Here follows the story of three men in whose debt I live every day: a Philadelphia surgeon who would speak softly to patients as he incised their eyes; a London doctor who defied the good and the great of British ophthalmology; and a blinded fighter pilot who parachuted into the skies over southern England.
But for them, my world would now be fading from view.
The story starts on an August day in 1940. Gordon Neil Spencer Cleaver and his mates in the Royal Air Force were again beating back relentless air raids by the German Luftwaffe during the Battle of Britain. In a military career that earned him a Distinguished Flying Cross, Cleaver had already scored no fewer than seven kills of Luftwaffe aircraft and survived a forced landing. Also a world-class skier before he joined the RAF, he must have been one helluva guy.
Cleaver flew what would be his final mission in a Hurricane fighter plane from an RAF airbase at Tangmere, close by the English Channel. He encountered Messerschmitt fighters escorting German bombers. The enemy fire disabled his craft. He bailed out, and farmers found him in a field near Winchester.
The horrific, irremediable damage was done. Embedded in his eyes were acrylic splinters from the Hurricane’s shattered canopy. All sight in his right eye and much in his left was lost. During his scramble for the start of that mission, his second of the day, Cleaver had left his goggles behind.
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He came under the care of an eye doctor by the name of Harold Ridley. Although there was little Ridley could do for his patient, he noted that the blinding splinters were inert — they didn’t cause inflammation. (Ridley tended to other similarly injured pilots, but Cleaver’s case is the best documented in surviving medical records.) The observation could not have been lost on Ridley, who for years had entertained the idea of intraocular lenses for cataract patients. People who in those days had their natural lenses surgically removed, whether because of injury or aging, had to make do with thick vision-distorting spectacles.
Ridley went on to military service in Africa and Asia, but memories of those RAF pilots stayed with him. Not long after his return to London, he asked a British optical company to collaborate with him on a radical idea: an intraocular lens (IOL) fashioned of a plastic much like that in the canopy of Cleaver’s Hurricane. Ridley began testing the lens in 1949. The first patient was a middle-aged woman who met his requirements for an experimental subject: “one perfectly normal eye” and a willingness “to accept some unknown risk.”
Regulation of medical devices being nothing like it is today, Ridley hoped to discreetly complete a number of IOL implants for publication. Word got out, however, and rebukes from his peers soon followed. Did the man not understand that foreign objects were only to be removed from the eye? It must be said that Ridley’s early work, crude by the standards of decades later, progressed by trial and error. An early challenge was calculating IOL refractive power. Fixation within the eye remained problematic for years.
Ridley needed professional allies, and in 1952 he found one: Warren Reese of Philadelphia’s Wills Eye Hospital. The two men met when Ridley lectured about his IOL technique at a conference in Chicago. Reese, then aged 60, was an experienced eye surgeon. Among his other talents, he had a gift for applying “local vocal” anesthesia, that is, talking still-conscious patients through their experience on the operating table. He returned home from Chicago with lenses Ridley provided him and went to work along with a younger colleague, Turgut Hamdi.
By 1960, Reese was arguing in the British Journal of Ophthalmology that “the Ridley operation has not been given a ‘square deal,’ and it is hoped that the data here presented may cause it to be regarded favorably.” The data concerned 39 bilateral implants — a lens in each eye for 39 patients — which had been done at Wills Eye. Philadelphia had become what Ridley’s biographer, David Apple, would later call “the location where the IOL was first accepted, widely experimented upon, and given its prominence.”
Reese and Hamdi pioneered IOL implants without hindrance at Wills Eye. Elsewhere, though, skepticism endured, and not wholly without reason. Reese himself cautioned that success with the new operation required sound judgment and skillful hands. Ridley, who never sought a single pound sterling for his invention, saw certain lens designers enter the market with poor follow-on models — “better IUDs than IOLs,” as Apple, an ophthalmic-devices researcher, recalled the sarcastic joke.
And yet continuing, brilliant innovation eventually led to the day when IOLs would be regarded as a common passage in old age. A doctor trained at Wills Eye, Charles Kelman, invented the procedure that changed cataract surgery, once followed by days in the hospital, into an outpatient event. That was phacoemulsification: liquefying the lens, then sucking it out. Another big advance, named after its inventor, was the “Mazzocco taco,” a foldable lens that could be slipped through a small incision.
Cleaver, Ridley, Reese — I owe them, big time. Perhaps you do, too.
I knew nothing of this history when I was taken into an operating room several years ago and lightly sedated. The surgeon — as it happened, Wills-Eye-trained — made a small slit in one eyeball, then emulsified and aspirated the lens. It was a hold-your-breath moment for his patient. I “saw” a swirl of colors. A poet reporting this experience has spoken of “wondrous color … only rarely seen (in) dreams”; an artist, who sketched an image of his visual experience, has likened it to “a colorful monkey.” The surgeon then inserted the folded lens through the incision and, after the lens opened, secured its position.
That was the right eye. I’d guess the whole procedure was done inside 30 minutes. Eleven days later, the same miracle was performed on the left eye.
I say miracle because for most of my adult life I had not been able to see the big “E” on an eye chart without the aid of corrective lenses. As cataracts further dimmed my vision, I put off surgery until the moonless and rainy night when my wife remarked, “You’re driving a lot slower than usual.” It was past time.
After the initial operation, after the eye dilation had subsided, after the “star-bursting” around lights which can follow cataract surgery had died down, I marveled at the transformation. During a follow-up visit to the surgeon’s office, the letters on road signs vividly popped in the distance, even though I wore no glasses, no contacts. Other sights — the mottled bark of a tree, the license plate on a car, the flecked fieldstone of a farmhouse — also beckoned. Look, look!
I still need reading glasses. If I wanted the sharpest possible vision at a distance, I had to sacrifice some clarity up close. “No free lunch,” the surgeon said. I opted for 20/20 vision beyond arm’s length, understanding that it might eventually slip a bit. It has. Though for reasons only partly related to its lens, the right eye today is no better than 15/20. Even so, 15/20, unaided, in one eye, and still holding at 20/20 in the other? I’ll take it without complaint.
Warren Reese died in 1985. By then, he himself had long been blind in one eye, not owing to a cataract but rather an occlusion of a retinal blood vessel. In an appreciation of Reese’s career, the ophthalmologist-in-chief at Wills Eye remarked, “Dr. Reese was a dexterous surgeon, and above all had a serene equanimity. His calm voice was an effective tranquilizer, and many patients had their cataracts removed uneventfully with little more than a few drops of cocaine” applied to the eye as a local anesthetic “and soothing ‘vocal anesthesia.’”
Harold Ridley became Sir Harold but not until 2000, the year before his death. The belated knighthood recognized that the original Ridley lens led to the better IOLs which revolutionized the treatment of cataracts around the world. Late in life, Ridley himself underwent IOL implants in both eyes.
As for Flight Lieutenant Gordon Cleaver, the tale has been passed down that after his final dogfight he was visited in the hospital by a fellow pilot, one Jack Riddle. The blinded man’s first words of greeting: “Jack, tell them all to wear their goggles.” True story? All I know is it’s totally in character with the stoic best of that amazing generation. By the time of his death in 1995, Cleaver had undergone eighteen operations on his eyes and face, one of them a cataract operation making use of an IOL to improve sight in the one eye that still had any.
Cleaver, Ridley, Reese — I owe them, big time. Perhaps you do, too. Cataract operations using IOLs now number in the millions every year.
Richard Koenig is the author of the Kindle Single No Place to Go, an account of efforts to provide toilets during a cholera epidemic in Ghana.
One thought on “Why I can see: three men’s places in the history of cataract surgery”
I had cataract surgery last year by an eye surgeon trained at Wills. I used to wear coke bottle lenses without wich I was legally blind. The results of the surgery are nothing short of a miracle. 20)20 distance vision and only need *cheaters” for close up