Arnall Patz, MD, receives Presidential Medal of Freedom

Washington, DC-As a 31-year-old doctor fresh out of residency, Arnall Patz, MD, suggested a connection between high levels of oxygen and premature infants' blindness, and the medical community reacted with near hostility.

To the contrary, pediatricians and other physicians were devising ways to give these babies even more oxygen until Dr. Patz finally won approval to conduct a clinical trial that would investigate otherwise.

Those who know Dr. Patz, an ophthalmologist who went on to lead the American Academy of Ophthalmology (AAO) and the Wilmer Eye Institute at Johns Hopkins University, Baltimore, say he would be the last one, though, to show vindication toward his objectors. Friends and colleagues say the 84-year-old is a humble man who rarely lets on the enormity of his discovery, then identified as retrolental fibroplasia, and now known as retinopathy of prematurity (ROP). He also went on to develop one of the first argon lasers and was the first to write what he calls "a low-level paper" on his controlled study of its potential use with diabetic macular edema.

An unbelievable honor When the White House called to notify him of the award, Dr. Patz said he believed it might be a joke. He took the phone number and called it back the next day to confirm it was for real.

"I was astonished, totally overwhelmed, and highly honored," Dr. Patz said. "And I could name 50 other medical scientists who probably deserve it more than I do."

"This is a person who doesn't know how to brag about his accomplishments," said Peter J. McDonnell, MD, director of the Wilmer Eye Institute and the William Holland Wilmer Professor of ophthalmology at Johns Hopkins, where Dr. Patz maintains an office. "Frankly, so many of us feel [frustrated] that here's this remarkable scientific and medical achievement, and if you ask most people on the street about it today, they'd have no idea what you're talking about."

Oxygen a common factor It was just after World War II, and physicians had begun to administer oxygen to premature babies to boost their developing lungs and prevent cyanosis. What they could not explain, however, was why countless thousands of infants worldwide were becoming blind.

Dr. Patz said he and a pediatrician at Gallinger Municipal Hospital (now DC General Hospital) in Washington, DC, noticed that premature babies were routinely put in incubators with high, unmeasured amounts of oxygen for about 30 days. He toured several hospitals in the Baltimore and Washington, DC area, and found use of oxygen to be the only common factor. The more affluent hospitals often had a greater number of cases than those in which parents paid for oxygen by the bottle, an observation that was confirmed by an Australian doctor.

"Since oxygen was considered so innocuous, they didn't measure it, and theoretically, the higher the better," Dr. Patz recalled.

Dr. Patz sought funding for a controlled clinical trial in which alternate babies would receive the continuous high oxygen and the others would receive added oxygen for any clinical need and generally at much lower concentrations. However, the funding request was given a "horrible review," he said.