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Saving Sight: An eye surgeon’s look at life behind the mask and the heroes who changed the way we see

By William Tasman, M.D., Past President of the American Academy of Ophthalmology, Professor and Emeritus Chairman of Ophthalmology at Wills Eye Hospital and Jefferson Medical College

Irie Books, paperback, 232 pages.

Today’s ophthalmologists are more skilled at saving sight than ever before. Eye surgeons of the past, while extremely talented for their times, would be amazed to see our ability to remove cataracts in minutes, repair retinal detachments, close macular holes, and perform LASIK surgery. In fact, as one who started in medicine in the middle of the last century, I too am amazed. In the early 1950’s, there was no pill for high blood pressure and no good way to classify or treat diabetic retinopathy. Heparin and rhubarb were two medications used for diabetic retinopathy, and I am not sure the rhubarb even got out of the stomach. We certainly have come a long way. But, in an era when history is too often overlooked, how well do ophthalmologists remember the inventors who preceded them? The doctors whose work made preserving and restoring sight possible for millions around the world?

Saving Sight: An eye surgeon’s look at life behind the mask and the heroes who changed the way we see, is a newly released book by vitreoretinal surgeon and Tufts Medical School Assistant Professor Andrew Lam, M.D. The book chronicles the accomplishments of several 20th century giants of ophthalmology – men like Harold Ridley, Charles Kelman, Charles Schepens, Arnall Patz, Judah Folkman, and the innovators who developed refractive surgery. It also gives the general public an inside look at life as an eye surgeon, and it does all this in page-turning fashion.

Each chapter is dedicated to one hero and Lam uses personal vignettes, which are often dramatic or humorous, to demonstrate how each doctor’s invention is used to save sight today. For example, in the midst of telling the dramatic stories of Harold Ridley and Charles Kelman, the author recounts his own experience learning how to perform phacoemulsification. It’s not as easy as he expects. He has trouble seeing the capsule, it’s invisible! He wonders if he lacks stereovision, so he runs to the pediatric department to check, and he’s relieved to still see the monkeys jumping off the page. Eventually he gains confidence and skill, and shows how a successful cataract surgery changes one patient’s life in dramatic ways.

Such anecdotes are paired with dramatic re-tellings of our field’s greatest legends. Though ophthalmologists may know the outlines of these tales, there is much that will be new to them. For example, while many may know that Harold Ridley’s inspiration for the intraocular lens came from seeing inert plexiglass in a fighter pilot’s eyes, they may not know that he was subsequently ostracized and labeled a heretic, and that his adversarial relationship with one man, Sir Stewart DukeElder, derailed his career and drove him into depression. Ridley endured insults like: “Dr. Ridley, why don’t you GO HOME,” “This operation should never be done,” and “[the operation] offends the first principle of ophthalmic surgery.” Though he is considered a hero today, for most of his life many of Ridley’s peers considered him a failure.

And in the case of Charles Kelman, many ophthalmologists may know that his inspiration for phacoemulsification stemmed from his dentist’s tool, but are not as familiar with his many years of failed prototypes, nor his desperate desire to earn the admiration of his peers. After attempting the first phacoemulsification surgery ever, he wrote, “I looked at the eye. It was horrible. The cornea had deep white lines etched into it. The iris had been touched several times by the emulsifier and was ragged, chewed away…When I got up from the chair, I again looked at the clock. Four and a half hours, seventy-nine minutes of which were emulsification time.” The reader will find these discoveries did not come easily, and that these profiles contain far more heartbreak than victory, much more failure than success.

No other book to date has compiled the stories of ophthalmology’s champions as they are presented in this book. It is written for the general public, who will no doubt find it fascinating and enlightening. They will certainly come away with a far better understanding of the eye and what eye surgeons do to save sight.

Lam also uses episodic narratives of historical fiction to convey essential aspects of each biography. We, the readers, are there alongside Charles Schepens, feeling his terror on the day he is confronted by the Gestapo and accused of working for the Resistance by passing refugees into Spain. We are there, in the cockpit with Flight Lieutenant Gordon “Mouse” Cleaver as he battles Messerschmitts in the skies above Dover during the Battle of Britain; and with him still as his Hawker Hurricane gets shot down and his eyes are penetrated by plexiglass shards from his shattered canopy. We observe Louis Braille, who is also profiled, the moment he realizes that a French artillery captain’s secret battlefield code of dots and dashes could transform the lives of the blind. Though everyone knows Braille’s name, many are surprised to learn that he fought his entire life to promote his dot system, but failed miserably for decades and often despaired that anyone but himself would ever use it. At the age of forty-three, Louis Braille died completely unknown.

These are unforgettable tales of serendipity, defeat, and ultimately, triumph and the fulfillment of hope. It’s astonishing to comprehend the severe adversity these heroes overcame.

Lam’s style of writing is colloquial and accessible to the layperson. The prose is not overly technical, but nor does it skimp on medical detail. In his personal vignettes, Lam brings the reader into the operating room, and indeed, into the eye, in vivid and memorable fashion. Eye surgeons will not be turned off by his graphic descriptions of trauma and surgery. They will identify with his anxiety at the prospect of failing to extract a huge retina-embedded metal foreign body, his frustration when he cannot re-attach a retinal detachment in an eye with proliferative vitreoretinopathy, and his sense of fulfillment after accomplishing a difficult treatment in a baby with ROP.

In Saving Sight, Dr. Andrew Lam succeeds in conveying the remarkable stories of ophthalmology’s heroes in an engaging narrative that is accessible to the general reader. This book is an asset to ophthalmology. It will educate our patients and the public about the skills and limitations of eye surgeons. It is a tool that will enhance the education of residents and young ophthalmologists who wish to learn about the pioneers of the past. It is a resource that reminds us that our ability to save sight derives directly from the discoveries of our greatest heroes, and it ensures that their contributions will not be forgotten.