A clear view of cataract op history
‘Routine’ eye surgery once seen as reckless
IN BRITAIN, 300 000 cataract operations are performed annually. In South Africa the figure is rather less, about 45 000. Yet this procedure, today often taken for granted and regarded as “routine”, has a background of amazing discoveries and unbelievable contradictions.
Sir Harold Ridley, the surgeon whose name stands out as the hero in this research, invented the intra-ocular lens or IOL.
But it took many years before the immense value of his work was recognised by medical science.
Today, more than half the 20 million blind people in the world suffer from cataracts that are simply because of advancing age. But cataract, that is, the clouding of the lens which stops light from entering the eye, can also be because of trauma (injury), toxic chemicals, or certain diseases such as rubella or diabetes.
Attempts to treat people who had cataracts date back to thousands of years BC. Approaches in those days were gory and mostly unsuccessful. A sharp instrument was usually used to detach the opaque lens from the back of the eye. Patients suffered pain, inflammation, infection and even blindness as a result.
This primitive procedure, called “couching”, is still used in some developing countries.
Over the centuries ophthalmic science gradually developed, with anaesthetics and better instruments available. The opaque lens could now be removed or even broken up into more easily absorbed pieces. But the problem remained that after the operation patients had no lens at all in their eyes. So they had to be fitted with large, thick spectacles to allow limited vision.
It was only when the 1940s were reached that the all-important breakthrough took place.
During World War II, a young eye surgeon, Dr Harold Ridley, whose father was a Royal Navy ophthalmologist and whose mother was a close friend of Florence Nightingale, was working at St Luke’s Hospital in Guildford, south-west of London, trying to save the sight of pilots shot down in the Battle of Britain.
On August 15, 1940, Flight-Lieutenant Gordon Cleaver in his Hawker Hurricane was involved in an air-battle with the Luftwaffe over the south of England. Cleaver was a brilliant pilot, an air-ace with a string of victories against German Dorniers, Heinkels, and Ju 87s, as well as a number of Messerschmidt fighters and fighter-bombers to his name.
But this was not his lucky day. In his hurry to get airborne he had forgotten to wear his flight goggles. While he was returning to base to re-fuel, a bullet from an enemy fighter went through the side of his Hurricane’s canopy, shattering the Perspex window, small pieces of which entered his eyes.
The surgeon detailed to treat Cleaver was Dr Harold Ridley.
When Ridley finally removed the Perspex fragments from the pilot’s eyes, he noticed to his surprise that there was no inflammation. This moment has been called by some writers the “Eureka moment” because it changed the course of medical history.
Ridley started a train of thought. He reasoned that if the eye didn’t recognise the Perspex as a foreign body, with no immune response against it, then surely what you could take out you could put back in. It took years, but by the end of the war Ridley, with the help of optical equipment scientist John Pike, had developed the intraocular lens, a small disk made from Perspex.
On November 29, 1949, a nurse blind in one eye from cataract volunteered to be the first patient to have her cataract removed and replaced by a Perspex lens. Because Ridley was not entirely satisfied with the result, he did it again on February 8, 1950, this time successfully.
But, did the brilliant inventor of the IOL now receive the plaudits he deserved? On the contrary, his fellow ophthalmologists regarded his procedure as a reckless idea that was dangerous for the patient.
The surgeon’s job was to take things out of the body, not put them in, they argued. A leader among Ridley’s critics was Sir William Duke-Elder, the queen of England’s official eye surgeon, who convinced his colleagues that Ridley’s methods could endanger his patients. It was suggested that Ridley should be prosecuted.
British medical science regarded Ridley as no better than a heretic. Although Ridley by now had several successful operations under his belt, this attitude of his fellow professionals made him depressed.
Later, the US welcomed Ridley’s IOL invention. But it had taken a long time. Only in 1974, 25 years after the first IOL implant, doctors in the US and a few other countries began to realise the genius behind Ridley’s pioneering work. They had not been taught to regard Ridley as a crank.
Ridley had retired in 1971 but still attended medical conferences. At one such conference in San Francisco he was presented with a book containing 4 000 signatures from surgeons thanking him for his invention.
Britain, always slow to appreciate new technology, began to accept Ridley at last. He was made a Fellow of the Royal Society in 1986 and was knighted by the queen in 2000.
The ironic end to the Ridley story is that towards the end of his life, Sir Harold Ridley himself underwent cataract surgery on both of his eyes. He joked that he was the only man who had invented his own operation.
And, yes, more irony: Squadron Leader Gordon Cleaver, DFC, thanks to Ridley’s early efforts, had recovered some sight in one eye. But later in his life, in 1980, Cleaver also had to have cataract surgery in this eye, using an IOL made from material very similar to the Perspex piece that a German bullet had thrown into his eye.
That he successfully regained his sight was because of Ridley’s “eureka moment” observation of his eyes during the stresses of the Battle of Britain 40 years earlier.