Editor’s Blog: How ‘strange’ is evolution in ophthalmology?

As part of Ophthalmology Times’ coverage of the American Society of Cataract and Refractive Surgery meeting, Editor-in-Chief Mark L. Dlugoss will post blogs with his observations of the meeting.

For live coverage of ASCRS, follow @OphthTimes on Twitter.

San Francisco-As a surgeon during World War II, Sir Harold Ridley treated many Royal Air Force pilots who had sustained eye injuries after their aircraft came under German attack. When the cockpit canopies were shattered under fire, the faces of the pilots were sprayed with splinters of acrylic plastic, which in some cases became lodged in the eyes.

In performing surgery to remove those fragments, Dr. Ridley observed that the acrylic plastic, of which the canopies were made, did not trigger rejection within the eye. After the war, he decided to research the information further and it led him to develop artificial lenses for cataract surgery.

In November 1949, Dr. Ridley implanted the first IOL. Since then, ophthalmology has seen an incredible evolution of IOLs-from IOLs in the posterior chamber to anterior chamber to iris-fixated IOLs and back to the anterior chamber. Over 60 years, eye surgeons have seen IOL designs made of polymethylmethacrylate (PMMA), silicone, hydrophobic acrylics, and hydrophilic acrylics.

Nick Mamalis, MD, director of the Ophthalmic Pathology Laboratory at the University of Utah, Salt Lake City, outlined the history, growth, and future of IOLs in his Binkhorst Lecture, presented during the Opening Session of the American Society of Cataract and Refractive Surgery meeting on Saturday. The title of his lecture was: “Intraocular Lens Evolution: What a Long, Strange Trip It Has Been.”

The lecture was a solid history lesson on a device that was almost banned by the U.S. government in the early 1950s as being “dangerous.” Dr. Namalis covered all the bases-past, present, and future of IOLs, including multifocal and accommodating lenses. The ultimate goal is to develop an IOL that will achieve perfect vision at near, distance, and intermediate for cataract and refractive patients. While ophthalmology has yet to achieve that goal, Dr. Mamalis concluded that the future of IOLs is bright and promising.

What was interesting about Dr. Mamalis’ lecture was the title: “What a Long, Strange Trip It Has Been.” The history of the IOL has experienced some incredible twists and turns, with a good share of successes and failures over the past 64 years. As an observer of the ophthalmology market, “the strange trip” could be considered a characteristic of the evolution.

“Strange” is sometimes part of the discovery process and has to occur in order for evolution to begin. When you look at the history of the IOL, how strange was it that Dr. Ridley, in the course of performing fast-paced surgery on the eyes of fighter pilots in a war situation, was able to observe that the tiny fragments he was removing from their eyes would actually be tolerated by the human body?

How “strange” was it that Charles Kelman, MD, in the course of developing phacoemulsification, was able to perfect a device that would prove to be modern-day cataract surgery? What may be strange is that Dr. Kelman introduced phacoemulsification in 1967 after being inspired by his dentist's ultrasonic probe.

Ophthalmology has a history of “strange,” and actually that may be good for the specialty. Of all the specialties of medicine, ophthalmology keeps seeing innovation evolve on a regular basis. The technology in this market is always evolving and it keeps getting better and more efficient.

Even the failures in ophthalmology are never really failures. If a technology fails in ophthalmology, the idea is basically placed on some “scientific shelf” somewhere, where it sits until another ophthalmic scientist comes around and decides “for some strange reason” that this technology has a place in this marketplace. He re-develops the technology, and now it’s called an innovation.

It makes one wonder whether that is “strange”-or just “evolution?”