30th Annual Meeting Abstracts 2017 - Boston, Massachusetts
Author: Daniel Albert
Title: Burton Chance: An Ophthalmic Historian and Witness to 19th and 20th Century Ophthalmology
Abstract: Burton Chance, the prolific historian of 19th century American ophthalmology, was born on January 30, 1868. The US senate was then preparing for its impeachment trial of President Andrew Johnson; Jesse James was robbing banks in Missouri; and the typewriter and spring tape measure were patented that year. The 19th century was when American ophthalmology took root and Burton Chance devoted much of his career to taking its measure and recording its history, as well as participating in its early development.
In 1964, when Dr. Chance was 96 years old and had withdrawn from most ophthalmic and social contacts, I was privileged to have lunch with him. During the ensuing couple of hours, Dr. Chance reminisced about his training at the University of Pennsylvania, being inspired by his teacher, William Fisher Norris, Penn’s first Professor of Ophthalmology, and his subsequent association with Norris in Penn’s eye dispensary. He spoke of his friendship with Squier Littell, one of the founders of the Wills Eye Hospital, his residency at Wills in 1895, and his rise to be a Chief Surgeon there 20 years later. He recalled the days when the same Wills’ surgeons did orthopedic surgery for the “lame” as well as eye surgery for the “blind”. Dr. Chance recounted contributing his “Short Studies…” (a predecessor of Charles Snyders “Our Ophthalmic Heritage”) to Herman Knapp’s “Archives of Ophthalmology” and serving as a Consulting Editor to Edward Jackson at the AJO. I was a resident at the time of our meeting and as part of the celebration of PennMed’s bicentennial, was working with Harold Scheie on a history of Philadelphia ophthalmology.
In the research for our book, we had utilized Chance’s books and articles and the archival collections which he had donated to the College of Physicians, the National Museum of Health and Medicine, and the American Ophthalmological Society. However, Burton Chance’s personal memories of people and events that he spoke of at our lunch, added an additional dimension to the dry facts and accounts we had collected. These reminiscences together with a summary of Dr. Chance’s character and career, form the basis for my presentation.
Author: Donald L. Blanchard
Title: Henry Gray’s (Retinal) Anatomy The First 50 Years (1858-1908)
Abstract: Henry Gray published the first edition of Anatomy, Descriptive and Surgical with a special section on the retina in 1858. The sole illustration was a whole mount of the retina, despite the extensive work Gray had done in the histology of the retina and the previous discovery of the ophthalmoscope. As the new editions appeared with different editors the layers of the retina were described in increasing detail, but the functions of the various cells remained basically mysteries. It was felt that the vesicular (ganglion) portion of the retina was the essential layer for receiving the stimulus of light and that tubules transmitted the sensation to the sensorium of the brain. How such sensations were formed or conducted were problems left to speculative philosophers to solve, and for nearly fifty years the editors remained content with just describing the structures. Without fine serial sections, adequate staining, and proper fixatives this was difficult however. A common belief was that the retina was all one single cell that had different sub-forms and sub-layers.
Ramon y Cajal’s work is cited in the early 1900’s with his silver stains and recognition of cell walls, synapses, Law of Dynamic Polarization, amacrine cells, and horizontal cells, as well as showing a vastly clearer network and connection of the cells and layers that was not improved on until the advent of the electron microscope
Author: Christopher F. Blodi
Title: Adolf Hitler’s Vitreous Hemorrhages…and Other Visual Disorders
Abstract: Introduction: While Hitler’s eye disorders have been discussed in two publications (Cogan, DG: Doc Ophthalmol. 89: 9-13, 1995 and Rohrbach, JM: Klin Monbl Augenheilkd. 228: 644-650, 2011) neitherfocused on Hitler’s vitreous hemorrhages. The presentation reviews Hitler’s eye diseases with special attention given to posterior segment pathology.
Methods: review of primary and secondary publications
Results: Adolf Hitler suffered from a myriad of eye disorders, some possibly psychogenic or neurotic. Ophthalmoscopic exams point to one, perhaps two, episodes of vitreous hemorrhage in Hitler’s right eye. The etiology of this condition is uncertain.
Conclusions: Adolf Hitler’s eye disorders, including vitreous hemorrhage, add additional insight into his overall health and psychological makeup. Rec’d 12/22/2016
Author: George Bohigian
Title: Francis I. Proctor MD: His Life and His Legacy
Abstract: Francis I Proctor (1864-1936) attended Harvard for both his baccalaureate and medical degrees. He took postgraduate training in ophthalmology in Germany and at the Massachusetts Eye and Ear Infirmary. He practiced in Boston from 1891 until he retired in 1927.
He and his wife Elizabeth then moved to Santa Fe, New Mexico where they became interested in the ocular problems of the Native Indians where blinding trachoma was widespread on the reservations. In 1927, Proctor was appointed an ophthalmic consultant to the Bureau of Indians Affairs. He became associated with Phillips Thygeson MD, and Proctor helped Thygeson establish a trachoma research laboratory at Fort Apache, Arizona. With Proctor's support, Thygeson and associates demonstrated that the cause of trachoma was an infectious organism thought to be a filterable agent, identical to the Halberstaedter-Prowazek bodies found in the epithelial cells of infected eyes. Thygeson and his associates performed much seminal research on trachoma. Proctor was actively involved in this research until his death, and in his will he dedicated part of his estate to support research on trachoma and other eye diseases.
In 1947, Elizabeth, in collaboration with Thygeson, founded the Francis I Proctor Foundation as a memorial to her husband, using the sum of $300,000. The foundation was established in San Francisco and is associated with the University of California. Thygeson served as the Director of the Proctor Foundation from 1957 to 1970. The Foundation's initial mission was to study trachoma and other infectious diseases of the eye, and has grown to encompass the prevention of blindness through research and teaching on infectious and inflammatory ocular disease and is internationally recognized for its contributions. His wife also established the Proctor Medal in 1949, the first Achievement Award of the ARVO.
Thus, the name of Proctor lives on as a legacy of his and his wife's commitment to the prevention and treatment of blindness.
Author: Chi-Chao Chan
Additional Authors: Xiaoguang Cao, Chunying Li
Title: Dr. Lien-Teh Wu and People’s Hospital, the First Western Hospital Built by Chinese Government
Abstract: The People’s Hospital of Peking University (formerly the Central Hospital) in China was founded on January 27, 1918. This hospital was the first comprehensive western medical hospital built on funds solely by the Chinese government and people. The first president and founder of the hospital was Dr. Wu Lien-Teh (Liande Wu, 1879-1960), a Chinese medical pioneer. Dr. Wu, born in Malaysia was the first Chinese who graduated from the University of Cambridge Medical School. In 1907, he was recruited as the Vice-Director of the Imperial Army Medical College in Tianjin, China. In the winter of 1910, Dr. Wu was sent to Harbin to manage an unknown disease, which killed 99.9% of its victims. This was the large pneumonic plague infected by Yersinia pestis through the tarbagan marmot that claimed 60,000 victims within 7 months. He requested imperial sanction to cremate plague victims; this was the turning point of the epidemic. Dr. Wu chaired the International Plague Conference in Shenyang in 1911 and published his work in Lancet (1913; 182:529-35). In 1915, the Chinese National Medical Association was formed and Wu served as President from 1916–1920. In 1915, he also initiated building a western hospital by Chinese government. With the support of Yuan Shikai (Empire of China, 1915-1916), the government provided land and part of the funds; Wu raised the rest. The groundbreaking, completion, and official opening of the Central Hospital were in June 1916, December 1917, and January 1918, respectively. The Ophthalmology Department was established in 1937 (Chief: Xuan Weiren, a Polish physician). The first Chinese Chief was Jiechen Wei (1939-1942). In 1946, Central Hospital was renamed as Zhong-He hospital; in 1950, Central People's Hospital; in 1956, Beijing People's Hospital; and in 2000, Peking University People's Hospital. In 1991, People's Hospital relocated, People’s Hospital Eye Center resides at its original location.
Author: Louise Collins, DVM, MSLIS
Title: The Lucien Howe Library of Ophthalmology Collection
Abstract: The Boston Eye Infirmary was founded in 1824 by John Jeffries and Edward Reynolds, who began seeing patients in two rented rooms in a building in Scollay Square. In 1827, it was incorporated as the Massachusetts Charitable Eye and Ear Infirmary. It would be over 50 years before anything remotely resembling a library was considered, and more than 100 years before the Howe Library opened its doors. Thanks to the foresight and generosity of Dr. and Mrs. Lucien Howe the library became the intellectual hub of the hospital, and continues to thrive in the 21st century.
Attendees will be invited into the Rare Book Room to view a selection of books and instruments from the Howe Library collection.
Author: Ira Eliasoph
Title: Alvin Allace Hubbell (1846-1911) our Predecessor in History
Abstract: The Cogan Ophthalmic History Society started out as the American Ophthalmic History Society. The majority of papers presented have been about American Ophthalmology and individuals who have been important to that unfolding tale. We must include in our archives some detail about our Historian Predecessor Doctor Alvin Allace Hubbell. He made contributions to our science and practice, and was the author of the first History of Ophthalmology in America. That small book is a cornucopia of information on individuals and publications and our organizations. He mentions Ben Franklin as a cofounder of a hospital; Henry Howard of Montreal, whose textbook included his treatment of David Thompson, the greatest explorer and map maker of Canada; Elisha North and his eye clinic in New London, Connecticut: Delafield and Rogers, founders of the New York Eye and Ear Infirmary; Silas Weir Mitchell, the father of American neurology, and his 1860 work on experimental cataracts: Elkanah Williams who showed Helmholtz’s ophthalmoscope at Moorfield’s in London and brought the instrument to America. He was a dedicated advocate of proper training and ultimately (with Derrick Vail) of certification in ophthalmology.
Charles Joe Snyder wrote, “Hubbell, the first among American Ophthalmologists to give serious attention to the history and development of the specialty in this country. Hubbell never regarded himself as a polished medical historian; he knew, and did not hesitate to state, the limitations of his efforts. Yet his work has been used again and again as source material by later historians. It would seem he did his work better than he realized.” Lucien Howe wrote, “---when one of our band falls in the ranks, and a colleague is asked to prepare even a short biographic sketch, the assignment is considered an honor, and is entered upon as a labor of love.”
Author: Ira Eliasoph
Title: Come and Gone [poster]
Abstract: Over a period of years teaching residents, I would refer to something and get back blank stares. They don’t know about Sushruta and Charaka, or the story of Tobit's blindness, or von Helmholtz and Graefe - but that goes way back. They certainly are shocked and surprised that eye surgeons such as Emil Gruening held the cataract knife in their mouth! There were many instruments and techniques that had great popularity for a while during my span of years in our specialty, and then faded away. Such names as Crowell Beard, Paul Honan, Ramon Castroviejo, Conrad Berens, Isadore Goldstein, Peter Halberg, and Emanuel Krimsky were tied to some of these things. We thank them all for their contributions, but progress and new knowledge showed us the errors, misconceptions and folly of some of it. It is useful sometimes to put aside the ophthalmoscope and use the 20/20 Retrospectoscope. I would appreciate any and all additions to what I have brought together.
Author: Robert M. Feibel
Title: Mortimer Frank, Johann Ludwig Choulant, and the History of Anatomical Illustration
Abstract: Mortimer Frank (1874-1919) was an ophthalmologist in Chicago, Illinois. He entered clinical practice in 1901 and became well known as a skillful specialist. He published about 15 articles about ophthalmology, but by 1905 had turned his research and writing to the history of medicine. He published a number of papers on the history of medicine and ophthalmology. He was the secretary of the Chicago Society of the History of Medicine and editor of their Bulletin from 1915 until his death.
His major contribution to the history of medicine relates to the history of anatomical illustration. The classic book on that subject had been published in 1852 in German by the physician and historian, Johann Ludwig Choulant (1791-1861). However, by Frank’s time this text was out-of-date due to more recent research and was out of print. Frank took on the tremendous project of translating Choulant’s German text into readable English (History And Bibliography Of Anatomic Illustration In Its Relation To Anatomic Science And The Graphic Arts). He improved Choulant’s text with the results of his own and other scholars’ research, greatly enlarging the text. Frank also supplemented the original book with an extensive biography of Choulant, essays on anatomists not considered in the original text, and an essay on the history of anatomical illustration prior to those authors discussed by Choulant. Unfortunately, after finishing his work but prior to its publication in 1920, Frank died suddenly of a stroke in 1919. His colleagues completed the publication of the text on his behalf. This book, now referred to as Choulant/Frank, has been reprinted several times, and is still useful as a reference in this field, though much of its research is now dated.
Author: Gerald Fishman
Second Author: Marlene Fishman
Title: The Life and Times of Jan Evangelista Purkinje: Scientist and Czech Patriot
Abstract: Jan Evangelista Purkinje’s (1787-1869) research interests encompassed a wide radius that has favorably impacted upon several fields of medicine and science including, anatomy and physiology, neurology, audiology, pharmacology, embryology, botany, otolaryngology, visual physiology, and ophthalmology. Several of his research findings that are relevant to visually related phenomena are generally known to visual practitioners such as his contribution to the development of the direct ophthalmoscope, his study of the differences in light sensitivity during dark-adaptation (Purkinje’s Shift), and description of both visual entoptic and catoptric images. However, beyond vision, Purkinje’s far-reaching scope of medical and scientific contributions reflected only part of the reasons why he became a national hero to the Czech Republic. The presentation will focus on those contributions not directly related to his visually related investigations but rather on his discoveries in the fields of anatomy, physiology and pharmacology. Further emphasis will be on Purkinje’s personal life and character, providing insight into his genius, unique individuality, and his devotion to the Czech Republic and its people.
Author: Ronald S. Fishman
Title: Koller's Introduction of Local Anesthesia and Its Aftermath
Abstract: Karl Koller recognized the potential for surgery of the locally numbing effect of cocaine, confirmed it in the laboratory, and then clearly demonstrated it to a group that immediately understood its value. It quickly spread from eye surgery to other surgical fields, inadvertently beginning an epidemic of cocaine addiction in medical personnel.
Author: C. Stephen Foster
Title: History of Uveitis Therapy
Abstract: Uveitis or ophthalmia or matters which today we recognize as characteristic of intraocular inflammation have been a part of the human condition since written history has been recorded. We cannot know what was done for this problem prior to written history has recorded matters such as this, but from the time of Imhotep (2640 BC) it is clear that physicians were beginning to specialize in diseases of the eye and that they were faced with inflammation. Indeed, 100 of the 237 recipes for medication in the Ebers papyrus (1500 BC) were for eye problems. Blood letting, blister therapy and purging emerged by the 1800’s, followed by pupil dilation with tincture of belladonna by 1830. Fever therapy was in fashion in the early 20th century. And with the synthesis of “Compound E” by Kendall at the Mayo Clinic in 1948 and its application to patients with rheumatoid arthritis by Hench by 1949, it was not long before steroids were also used to treat uveitis (by Gordon at Cornell in 1950).
Roda-Perez’s employment of immunomodulatory therapy in Madrid in 1951 languished in obscurity, buried in the Spanish general medicine literature, but Wong at NIH, using similar reasoning published his work on treating patients with uveitis with methotrexate in 1965. Additional experiences with this and with other immunomodulatory medications followed, in Europe and in the United States, typically with employment of drugs marketed for other inflammatory diseases, used “off label” by eye doctors who were trying to save the vision of patients with sight-threatening ocular inflammatory disease. Today, no uveitis expert or ocular immunologist settles for chronic corticosteroid therapy, but rather strives to “re-train” the immune system of any patient with such a problem such that steroid-free durable remission and often outright cure is achieved.
Author: Albert Franceschetti
Title: Charles-Michel Billard (1800-1832): An unknown great figure of the XIXth century
Abstract: A few years ago, thanks to the French Inter-library Exchange System, I received a series of the French journal Archives Générales de Médecine (General Archives of Medicine) dating back to the beginning of the XIXth century. I was sure to find in them some articles of ophthalmology. I was rewarded with two articles by Charles-Michel Billard (1800-1832), a doctor unknown to me from Napoleon’s time.
This prompted me to research his life. I found he had been a man of remarkable qualities. He was from Angers, a smaller French city, where he played an important role, particularly after refusing to pursue his career in Paris. An investigation in Angers provided all the details of his short life. He is considered by Neonatologists as the founder of their speciality thanks to his treatise on new-borns, a 650 pages book, which was translated in English in 1845 as A Treatise of Diseases of Infants. He translated Lawrence’s lessons of Ophthalmology into French, which caused them to appear in French before than in English. Their French edition is complemented by an original section by Billard on the anatomy of the eye.Due to his knowledge of languages, he corresponded with many of the Europeans luminaries of his time. He travelled a lot, visiting, among other places, my region of Savoie and Geneva. He unfortunately died of tuberculosis at the age of 32, which prevented him from becoming one of the great figures of modern medicine.
Author: Charles Fritch
Title: Stanley M. Truhlsen, MD: Life and Career
Abstract: Intro: Dr. Stanley M. Truhlsen, an ophthalmologist, professor, editor, and philanthropist was born on November 13, 1920 in Herman Nebraska. 1933 -1951 - Education and Training (Herman High School, University of Nebraska College of Medicine, Internship at Albany Hospital and Residency at Barnes Hospital)1946 -1948 - Military Service (United States Air Force - Medical Corps)1951- Diplomate (American Board of Ophthalmologist), Fellow AAO, Opened private practice in Omaha1951-1974 - Assistant and Associate Professor at University of Nebraska Medical Center (UNMC)1970 -1993 - Member, Board of Directors for Nebraska Blue Cross/Blue Shield1975 - President, Nebraska Academy of Ophthalmology1976-1979 - Editor of AAOO (now AAO)1983 - President of American Academy of Ophthalmology (AAO)1985-1987 - Honorary position of the King of Quivira (Ak-Sar-Ben XCI)1989-1990 - Interim Chairman for UNMC, Department of Ophthalmology1992-1998 - Emeritus Clinic Professor of Ophthalmology at UNMC, Chairman for AAO foundation. He retired from Private Practice in 19931995-1996 - President of AOS2001-2010 - Awarded Lucien Howe Medal, Chairman of Academy Archives Committee and Senior Ophthalmologists Committee (AAO)2009 - First recipient of the EnergEyes Award (AAO)2012 - Humanitarian Award2013 - Philanthropists of the Year, Grand Opening of The Stanley M. Truhlsen Eye Institute in Omaha NebraskaConclusion: Dr. Truhlsen has two sons and two daughters. He is married to Dorothy Johnson.
Author: Jay M. Galst
Title: Otto Wichterle, Father of the Soft Contact Lens
Abstract: A brief biography of the Czech chemist Otto Wichterle, 1913-1998, will be presented along with the events leading to the invention of the soft contact lens.For the centennial of Wichterle's birth in 2013, the Czech Republic issued commemorative coins, a postage stamp and medals in his memory. These items will be shown and discussed as part of this presentation.
Author: Alice (“Wendy”) Gasch
Title: Lash Lure and Paraphenylenediamine: Toxic Beauty Past & Present
Abstract: Purpose: to provide an overview of Lash Lure’s significant role in initiating federal regulatory control of cosmetics and to relay why Lash Lure’s deleterious ingredient, paraphenylenediamine (PPD), which prompted this control, remains a potentially lethal threat Methods: review of material on the internet and in printResults: Lash Lure was an eyelash and eyebrow dye popular in the United States in the early 1930’s. At that time, American women widely used make-up, but cosmetics were not regulated. An ingredient of Lash Lure, PPD, was found to cause severe allergic reactions and blindness, and facilitated at least one death. Lash Lure was not the only harmful cosmetic of its time, but it drew major attention – which proved to be important for passage of the Food, Drug and Cosmetic Act of 1938. This Act provided the first regulatory control over cosmetics. Despite the Act and amendments to it in 1960, which strengthened it, cosmetics and PPD remain a health threat -- and this threat is increasing with increasing cosmetic use. Conclusion: Beware of dying to be beautiful.
Author: Henry Guly
Title: Snow blindness during the Heroic Age of Antarctic exploration.
Abstract: Purpose: to describe the pathology, prevention and treatment of snow blindness on the expeditions of the Heroic Age of Antarctic exploration.Methods: a review of the literature (medical and non-medical) of the era.Results: The Heroic Age of Antarctic exploration is generally reckoned to have started in 1895 and to have ended with the death of Sir Ernest Shackleton in 1922. During this time there were at least 18 expeditions to the Antarctic. Snow blindness was one of the commonest medical problems. It occurred on all the expeditions and there are some very graphic descriptions of it.
However the descriptions do not always match the current view of photokeratoconjunctivitis and other conditions including cold injury of the cornea, solar retinopathy, cocaine toxicity, trauma and empty field myopia may have contributed to their eye symptoms. Similar symptoms also occurred as a result of cooking on smoky fires in an enclosed space. Some explorers complained of long term eye problems which they blamed on the polar environment. Dogs and horses also suffered from the condition.Prevention should be easy, but glasses were not always easy to wear. The mainstay of treatment was topical zinc sulphate and cocaine but other drugs used were silver nitrate, laudanum and adrenaline. Non drug treatments included compresses of tea leaves and “snow poultices”.
Author: David G. Harper
Title: The Discovery of Hypermetropia: Accommodation to a New Era
Abstract: Hypermetropia was unknown and ocular accommodation was imperfectly understood prior to the work of Donders and Helmholtz during the decade of the 1850s. Prior to that time, myopia and presbyopia were thought to be opposite refractive errors and a “Perfect Vision” category included everybody else without obvious ocular disease. Other than the very small percentage of strictly emmetropic individuals, people in this latter category were hypermetropic. There was no understanding that hypermetropia required several diopters of accommodative effort to see distant objects clearly and that additional accommodation was required for near vision. Asthenopia, consisting of blurred vision and headache occurring with prolonged close work, was frequently encountered in this population group.
Another term, hyperpresbyopia, designated young people who required convex lenses to see clearly both in the distance and at near. Working during the early 1850s, Helmholtz developed his theory of accommodation which he published in 1856. At a meeting in Heidelberg in 1859, Donders reported that presbyopia and hyperpresbyopia were entirely different conditions, noting that an eye could be very hyperpresbyopic without having any presbyopia and suggested that the term hyperpresbyopia be set aside. Helmholtz immediately proposed the term hyperopia. Donders then suggested that the term hypermetropia would be more in accordance with the nomenclature that he had already employed with the words ametropia and emmetropia. This collaboration of Donders and Helmholtz during the 1850s lead, for the first time ever, to a clear understanding of hypermetropia and its relationship to accommodation.
Author: Thomas R. Hedges
Second Author: Marisa Gobuty Tieger
Title: Josef Igersheimer, An Émigré Ophthalmologist’s Story
Abstract: Josef Igersheimer trained with von Hipple and Gonin. He had a successful career in Frankfurt until he was forced to leave Nazi Germany for Ankora in 1933. He is still revered in Turkey for revolutionizing ophthalmology there. However, there was jealousy among Turkish ophthalmologists and Dr. Igersheimer decided to come to the United States in 1939. Here he was welcomed, along with other exiled physicians, by the New England Medical Center and Tufts Medical School. He was supported by David Cogan with regard to his academic interest in neuro ophthalmology. However, he is relatively unknown, even though he was a great teacher and superb ophthalmic surgeon. His story is both inspiring and tragic.
Author: Richard Keeler
Title: "Pallor of Greatness": Portrait of William Bowman and his Friends
Abstract: The year 2016 was the 200th anniversary of the birth of the great physiologist and ophthalmologist, Sir William Bowman BART FRS.
As part of the celebration of this event, contact was made with his great, great, granddaughter owner of a famous portrait of him by GF Watts, the leading Victorian painter, to find out more about her illustrious forebear.
This paper will explore Bowman’s relationship with Watts and his friendship with many famous men and women of the day.
From his early childhood Bowman came into contact with some of the outstanding artists and medical men and women of the Victorian era. These included Sir Joseph Hodgson, Robert Bentley Todd, Frans Donders, Albrecht von Graefe, Florence Nightingale, Sir Francis Galton, Sir William Osler and Charles Darwin.
The visit to view the original portrait by Watts of Bowman when he was 49 years old, was further enhanced by being shown the famous oil painting by Walter William Ouless of him when he was 74, two years before he died.
Bowman was a close friend of Florence Nightingale for 20 years. Bowman’s relatives are also the proud owners of the original collection of letters that Florence Nightingale wrote to Bowman from Scutari during the Crimean War.
The talk will trace Bowman’s life , the people he was influenced by and those that he influenced, the names of Donders and von Graefe coming to mind especially.
Sir William Bowman, Frans Donders and Albrecht von Graefe were largely responsible for bringing ophthalmology into the modern era in the middle of the 19th Century. The story of their meeting during the Great Exhibition in 1851 will be told.
Author: Linda Lawrence
Title: The Definition of Blindness
“The definition of a word is fixed by usage. Blindness has been so widely used by people who had no exact knowledge of what they meant by it that it cannot be restricted to a sharply defined impairment to vision.”1.
What is the history of the legal definition of blindness? The recommendations from June 1934, for the definition of blindness were read before the Section of Ophthalmology at the Eighty-Fifth Annual Session of the AMA in Cleveland. This terminology will be reviewed, along with the subsequent implementations in the workplace, education, and for actual entry into schools for the blind.1. What is the historical backdrop of the need for a definition of blindness? From antiquity, blindness was depicted in art and literature. In the Old Testament, those who were blind, typically depicted with eyes destroyed, were treated with compassion, but could not participate in rituals. In early Christianity, the story of St Paul introduced ‘temporary blindness’. In the middle ages, the blind were treated with contempt, and portrayed as deceitful beggars or “false blind”. The blind were excluded from most societal functions and mocked in art and literature. In the Renaissance, there was little depiction in art as to the daily life of those with blindness. Today the definition of blindness continues includes the rising number of patients with neurological visual impairment where acuity and visual field no longer adequately describe the need for educational, vocational or economic access and benefits. Modern legislative attempts to mandate Braille be taught for all children that are “legally blind” is once again bringing up the discussion about “what is legally blind?” References: 1. Jackson E, Snell AC, Gradle HS. REPORT OF THE COMMITTEE ON DEFINITION OF BLINDNESS. JAMA. 1934;103(19):1445-1446. doi:10.1001/jama.1934.72750450006009a
Author: Jacqueline Leavitt
Title: Sarah Edith Ives
Abstract: Sarah Edith Ives Cogan, MD graduated from Women’s Medical College of Pennsylvania in 1898 and was one of the first women ophthalmologists at the Mass Eye and Ear Infirmary. She had several private practice offices throughout Massachusetts, setting up wherever her husband. The Reverend James J. Cogan, was rector in the Episcopalian church. She also worked at the Boston Dispensary and saw patients in the summers in Provincetown, MA. She was active in her community and church. Her two children included Mary Cogan Bromage and David Glendenning Cogan.
Author: Christopher Leffler
Second Author: Stephen G. Schwartz
Title: Adventures of Some Early American Eye Surgeons
Abstract: Several early American eye surgeons lived adventuresome lives. One eye surgeon served during the American Revolution, and reported an event which is said to have galvanized the American fighting spirit, and led to one of the first major victories of the Continental Army. Another eye surgeon during the Revolutionary period was accused of mass murder, was sentenced to death three times for various offenses, and was ultimately executed for a murder. Another eye surgeon was also a privateer, and was accused of piracy. A promising eye surgeon and anatomist was rumored to have had an affair, and was killed in a duel with the jealous husband.
Author: Charles Letocha
Title: The Royal Oculist - Carl Theodor in Bavaria
Abstract: Born into the Bavarian royal family, Duke Carl Theodor (1839-1909) was always studious, without much interest in military matters. Although he did serve in the Bavarian army twice, he was more interested in academic pursuits and received his undergraduate degree in Munich. After studying ophthalmology with Deutschland, von Arlt, and Horner, he established a practice in Menton, France. Three years later, he opened an eye clinic in his castle at Tegernsee, in Bavaria. He was particularly skilled in cataract surgery, performing 5000 operations during his career. He was assisted in surgery by his second wife, who was also of royal descent. The majority of his patients were poor and most of his work was gratis. In 1895, he founded the Augenklinik Herzog Carl Theodor in Munich; this remains a well-respected institution.
Author: Maurice H. Luntz
Title: Sir Benjamin Rycroft 1902 to 1967: His Contributions to Ophthalmic Plastic and Reconstructive Surgery
Abstract: A resume of Sir Benjamin's early medical career leading to the Ophthalmic Plastic Surgery unit he established at the Queen Victoria Hospital in East Grinstead in 1945. Here he and his team treated large numbers of injured and burnt World War 2 veterans. They adopted a critical approach to their surgery, using accepted techniques of that time, and achieved more sophisticated surgical procedures and better results.
Rycroft, fully aware of the importance of disseminating this knowledge travelled widely, and organised courses and internships at East Grinstead His unit taught many physicians from the British sphere of influence wishing to practice in Ophthalmic Plastic and Reconstructive Surgery . However he was not well known in the USA..
His major achievement was his role in organising a national campaign winning support from his colleagues and the medical establishment to press for a Corneal Graft Act of Parliament which was passed in 1952. The Act greatly facilitated the acquisition of corneas for Keratoplasty benefitting patients requiring surgery and surgeons performing the procedure. The increased flow of donor material and the successful application at East Grinstead of storing donor material at --79 degrees centigrade allowed Sir Benjamin to establish the first Eye Bank in the UK.at East Grinstead. This Eye Bank is still functioning today.
Sir Benjamin paved the way to transplantation of human parts when the Corneal Graft Act was broadened in 1961 to include all human parts.
He was planning for the Second International Corneo-Plastic Conference to be held in London in 1967 and had agreed to be President of the First South African Ophthalmological Symposium in Johannesburg in 1968 when his untimely demise in 1967 robbed him of these events.
Author: Mark J. Mannis
Title: New Trends in Medical Therapy for the Cornea: 2017, 1917, 2117
Abstract: Contemporary ophthalmology has witnessed novel therapies for a variety of significant corneal disorders. The advent scleral contact lenses, collagen crosslinking, amniotic membrane, autologous serum and neuro-stimulation for dry eye, novel forms of drug delivery and cell-based therapy are radically changing the way in which cornea and external disease is practiced in 2017. Yet, most of these innovations have intellectual roots in the thought and practice of a century ago, and they presage new developments of a century hence.
Author: Curtis Margo
Second Author: Lynn E. Harman
Title: Sir Charles Sherrington, His Law, and Great Debates in Neuroscience
Abstract: Background: There is an incongruity in the relatively unexciting and self-evident nature of Sherrington’s law of reciprocal innervation clinically and the influence it has had on research related to the structural and functional organization of the nervous system. This paper will explore the reasons for this discrepancy. Methods: Review of Sherrington’s original publication and relevant literature. Results: Sherrington’s law was based on an animal experiment published in 1894. The fact that opposing extraocular muscles must simultaneously and synchronously contract and relax for purposeful eye movement seems intuitive, but how exactly this reflex occurs at a cellular level took more than half a century to figure out. Critical questions revolved around how the central nervous system was “wired,” particularly how neurons communicate with one another. Sherrington’s law played important roles in 2 great neuroscience debates: the neuron doctrine versus the reticular theory of brain organization, and whether synaptic transmission was electrical or chemical in nature. Conclusions: In both great debates, the law of reciprocal innervation influenced the content of the discussions and anticipated their outcomes. Sherrington’s law is best explained in terms of a central nervous system where the neuron is the functional unit of organization, and where information is transferred between neurons chemically. Researchers forced to explain the phenomenon of reciprocal innervation eventually verified these assumptions.
Author: Harry Mark
Title: The Role of Eye Size in Ophthalmology
Abstract: Untill the invention of keratometry and ultra-sound biometry the globe's length was usually measured on cadaver specimen. Thomas Young in 1800 did the first in vivo measurement of his own, apparently exophthalmic, globe.The geometrical size (volume) of the eye is important in health and disease. The apparent size varies from the real measured one, for instance, it appears larger with upper lid retraction and exophthalmos, and smaller with ptosis and enophthalmos. The most practical measure of the globe's size, and hence available data, is by a-scan sonometry of axial length, though x-ray images render more complete information.Size varies a little with refraction due to emmetropization, though statistically myopes have larger eyes and hyperopes smaller than normal eyes. It explains why myopes tend to exophoria/tropia and hyperopes to esophoria/tropia.The cornea of larger eyes is usually flatter and thinner than in smaller ones, and the ocular volume larger, therefore tonometric data in the larger globes are lower.Visual acuity is usually better in larger eyes than smaller ones, either due to a larger optical image on the retina, or an increased number of retinal perceptive elements. Amblyopia is more likely to develop in smaller eyes. Larger globes are more susceptible to retinal stretching (Myopic crescent) and retinal detachments.
Author: Michael Marmor
Title: John Dalton’s Papers on Color Blindness
Abstract: Purpose: John Dalton’s insight and investigation into his own color-deficiency were described in a famous 1794 paper and discussed at the 2008 Cogan meeting by Gerald Fishman. Some of Dalton’s papers have become available on the web, and these give new awareness of how he approached this discovery.Methods: Surviving Dalton papers from the Manchester Literary and Philosophical Society were reviewed. Examples will illustrate aspects of his scientific approach and his life.Results: Dalton noted that a pink geranium looked blue to him in sunlight, but turned pink under candlelight…a change other people did not recognize. His preserved notebooks show how he recorded observations of colored threads, including pink yarn. Notes entitled “Mr. Dalton’s Ribbands” were probably made by one of his subjects, for he tested other men. His lecture notes show that he was well informed about vision, as he drew a beautiful sketch of the eye, and noted image inversion upon the retina. He wrote notes on a book by Hussey that documented how colors are formed through clear colored liquids. This may have encouraged his conclusion that his own vitreous was blue. Dalton did not accept Thomas Young’s idea of three retinal color receptors, and willed that his eyes to be opened after death to prove the point (he was wrong). This tissue is still on display in Manchester.Conclusions: The preserved papers from Dalton’s life add insight to how he thought and worked scientifically. Dalton never studied color after his 1794 paper, and his fame is derived from studies in chemistry that led to the first formulation of modern atomic theory.
Author: Norman B. Medow
Title: The Wild Wildes: Sir William, Lady Jane, and of course…OSCAR.
Abstract: During the Victorian Fin de Siècle era, there were many interesting and memorable families; but few were able to compete with the Wilde Family.
Sir William was the leading Ophthalmologist/Otolaryngologist of Ireland who founded the St. Marks Ophthalmic Hospital of Dublin. His wife Jane was a leading Poet and Nationalist who was also noted for defending her husband in an infidelity trial that, SHE INSTITUTED as being slanderous! The trial mesmerized all of Ireland and well beyond!
Then there was Oscar Wilde…the son that would not wish to be considered as an under achiever vis-a-vis his parents achievements. Oscar would test the mores of the Era, and bring them to a breaking point in his own trial that proved to be every bit as exciting as his Fathers trial was…and more!
This talk explores the values and virtues of the Victorian Era and of the Wild Wildes that lived in it!
Author: Gerald Meltzer
Title: The Halifax Explosion of 1917
Abstract: On the morning of December 6, 1917 the Belgian freighter Mont Blanc exploded in Halifax Harbor killing instantly 4% of the city’s population. This paper reviews events leading up to the explosion, the treatment of 592 patients who suffered eye injuries related to the explosion and lessons learned from this tragedy.
Explosive injuries are increasing in frequency during these turbulent times. These disasters can overwhelm a community’s medical resources such as happened in Halifax, Nova Scotia on the morning of December 6, 1917 when the Mont Blanc exploded releasing the equivalent energy of 2.9 kilotons of TNT, destroying all structures within a half mile radius, killing 1600, injuring 9000 and leaving 20,000 homeless in this community of 47,000. 12 ophthalmologists treated 592 people with eye injuries and performed 249 enucleations, 16 of which were bilateral. Even though enucleation was the generally recommended treatment for penetrating wounds of the eye, several eyes with presenting iris, ciliary body or vitreous were saved by excising the incarcerated tissue and repairing the wound without the patient developing sympathetic ophthalmia.
Medical management of disasters and mass casualties from bombings continue to present unique challenges for the medical community. These disasters can easily overwhelm the resources available. Analysis of past experiences such as the Halifax explosion of 1917 and the Texas City, Texas explosion of 1947 can help us prepare for tomorrow’s tragedies.
Author: Rolando Neri-Vela
Title: Manuel Uribe Troncoso and His Works
Abstract: Manuel Uribe Troncoso was a Mexican ophthalmologist who livedin Mexico and the United States. He was a founder of The Mexican Society of Ophthalmology in 1893 and Anales de Oftalmologia in 1898.During his life, he introduced the idea of the scholar hygiene, to improve the advantage in schools. In United States, he wrote some of his works, as Treatise of Gonioscopy, Internal Diseases of the Eye and Por Tierras Mejicanas. He is well known because of his studies about the mechanism of production of aqueous humor and the invention of the gonioscope.
Author: Steven Newman
Title: The American Board of Ophthalmology and Origins of Specialty Education
Abstract: Introduction: The first examination given by the American Board of Ophthalmic Examination (Memphis Tennessee, repeated April 1917 New York City) was 12/16. This 100th anniversary of the American Board of Ophthalmology, the forerunner of medical subspecialty boards provides an opportunity to review the historical events. Materials & Methods: Primary and secondary source material (including the recent Ophthalmology Supplement) have been utilized as well as a review of three books written by Kenneth Ludmerer (development of medical education). Results: The Board still emphasizes “protecting the public,” the development of the ABO had a far more complicated history. During the 19th century science truly entered medical practice and education. Ophthalmology was probably a better example of the changes during the 19th century (1851, Helmholtz’s ophthalmoscope; 1864 Donder’s approach to refractive error; von Graefe and others advances in surgical technique). Although the AMA (1847) jealously guarded the ability of medical school graduates to practice any form of medicine they chose the increasing scientific basis of ophthalmology in particular made specialization inevitable. Several individuals, most notably Edward Jackson, recognized the education gap proposing a graduate degree in ophthalmology. Alternative approaches to insure minimum bases for ophthalmic knowledge was explored the American Ophthalmological Society, AAOO, and the Section for Ophthalmology of the AMA. Conclusions: 1. Combined work resulted in a series of suggestions for instituting criteria for certification by a newly formed board with representatives for all three organizations. 2. Although the primary indication was to ensure adequate ophthalmic training, this clearly translated into better patient care. 3. Scope of practice issues certainly helped drive changes; particularly the rise of optometry and work by general practitioners and opticians. 4. Gradual development of additional medical specialty boards, attest to the importance of this issue, made more so by the push for maintenanceof certification.
Author: James Ravin
Title: Gelsemium: From Sir Arthur Conan Doyle's self-experiments to use as a toxin by the Russians
Abstract: Self-experimentation has a long history in medicine, and several Nobel Prizes have been awarded for this type of investigation. Poisoning has an even longer history.While a medical student, Arthur Conan Doyle experimented with a plant toxin, gelsemium, and published his results in the British Medical Journal. Later he became an ophthalmologist and still later knighted for his political activity. Recently the Russians have used gelsemium in targeted killing. At least that is the current consideration in a celebrated case which is expected to be decided this spring.
Author: David S. Sanders
Second Author: Sayoko E. Moroi
Title: The History and Development of Iris Prosthetics
Abstract: Introduction: Our purpose is to describe the history of iris prosthetics in relation to iris trauma reconstruction, iris prosthetics, and changing eye color.Methods: Review of publications, book chapters, and websites including ClinicalTrials.gov. This review excludes colored contact lenses.Results: The first recorded approach to address eye color was tattooing of a corneal scar by Galen in the 2nd century A.D. Such practice continues and has extended by some to tattoo the conjunctiva and sclera. In 1964, Dr. Peter Choyce implanted an anterior chamber iris prosthesis, and later developed anterior chamber intraocular lenses with opaque sections for iris defects or aniridia. In the early 1990s, the lens company Morcher (Stuttgart, Germany) developed a posterior chamber polymethylmethacrylate (PMMA) black iris-lens diaphragm. Ophtec (Groningen, The Netherlands) followed with several color options for the iris-lens diaphragm. Both companies have since developed iris prostheses utilizing capsular tension rings, which reduced the incision size for implantation. In 2007, a foldable silicone iris prosthesis (ArtificialIris; HumanOptics, Erlangen Germany) was introduced which decreased the incision size with implantation via endocapsular or suture fixation techniques. There are two U.S. clinical trials to determine the safety and effectiveness of different iris prosthetics for the indication of photophobia with iris defects. Neither prosthetic is currently approved by the FDA as an implant. A photo-responsive iris prosthesis with a reversible change in opacity is also currently being investigated. There are medical destination programs to implant artificial irises for the sole purpose to change iris color. Conclusions: A major limitation of current prosthetics relates to a fixed pupil size, which is a potential concern for management of age-related retinopathy. Developing an iris prosthetic that is less expensive, safe and compatible for an aging group of patients, who have early onset photophobia and iris defects, aligns with the Precision Medicine Initiative.
Author: Joseph W. Sassani
Title: Dr. Robert J. Morrison: Contact Lens Pioneer, Inventor, and Eye Doctor to Many Including the Rich and the Famous
Abstract: Robert J. Morrison, OD, is known to many people as the eye doctor to the rich and famous who cared for American and International celebrities including royalty in at least 17 European palaces. Perhaps, the most publicized photograph of Dr. Morrison is of him standing beside the Rolls Royce automobile that was given to him by a grateful patient, Queen Juliana of the Netherlands. Nevertheless, there is much more to Dr. Morrison’s celebrated career than high profile patients.
Dr. Morrison was not a distinguished student. Rather, he is said to have been more “devoted to tennis and girls than to books”. Later when asked if he had any regrets about his life prior to Optometry School, he said, “I would have studied more.”
After graduating from Optometry School and opening his practice in Harrisburg, PA, however, his career was characterized by an insatiable hunger to improve his knowledge base and by a drive to solve clinical problems. He was the first to report the possibility of using rigid contact lenses to halt the progression of myopia. He developed a process to provide low-cost refractive correction for those not able to afford traditional eyeglasses. He introduced “piggy-back” contact lens use. Perhaps, his greatest contribution to eye care was helping to make soft contact lenses practical and introducing them to the US. Unfortunately, his experience with soft contact lenses and with those who tried to manipulate him was, perhaps, his greatest professional challenge.
Dr. Morrison died, January 7, 2015. Fifteen years earlier, he received radiotherapy treatments for carcinoma of the tongue that left him unable to eat solid foods for the rest of his life. Nevertheless, Dr. Morrison maintained an upbeat positive attitude. Perhaps, we can all benefit from one of his guiding principles, “Never take a good idea to your grave”.
Author: Ivan R. Schwab
Title: Does My Dog See in Color? The Evolution of Color Vision. 2017 Snyder Lecture
Abstract: The millions of hues in our visual world bring us great joy and subtle detail, but it hasn’t always been this way. What brings us to this riot of color? Why do we have color vision at all?
More than three billion years ago, prokaryotes added rhodopsin as a proton pump to be used as an energy source. Eventually, both prokaryotes and eukaryotes would add a rhodopsin to emphasize certain wavelengths in the electromagnetic spectrum. Color vision would have to wait, though, as it would require at least two different rhodosins for the perception of color.
Color vision would not appear until approximately one billion years ago in the early Metazoa, and then, likely only to manage the bright glare, reflections and shimmerings of the early, shallow, aquatic environment that would have been minimally protected by a thin atmosphere or robust aquatic vegetation. The opsins that react to shorter wavelengths of the visible spectrum would be dazzled by the glare and the longer wavelengths would be selected to deal with the luminance and perhaps brightness. Once different opsins proved an advantage in contrast and discrimination for the early Metazoa, the race for color vision would be on, though not all lineages would find advantage in participation.
Arthropods and vertebrates, as the two principal phyla with confirmed color vision, would find advantages in color vision, and this would likely contribute to their phylogenetic success. And, yet, there may be a few outliers among the mollusks, and perhaps the annelids suggesting that some lineages are still toying with the leap to color vision.
Arthropods and vertebrates would use duplication and spontaneous mutation to discover the range of color vision in what is now called the visible electromagnetic spectrum. The choices of these opsins were, in some ways, random but limited and formed by environment and especially physics.
The twists and turns of the evolution of these nuggets of genetic choices is a long and winding story replete with losses and gains, near extinction with resuscitation, and some wondrous examples of the random cleverness of evolution over unfathomable lengths of time. As ophthalmologists, we think in terms of primate color vision which, while interesting in and of itself, is only a small and rather pedestrian side story to the overall course of color vision. The rest of the story is steeped in color vision co-option, neurological channels, multiples of visual pigments, perfection on the wing, and evolutionary oddities that do not seem to fit anywhere but that specific creature.
Color vision depends on different visual pigments, and there is likely an optimal number since each different neurologic input requires a separate channel for interpretation and integration. More than four opsins likely are not helpful, and the neurology and embryology to maintain them are expensive. Although more opsins may provide other information or may be summed, the rare species that have more than four opsins may be using them for other tasks or somehow separating the input much like our own eye uses melanopsin and cryptochromes for circadian rhythm.
The story of the evolution of color vision is so complicated, intertwined, and convoluted that it seems to parallel metazoan evolution itself—and perhaps it is a proxy for the understanding of the machinations of evolution.
Author: Catherine Arnott Smith
Second Author: Jennifer Arnott
Title: Metadata Facilitating Context: The Case of the Perkins School Archives
Abstract: The Perkins School for the Blind has invaluable primary source documents, such as correspondence of significant figures in the school’s history: Helen Keller, Anne Sullivan, Laura Bridgman and Samuel Gridley Howe. Also documented in these archives are the educational experiences of the more than 6,000 non-celebrity students Perkins has educated since 1832. As the Perkins Archives release more content digitally, it is helpful to provide researchers with aggregate information about the student population so that individual students’ experiences can be understood in wider context, and so that the social history of the visually impaired can be better understood. This data can anchor understanding of changes in student populations and offered programs, preparation for adult life, and provide context for attitudes towards those who are blind and visually impaired at different points in time. Perkins’ student registration files begin in 1832 and include important information on cause of blindness and student backgrounds as well as academic information and correspondence. In this paper, we report on a project to mine historic medical terminology in Perkins student files and other restricted access materials for improved context for digitized historical materials. This limited scope project focused on years of high interest to researchers since they include both Anne Sullivan and Helen Keller. First, information about students’ causes of blindness for the years between 1880 and 1900 was logged in an Access database. The data was then normalized and metadata was then developed to represent the etiology of blindness in a standardized way, using source vocabularies from the Unified Medical Language System (National Library of Medicine, Bethesda, MD) and contemporary historical references as necessary. The metadata scheme will allow Perkins Research Library and Archives staff to use consistent terminology and comparative statistics when sharing historical information both within the Perkins community and with outside researchers.
Author: William Tasman
Title: Fyodorov, his IOL, and the Berlin Wall
Abstract: In the developing era of intraocular lenses, a very significant contributor was Svyatoslav Fyodorov in Moscow, Soviet Republic. He became famous for his assembly line surgeries and he was also a vigorous athletic gentleman who liked to stay in shape. I met him at the 1990 International Ophthalmology Conference in Singapore, and did not know that he had lost a foot and an ankle in an early aviation accident. He had not been piloting the aircraft. Later in life while a passenger in his own helicopter he unfortunately died when it crashed. The thing that I will always remember about that Singapore meeting is that Fyodorov entered the room, I am told, walking on his hands. He was indeed a showman and gave one of the most beautifully illustrated talks, utilizing scenes of nature, that I have ever seen. The trip was also extremely memorable because we returned to the US by circumnavigating the globe instead of going back through Hawaii and the West Coast of the US. One of our first stops on the return leg of our trip was Berlin, Germany. We arrived as the Berlin Wall was starting to be torn down, and had a chance to participate in that historic event.
Author: Frans J. Van de Velde
Title: The Legacy of Dr. Charles L. Schepens at the Massachusetts Eye and Ear Infirmary
Abstract: A contextual review of historical materials from the Schepens and private artifact collections, including film segments, are given. Charles L. Schepens (born in Belgium in 1912, deceased in the United States in 2006) graduated as a medical doctor from the University of Ghent in 1936. Significantly, in Ghent he also worked in the research lab of Dr. C. Heymans, Nobel prize winner. He further trained in ophthalmology in London (I. Mann), in Utrecht (H. Weve), and in Brussels. During WWII he was a resistance leader in Southern France, an activity for which he ultimately received the Légion d’honneur. In London he started working on his first binocular indirect ophthalmoscope. This instrument was to improve dramatically the outcome of retinal detachment surgery by allowing a careful observation of the retinal periphery where tears are often difficult to detect. He became close to Marc Amsler and H. Arruga. In 1950, he established with the wholehearted support of Dr. E. Dunphy, then Henry Willard Williams Professor of Ophthalmology, the Retina Foundation, currently the Schepens Eye Research Institute. He was also the founding director of the Retina Service at MEEI in 1948, a first for ophthalmology. He trained over 300 ophthalmologists and published with them over 400 papers and books. The American Academy of Ophthalmology gave him the inaugural Laureate Award, its highest distinction. Dr. Schepens was a passionate, effective fund raiser, and attracted many bright people early on, some from as close as MIT (Marie Jakus), some from a continent away (C.H. Dohlman); both factors explaining the great success of the newly founded institute.
Page last updated: November 27, 2017