer’s last medallic art work was this Coutela medal, which was struck the year he died.
Summary or conclusions: A previously unknown medal of the ophthalmologist Charles Coutela was found listed in an internet auction. With the help of internet sources, details of his place in history was found. It is fascinating how Coutela relates to other aspects of our ophthalmic history which has previously been presented at a Cogan Society meeting.
Need Title and Author
Introduction or Purpose:
Historical approach or resources:
Body of paper: The artificial eye, a hemispherical construct, was made of “bitumen-like” material with a specific gravity suggesting it was made of natural tar mixed with animal fat. The artificial eye was slightly more than one inch in diameter, and may have been worn under her eyelid within her orbit. The eye structure had largely been thinly coated with gold. There are grooves visibly impressed upon it. There is a pupil or iris (a circular central decorative depressed ring). From this depression, lines radiate out (in?) at roughly 45o intervals “like rays of light”. Apparently, fine gold wires were located within each depression. Was there an iris as well as a pupil? Fine depressions suggest this possibility. There are also some less regular depressions. These may be the equivalent of capillaries. In the periphery, small white paint residua are observed which may be remains of a painted scleral zone.
The artificial eye had two smooth holes drilled through it near the lateral edges. Through these holes, supporting cords or chains were tied about her head to position the structure. Residua were found. Assume this “eye” was worn for some period of time, because evidence of wear (?) from these supports was impressed upon the orbital wall. Also, there was evidence of a prior sizeable orbital abscess.
Summary or conclusions: She was thought to have been a seer or priestess. She must have created quite an impression, i.e., she must have had ”a startling appearance”! We do not know how she lost vision in this eye, but it is doubtful that her eye was of normal size for so large a hemispherical object to be worn (if so) under her lid, unless the eye had been removed, or, possibly she had phthisis bulbi(?). For a first of kind found, this was a rather elegant artificial eye!
When Fathers’ Disagree; Enucleation of a Footnote
John W. Gittinger, Jr., M.D.
Introduction or purpose: In my presentation to the Society in 1999, “Radiation and Cataracts; Cause or Cure,” I mentioned in passing that William Herbert Rollins had an interchange over the safety of X-rays with an early radiologist. Rollins’correspondent, a self-described “Sciagrapher to the Children’s Hospital,” was none other than Ernest Amory Codman, now recognized as the “Father of Outcomes Measurement” and a hero of the outcomes movement that is reshaping medicine.
Historical approach or resources: E.A. Codman was remarkable in his openness and left an autobiography in the form of an introduction to his book, The Shoulder: Rupture of the Supraspinatus Tendon and Other Lesions in or about the Subacromial Bursa. He is also the subject of a recently published biography by E.J. Mallon, Ernest Amory Codman; The End Result of a Life in Medicine.
Body of paper: The disagreement between Rollins and Codman exemplifies the emergence of scientific medicine at the beginning of the 20th century. Both men were Harvard Medical School graduates who made important contributions not really appreciated in their lifetimes.
Summary or conclusions: As models of what physicians and surgeons should be, Rollins and Codman deserve our admiration and emulation. Their lives are lessons in service to humanity through medicine.
The Algernon B. Reese and Joseph A.C. Wadsworth Ophthalmic Pathology Collections – In Search of A Long Term Safe Haven
Gordon K. Klintworth, M.D.
Historical Approach or Resources: Personal experience, a collection of original material and the literature.
Body of Paper: Algernon Beverly Reese (1896 – 1981) was an internationally renowned ophthalmologist, who many regard as the father of ocular oncology as evidenced by his classic textbook “Tumors of the Eye”, which has survived into three editions. He published more than 200 articles and many book chapters. He pioneered the treatment of retinoblastoma and other serious ocular diseases in childhood. Particularly since his death many of Algernon Reese’s views on the retinopathy of prematurity have been severely criticized for containing falsehoods and for encouraging unethical eugenic behavior with regard to premature infants. Many of his patients were famous and they included Bob Hope, Babe Ruth, George Gershwin, Ernest Hemingway as well as the Duke and Dutchess of Windsor. He was born in North Carolina and graduated from Davison College in 1917. He obtained his MD from Harvard University in 1921. This was followed by a residency at Roosevelt Hospital and an Ophthalmology residency at New York Eye and Ear Clinic. In 1926 Reese started a private practice in New York and in 1928 he joined the faculty of Columbia University’s College of Physicians and Surgeons after learning the importance of Pathology under the tutelage of Frederick Verhoeff in Boston and Professor Ernest Fuchs in Vienna. He clearly appreciated the importance of Ophthalmic Pathology and was a founding member of the Pathology Study Club that is now known as the Verhoeff-Zimmernan Society. Reese collected glass slides and information about them and his collection was passed on to his nephew Joseph A.C. Wadsworth (the first chairman of the Ophthalmology Department at Duke University) who also developed a profound love for Ophthalmic Pathology. Like his uncle Wadsworth also collected material from his cases and from those distributed at the Verhoeff-Zimmerman Society when it was previously know under its former designations. After his retirement Wadsworth gave his Ophthalmic Pathology collection as the one previously owned by Reese to me for safe keeping. Currently a goal of mine is to find a safe haven for these collections where they will be protected and cherished for their historical value for scholars who would like to review the material. Another famous student of Dr. Algernon Reese who became a prominent Ophthalmic Pathologist was Frederick C. Blodi.
Summary: The discipline of Ophthalmic Pathology receives insufficient attention in most Departments of Pathology and Ophthalmology and important personal collections of prominent Ophthalmic Pathologists lack the space and financial resources that they deserve to maintain the resources.
Pars Planitis: History and evaluation of thinking about an ocular inflammation syndrome
David L. Knox, M.D.
Introduction or purpose: Tell a story.
Historical approach or resources: Personal experiences and reflections.
Body of paper: Description of thinking and people involved.
Summary or conclusions: How ideas require time for acceptance
Ophthalmological Examinations performed at Ellis Island, the Isola della Lacrime (the island of tears)
Donelson R. Manley, M.D.
Historical approach or resources:
1. A visit to Ellis Island
2. Book: Science at the Boarders by Amy L. Fairchild, 2003, Johns Hopkins University Press which describes Immigrant Medical examinations.
3. Book: Encyclopedia of Ellis Island by Barry Moreno, 2004, Greenwood Press, Westport, CT which describes eye diseases including trachoma and examination techniques.
4. Telephone conversation with Barry Moreno, Librarian at Ellis Island.
Introduction or Purpose: Twelve million foreigners were processed at this facility between 1892 and 1954. Federal law required that those who had loathsome or dangerous contagious diseases be denied entry. Some specific eye diseases were included. The type of eye examination and diseases will be discussed.
Body of Paper: Arriving boats were subject to inspections. The immigrants were given medical examinations by doctors known as medical officers and surgeons. They merely supplied medical facts enabling the immigrant inspectors to make informed decisions in landing, detaining or excluding an alien with health problems. Eighty percent of the immigrants passed both the immigration and medical examination and were admitted. Trachoma was a disease already present in the United States and much feared. It was designated a dangerous contagious disease by the Surgeon General in 1897. It was the most feared eye disease for the immigrant to be diagnosed with. All immigrants having red, watery or inflamed eyes were examined carefully. A specific eye examination technique was developed and followed and this will be described. Certain ethnic groups were found to have to have a higher incidence of this disease.
Summary or Conclusions: Some individuals were treated and kept in the hospital for up to 6 months and were then admitted. There are millions of unregistered aliens in the United States today and none had medical examinations prior to entry. We now see them in our offices and Emergency Departments. We are now seeing eye diseases from all over the world. The technique used for examining the eyes at Ellis Island would not be acceptable today.
Keratoconus: The Historical Evolution of its Management
Mark J. Mannis, M.D.
Co-author: Jay Bradley, Enrique Graue
Introduction or purpose: To review the historical development of the treatment modalities for keratoconus.
Historical approach or resources: Review of available surgical repots, review of papers, text books.
Body of paper: Discussion of surgical techniques ranging from paracentesis and optical iridectomy to modern lamellar keratoplasty, intercorneal rings, and collagen cross linking.
Summary or conclusions: the treatment of keratoconus throughout history has been based largely on attempts to normalize corneal optics by flattening the cone. Therapy has not typically been based upon understanding of pathophysiology.
Isaac Newton and the Phosphene
Harry H. Mark, MD, FACS
Introduction or purpose: Systematic research of the subjective visual phenomenon of the phosphene was first carried out by Isaac Newton in his youth. It led the way to significant insights into the visual system as well as to the nature of light.
Historical approach or resources: Review, utilizing primary and secondary printed and on-line sources.
Body of paper: Isaac Newton’s contributions to ophthalmology are little known, though he dissected the eye with his own hands. His groundbreaking investigations of the phosphene on his own eyes paved the way to his corpuscular theory of light. It stimulated Thomas Young to measure for the first time the axial length in vivo. It formed the basis for Johannes Mueller law of specific energies. Phosphenes were also employed for retinal functional tests prior to cataract surgery and for tonometric measurements.
Summary or conclusions: Isaac Newton’s original investigation of the phosphene resulted in significant advance of our knowledge of the visual system and the nature of light itself.
The Eye’s Mind: a poetic excursion into ocular evolution
Michael Marmor, M.D.
Introduction or purpose: To address, with some literary panache, the important issue of which came first: eye or brain.
Historical approach or resources: Writings about invertebrate eyes and the sequence of evolution. And a tip of the hat to Ivan Schwab and Alfredo Sadun who posed this issue.
Body of paper: An inquiry into whether eyes are an out-pouching of the brain…or perhaps vice versa.
Summary or conclusions: Eat your heart out, Neurology!
The evolution of Cataract Surgery in Children
Norman B Medow, M.D.
Introduction and Historical Approach: Much is known about the history of cataract surgery in adults but little history has been collated on pediatric cataract surgery. Using books and articles written primarily from the 18th to 20th century a clear idea has been gathered about cataract surgery in children.
Body of Paper: No mention of cataract surgery in children is found in the writings of Susruta, Galen, Bartish, Pare or Beer. The first discussion of Children's cataract surgery begins in the early to mid-19th century and coincides with the development of anesthesia--most probably the significant reason that pediatric cataract surgery had not been written about before. Much controversy existed along the way as to the timing of cataract surgery in children. Operate early, operate late or . . . do not operate at all. This paper will review these controversies and bring us to the present, when controversy has not been eliminated. When to operate, early or late , and what to do--implant or no implant.
The Blindness of George Du Maurier (1834-1896)
James G. Ravin, M.D.
Introduction or purpose: To describe the ocular problems of the late Victorian author and artist George Du Maurier.
Historical approach or resources: Review of the literature and examination of primary source material.
Body of paper: Du Maurier was very famous during his lifetime and wrote a novel, Trilby, that was probably the best selling work of fiction in the United States and in Britain at the end of the Nineteenth Century and is still in print. One character from this novel, Svengali, is known today for his ability to exert mind control over others. Du Maurier was also an illustrator for Punch magazine, where he specialized in social commentary. Du Maurier became blind in one eye as a young man and lived the rest of his life with the fear of losing the other
Summary or conclusions: A differential diagnosis for Du Maurier's problem will be given.
David M. Reifler, M.D.
Introduction or purpose: Research for a biography of ALBERT TICHO (1883-1960) revealed his role in the emergence of Jewish medical institutions of Palestine. Ticho’s early career will be reviewed including his work at the Lemaan Tsiyon Eye Hospital and in the War against Trachoma, his involvement with the nascent Hadassah Medical Organization, and the establishment of his Private Ophthalmic Hospital.
Historical approach or resources: Resources included family members, archived materials and published reports, and many historical writings.
Body of paper: Albert Ticho was born in Boskovice, Moravia on October 27, 1883. After graduating from the University of Vienna Medical School in 1908, he specialized in ophthalmology, serving as an assistant to OTTO BERGMEISTER (1845-1918) at the Rudolf Hospital. The 29-year-old Ticho became the first ophthalmologist to permanently settle in Jerusalem when he emigrated from Vienna in 1912. Here he assumed the directorship of the Lemaan Tsiyon Eye Hospital. The hospital had first opened in 1908, but its first director, MOSES ERLANGER (1880-1963), had left Jerusalem in 1910 and returned to his home in Lucerne, Switzerland. In early 1913, Ticho began training and supervising the first Hadassah nurses in Palestine, ROSE KAPLAN (1867-1917) and RACHEL LANDY (1884-1952). Together, they carried the treatment of trachoma into the schools of Jerusalem. In 1914 Ticho co-hosted and participated in the first medical conference of Jewish physicians in Palestine; he contributed to its proceedings that constituted the first modern medical book published in Hebrew. During World War I, Ticho served in the Austrian Army but he was allowed to keep the Lemaan Tsiyon Eye Hospital open until he was forced to leave Jerusalem for Damascus just days before the British conquest of the city. Ticho returned to Jerusalem following the end of the war. His friend, HARRY FRIEDENWALD (1864-1950), convinced Ticho to become Head of the Department of Ophthalmology at the Rothschild-Hadassah Hospital, succeeding the American, JOSEPH KRIMSKY (1883-1971). The hospital was then under the management of the American Zionist Medical Unit directed by ISAAC MAX RUBINOW (1875-1936). For the first 20 months in this position, Ticho was allowed to retain his private practice until this policy was generally abolished. Ticho taught ophthalmology in the Hadassah Nurses’ Training School and, representing the medical faculty, addressed its first graduating class in December 1921. In 1922, Ticho left Hadassah and his successor, ARYEH FEIGENBAUM (1885-1981), eventually founded academic ophthalmology in the State of Israel. In establishing a private hospital and clinic that he later moved into his spacious residence, Ticho became equally famous throughout the Middle East as an ophthalmologist, serving persons of all religions and social classes. Albert Ticho died in Jerusalem on October 15, 1960.
Summary or conclusions: While Albert Ticho’s name is well known throughout Israel, his wife, the artist ANNA TICHO (1894-1980), eventually achieved even greater fame and official recognition that overshadowed that of her husband. In 1984, the the couple’s residence became an extension of the Israel Museum where visitors can learn about the Tichos and the Jerusalem of a bygone era.
Phylogeny of the Cornea
Ivan R. Schwab, M.D.
Introduction or purpose: Understand the development of the cornea
Historical approach or resources: Review of comparative anatomy and embryology
Body of paper: The cornea began as a protective element, not a refractive one. Phylogenetically, the first cornea appears in the hagfish, a sister group to vertebrates, or more than likely in hagfish extinct predecessors. Hagfish have what is known as a primitive translucent cornea which is merely a continuation of the sclera forward to cover the lens. Hagfish have an epidermal covering known as a primary spectacle consisting of a continuation of the skin of the head. The primitive eye can move freely beneath the epidermis and is not fused with the skin.
In more derived fish, the epidermis and primitive cornea have fused to create a more definitive cornea. When this occurs, a sulcus appears permitting the globe to rotate in coordination with the now fused cornea. These are different tissues and the line between these two layers remains, creating a potential space.
The dermis, then, is the anterior 2/3 of the cornea, and the mesoderm and primitive cornea is much of the posterior 1/3 of the cornea, but neuroectoderm may play a role at least in the endothelium.
Once terrestrial animals evolved, lids formed. These first appeared in frogs, and matured in reptiles. Mucous membranes line the inner palpebral and bulbar surfaces creating true lids. Some lizards and snakes have developed fused lids, and these become a tertiary spectacle because these lids are lined with mucous membranes. Some lizards even have clear scales in their lower lids permitting a temporary tertiary spectacle.
There is an important epithelial step here. Hagfish have no corneal or conjunctival epithelium as such, but rather a stromal, primitive cornea. Fish have fused the primitive layer of corneal stroma and epidermis and essentially co-opted the epidermis into corneal epithelium. When lids appear, conjunctiva appears as a continuation of the epidermal skin, but it has now changed into mucous membrane, and changed again to create a slightly different arrangement of cells for clarity and organization to create corneal epithelium.
As tetrapods gained land in the late Devonian and early Carboniferous, smoother optics were required. That was accomplished in the early amphibians, and echoes of that process remain, even now. Tadpoles have secondary spectacles, much like the ancestors of the tetrapods—the lungfish. But, metamorphosis is the signal for much change, and the cornea is no exception. During metamorphosis, the two layers, the “primitive” cornea and the epidermis fuse, and the lids appear. The cornea steepens, and the optics became smoother. Crown species such as primates and birds developed Bowman’s layer, but the original potential space in the cornea remains, even now.
Summary or conclusions: Corneal development will have important implications for bioengineering of corneal tissues.
This is Dedicated to the One I Love: Trends and Highlights in the Dedications and Acknowledgements of Ophthalmic Texts
Pamela C. Sieving, M.D.
Introduction or purpose: Authors of books have traditionally been accorded the privilege of dedicating their work to individuals and groups. These dedications manifest the authors’ desire to express a professional debt, a tribute, an expression of gratitude, or the recognition of a relationship of some importance. This paper looks at dedications over the decades.
Historical approach or resources: Examination of physical texts in several ophthalmic libraries, and collections housed in general medical libraries.
Body of paper: Dedications by the authors of texts provide insight into their professional and personal relationships. This presentation traces patterns in these dedications over time. The broadest divisions are between ‘professional’ and ‘personal’ aspects of these dedications, and between tones of formality or informality, even intimacy. In some cases, authors use these few lines to speak in code, with references understood only by the dedicatee.
Summary or conclusions: Dedications in monographs rarely add content related to the scientific and clinical knowledge in the text, but provide insights into the lives of the authors, their contemporaries and predecessors.
Sociological Aspects of Subdiscipline Formation: Ocular Immunopathology
Arthur M. Silverstein, M.D.
Abstract: Several years ago I spoke on the intellectual/theory-based history of the rise of ocular immunopathology as a subdiscipline of ophthalmology, with respect to both basic science and clinical aspects. In this talk I hope to review some of the non-scientific aspects of this process: the importance of personal interests and obsessions; chance encounters and friendships; competitions for prestige and advancement; political agendas; governmental intercessions; and other similar factors that may affect the direction and progress of a field.
Resources: My own extensive library of reference materials in the field, and personal involvement over 40-odd years.
Conclusions: The historian of a biomedical science cannot neglect sociological influences in most historical review of a field.
Familial Exudative Vitreoretinopathy (FEVR) 1968-2008
William S. Tasman, M.D.
Introduction: To follow the course of the disease from its original description in 1968 to 2008 (40th anniversary) when a gene defect has been identified.
Historical approach: Personal involvement at the time of the original description of the disease by Charles Schepens and Criswick and participation in the identification of the frizzle 4 gene.
Body of paper: The paper will review the original description of FEVR in Swampscott Massachusetts at the first meeting of the Retina Society. Over the last 40 years many cases of FEVR have been followed and the description of the disease has been amplified. Of interest are some "cold cases" dating back to 1958 and how identification of the disease was subsequently made.
Conclusions: FEVR is a disease described during my professional lifetime and as such I have had a chance to follow many cases and see the changes in clinical findings and management.
Ida Mann and some of the obstacles she hurdled.
H. Stanley Thompson, M.D.
Introduction or purpose: This is a brief biosketch of a remarkable woman. Born in 1893 and introduced to ophthalmology at a moment when there were very few women in medicine, she quickly demonstrated that she was one of the brightest and hardest working ophthalmologists in the world, with an inexhaustible zest for life and learning.
Historical approach or resources:
1. The Chase. An Autobiography by Ida Mann (1986)
2. The Development of the Human Eye (1928)
3. The Science of Seeing (with Antoinette Pirie, 1946)
4. The Cockney and the Crocodile (by Caroline Gye, 1962)
5. China 13 (by Caroline Gye, 1964)
6. Culture, Race, Climate and Eye Disease (Ida Mann, 1966)
2008 Snyder Lecture
INSTRUMENT ANCESTRY : Genesis of the Ophthalmic Examination
Richard Keeler, M.D.
Introduction or purpose: The 2008 Snyder Lecture will explore the origin of a number of ophthalmic instruments used in every day practice. It will trace the inventor for each and where applicable how and why they were influenced.
Historical approach or resources: Before the 19thC there were no instruments for examining the eye. The Optometer followed by Trial lenses were the only instruments used before the discovery of the Ophthalmoscope in 1850 but thereafter there were a series of inventions throughout the second half of the 19th C including the Tonometer and Perimeter.
Historical resources: Histories, encyclopedias and antiquarian books on the history of ophthalmology were consulted along with an extensive library of leaflets, papers and pamphlets to ascertain the true genesis of instruments.
Body of paper: The lecture will be accompanied by many photographs of instruments and their inventors hitherto unseen. It will attempt to answer the question why certain instruments were made and why it took so long for some to emerge.
Summary or conclusions: The origin of many of today’s instruments will be found in the first fifty years after the appearance of the ophthalmoscope. Certain names such as Albrecht von Graefe will appear time and again emphasizing the great contribution they made to ophthalmology today.