Birth of the Intraocular Lens Herve M Byron, Chandrappa S Reshmi, Henry Hirschman
INDEX
A
All-out Iris claw fixation 29
American experience 31
challenge 33
inert material 33
Iris fixation/support 33
lens replacement 33
stable fixation 33
epiphany 44
first implant malpractice case 51
first trip to Holland 41
intraocular lenses: the fight for what is right 47
American infra-ocular implant society 49
battle with FDA-Nader-Wolfe 49
change to capsular fixation 51
change to ECCE and phacoemulsification 50
endothelial study-viscoelastics 50
IOL symposium academy 1975 49
miami moratorium 48
IOL power calculation and the launch of the American intraocular implant society 54
beginning of AIOIS 56
drews era 61
first SAB meeting 57
government battle 59
groundwork 57
honors 61
Nidus for ESCRS 58
retirement 61
spring scientific symposium 60
IOL revolution: view from America 38
story of the intraocular lens 31
American innovators: perspectives 112
C William Simcoe 116
Dennis shepard 133
early US IOL history 133
J Elliott Blaydes 126
final comments 129
highlight of my career 129
how IOLs further changed my practice 129
my experience 126
my experience with intraocular lenses 126
Jack A Singer 137
James P Gills 119
IOL story 119
John J Alpar 130
Exegi monumentum 130
K Buol Heslin 122
Robert H Osher 134
Thomas R Mazzocco 112
early history and development of foldable implant lenses 112
Anesthesia in cataract surgery 165
Artificial lens 27
complications 28
discussion and clinical study 27
experience with 868
lenses 28
Artisan® aphakia lens 30
Artisan® lens 29
Artisan® myopia lens 30
B
Being wrong by being right too early 26
Binkhorst iris clip lens 22
Binkhorst vs Binkhorst 157
C
Canadian experience 141
Canadian innovators: perspectives 141
Geoffrey M Kwitko 143
Herbert N Fitterman 141
catching the phaco and IOL wave 145
Cap brooch 22
Casaamata 6
Cataract extraction 18
Cataract/IOL procedures 18
Charlie’s miracle operation 12
Choyce lens 21
Choyce’s series 28
Comitatus palat 5
Contributions to the IOL 111
Corneal dystrophy 28
D
Development of intraocular lenses 84
E
Earliest calculators and computers 63
Early IOL power studies 65
Elschnig pearls 14
Endothelial depletion syndrome 22
Enhanced edge 98
Evolution of the David J Apple laboratories for ophthalmic devices research 90
Evolution of the truncated optic edge 97
Extracapsular cataract operation 11
Eye lab 67
F
First dedicated IOL power A-scan (the invention of the applanation method) 64
First IOL power calculations 62
Fixation loops 28
Fluorescence angiography 15
Foreign body 11
Future of IOL pathology 98
Fyodorov “Sputnik” lens 23
H
Haptics 11
Harold’s care 10
Hirschberg’s history of ophthalmology 2
Hoffer Q formula 70
I
In perpetuum 4
Incisional extracapsular cataract extraction 13
Influence of surgical techniques and IOL design on PCO 96
Innovations 26
medallion lens 26
pupil fixation 26
Intact posterior capsule 13
Intraocular lenses—generations 83
Intraocular malignant tumors 17
IOL power calculation history 62
IOL saga through five decades and three continents 16
IOLs for presbyopia: A brush with the future 167
Iris Claw lens design 29
Iris Clip lens 22
Iris fixated medallion lens 26
Israeli connection 161
J
Johann virgilius casaamata 8
John the baptist syndrome 69
L
Lamellar scleral resection 17
Lens designs 12
Lens implantation 10, 24
Lens type: single loop, single claw 29
Liqueur ophthalmique 2
Lobster Claw 29
Luebeckische Anzeigen 2
M
Militiae Auratae 5
Muenchow 6
N
National costume 21
O
Ophthalmic library 6
Optical time bomb 25
Origin of the Binkhorst’s irido-capsular lens 25
Origin of the concept of intraocular lenses 1
P
Pathological studies on intraocular lenses 83
Pathology of posterior capsule opacification 95
Pear 29
Personal formula history 63
Personal ultrasound history 62
Phaco operation 12
Phacoemulsification and IOL design 77
Pintles 23
Pro tempore 4
Published studies from the David J Apple, center, early 1980s- present 93
R
Refractive keratotomy 15
Research on posterior capsule opacification 95
Ridley lens 20
Ringscotoma 26
S
Scleral plastic bands 17
Serendipitous discovery 29
Sinskey style lens 15
Slit lamp 21
Slotted medallion lens 26, 27
Sterilisation 23
Synechiae around the posterior loops 24
T
Tadini’s knife 6
Tadinis’ origin 6
Time bomb 25
Treatment of retinoblastoma 17
Tribulations 158
Tribute to the pioneer 159
triumph 159
U
Ultrasound velocities for axial length measurement 68
US food and drug administration and IOLs: when innovation won the day 73
Jerald Jacobs 75
Richard Kratz 73
W
Watching history unfold 152
unfolding the early history of “intraocular lens implant” in the United States of America 152
history was made 153
history was made again 153
lessons learned 155
surgical procedure 153
trials 152
visitors from near and far 154
Worst Iris Claw 29
Worst Iris Claw IOL, the Artisan® lens 29
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1Birth of the INTRAOCULAR LENS
2Birth of the INTRAOCULAR LENS
Editor Herve M. Byron M.D., F.A.C.S. Clinical Professor of Ophthalmology New York University Medical School New York USA Associate Editors Chandrappa S. Reshmi M.D., F.A.C.S., F.I.C.S. Assistant Clinical Professor of Ophthalmology University of Pittsburgh School of Medicine Pittsburgh USA Henry Hirschman MD (Ret.) Driftwood, Texas, USA
3
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Birth of the Intraocular Lens
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4CONTRIBUTORS  
EDITOR
Herve M. Byron, MD, of New York City, is Clinical Professor of Ophthalmology at New York University Medical School. Dr. Byron was in the first group of U.S. ophthalmologists to visit IOL pioneer Cornelius Binkhorst in 1967, after which he returned and began to perform IOL implantation. Dr. Byron spent much time and effort teaching other U.S. surgeons how to implant IOLs; these surgeons, many of whom themselves came to be widely known as IOL pioneers, helped spread the technology around the country and the world. Dr. Byron performed the first triple procedure (cornea transplant, cataract extraction, IOL implantation) ever recorded. Over the course of his career, he lectured and wrote extensively about implant surgery and its complications, for which he was awarded the Senior Merit Award for Teaching from the American Academy of Ophthalmology and the Hugh Minor Distinguished Service Award from the Contact Lens Association of Ophthalmologists, of which he was past president. He was a founding member of the American Society of Cataract and Refractive Surgery and is past president of the New York Intraocular Implant Society.
 
ASSOCIATE EDITORS
Chandrappa S. Reshmi, MD, Assistant Clinical Professor of Ophthalmology, University of Pittsburgh School of Medicine, completed his residency in ophthalmology at New York Medical College and fellowship in cornea at Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston. During his residency in 1968, he became the first resident-in-training in the world to implant the Copeland IOL, and assisted Herve Byron, MD, in performing the world's first “triple procedure”—a combined extracapsular cataract extraction, implantation of a Binkhorst two-loop IOL, and corneal transplant. He was also the first ophthalmologist to film a triple procedure (1976) for presentation to colleagues at meetings around the world. Other milestones in his career: organized IOL symposia in Pittsburgh (1976–1979); first to present the results of bilateral keratoplasty and Binkhorst IOL (1978); served on invited teaching faculty for Binkhorst IOL course, Terneuzen, Holland (1978); since 1982, organized IOL workshops at Sarojini Devi Eye Hospital, Hyderabad, India; founding member of ophthalmic film festival (1987) held at meetings of the All-India Ophthalmological Society and instituted C.S. Reshmi Gold Medal for the best film; and is the longest-serving (20 years) judge at the ESCRS-Alcon Video Festival for which he was recognized during the ESCRS congress held in Stockholm, Sweden, in 2007.
Henry Hirschman, MD, learned about IOLs in November 1967 from Miles Galin, MD, and Herve Byron, MD. The approach held such promise that he decided to become an “early adapter.” Instead of an early adapter, he became what he describes as an “early survivor,” facing with other like-minded colleagues an unexpected hostility directed toward the new technology. Dr. Hirschman was the first surgeon to combine phacoemulsification with IOL implantation and, in 1974, began the earliest series of American IOL courses. He sponsored a progression of Mayo Clinic residents for 6-month fellowships, and lectured and taught at other courses around the world. Dr. Hirschman is retired and lives in Driftwood, Texas.
 
CONTRIBUTORS
5John J. Alpar, MD, FACS, of Amarillo, Texas, was one of the early implanters who worked with different lens styles, indications, and the use of viscoelastics in lens implantation. He also chaired the ANSI and ISO standard committees on IOLs.
David J. Apple, MD, is a world-renowned expert in the field of ocular pathology, cataract surgery/intraocular lens implantation, and refractive surgery. He is Professor of Ophthalmology and Pathology and Director of the David J. Apple Laboratories for Ophthalmic Devices Research at the John A. Moran Eye Center, University of Utah, Salt Lake City. From 1981 to 1988, he was professor of ophthalmology and pathology at the University of Utah School of Medicine in Salt Lake City, where he cofounded and developed the Center for Intraocular Lens Research. This center, which has received international acclaim, was transferred to Charleston, SC, in 1988, and renamed the Center for Research on Ocular Therapeutics and Biodevices. As chairman of ophthalmology, Dr. Apple led a major renovation of the Storm Eye Institute of the Medical University of South Carolina. Upon completion of the renovation in 1998, and while undergoing cancer treatment, he resigned as chair and became director of research. In 2002. He returned to Salt Lake City. Dr. Apple is a recipient of the Innovator's (Kelman) Award (2005) and the Binkhorst Lecture and Medal (1988). He has presented more than 938 scientific lectures and 128 scientific posters, exhibits, and videos. He has authored 510 scientific publications, including 15 textbooks, 68 chapters in textbooks, and more than 366 journal articles. His classic textbook, Ocular Pathology, Clinical Applications and Self-Assessment, coauthored by Maurice Rabb, MD, was first published in 1974. The 5th edition appeared in January 1998. He has trained over 200 students, residents, and fellows over the past 20 years.
Eric J. Arnott, MD, of Hampshire, UK, is a countryman of Harold Ridley, the British ophthalmologist credited with implanting the first modern IOL (1949). An active lecturer and author, Dr. Arnott invented a number of lens designs, including the totally encircling-loop lens.
Gerd U. Auffarth, MD, of Heidelberg, Germany, is Professor and Vice-Chairman of the Department of Ophthalmology, University of Heidelberg; director of the International Vision Correction Research Centre (IVCRC); board member and secretary of the German Society for IOL Implantation and Refractive Surgery (DGII); honorary member of the Hungarian Society for IOL implantation; board member of the European Society for Cataract and Refractive Surgeons (ESCRS); and a member of the International Intraocular Implant Club (IIIC). His surgical videos have won over 30 awards throughout the world. He was the first surgeon worldwide to implant a toric, aspheric, multifocal IOL.
J. Elliott Blaydes, MD, of Bluefield, WV, and Naples, Fla., is Clinical Professor of Ophthalmology, West Virginia University, Morgantown. He was director of the Humana Center of Excellence in Ophthalmology from 1982 to 1992. In 1984, he successfully performed the second and third folded-IOL implants through a 3-mm phacoemulsification incision.
Michael Blumenthal, MD (dec), of Israel, at age 34 became the youngest director of an eye department in Israel, implanting his first IOLs in the 1970s. Prof. Blumenthal founded the Ein Tal Eye Center in Tel Aviv in 1984. Prior to his death in April 2007, he served as the Sydney A. Fox Chair in Ophthalmology at Tel Aviv University.
Robert C. Drews, MD, FACS, FRCOphth, of St. Louis, is past president of the International Intraocular Implant Club (IIIC), the American Society of Cataract and Refractive Surgery (ASCRS), and the International Ophthalmic Microsurgery Study Group (IOMSG). He has published studies of IOL defects in relation to complications and books on cataract/IOL microsurgery.6
Paul U. Fechner, MD, MS, DO, of Hannover, Germany, is past head of the Department of Ophthalmology of Robert Koch Hospital in Hannover-Gehrden. He has written more than 130 papers and a number of books, including a book on cataract/IOL surgery with John Alpar, MD. He was the first surgeon worldwide to implant a phakic Artisan lens (1986) and the first surgeon in the West to implant a phakic posterior chamber lens (1990).
Herbert N. Fitterman, MD, FRCS, of Vancouver, BC, is a member of ASCRS and the International Society of Cataract and Refractive Surgery. He and Marvin Kwitko, MD, were the first two ophthalmologists to implant IOLs in Canada. Past Chairman, Dept. of Ophthalmology, St. Paul's Hospital.
Miles Galin, MD, of New York City, was the chairman of the Department of Ophthalmology at New York Medical College in 1967, when he and three other ophthalmologists visited Dutch IOL pioneer Cornelius Binkhorst. After his return, his department was the first in the country to endorse and teach the use of IOLs at the time of cataract surgery. He has written and lectured extensively worldwide.
James P. Gills, MD, is founder and director of St. Luke's Cataract and Laser Institute, Tarpon Springs, Fla., the country's largest free-standing ambulatory surgery and eye care center. His innovations relate to improve IOL power accuracy, refinements of incision techniques, and use of piggyback IOLs. He pioneered the use of intraocular lidocaine for cataract surgery, which is widely used today.
Howard V. Gimbel, MD, MPH, of Calgary, Alberta, is the Founder, Medical Director, and Senior Surgeon at Gimbel Eye Centres, as well as professor and chairman of the Department of Ophthalmology at Loma Linda University School of Medicine, Loma Linda, Calif. He was the first surgeon in Canada to remove cataracts by phacoemulsification.
K. Buol Heslin, MD, of New York City, served as Associate Editor of the Journal of Cataract and Refractive Surgery from 1981 to 1992. A founding member of the New York Implant Society, he is best known for the development of phacoemulsification devices for Surgical Design Corp. and for IOLAB/Johnson & Johnson. The Heslin/Mackool Ocusystem, introduced in 1980, was the first device to combine phacoemulsification and full vitrectomy capability in a single instrument.
Don R. Hirschman, CRNA, MHA, ND, of Derby, Kan., is Director of Anesthesia for Associated Eye, of Wichita, Kans., and anesthetist at the Veterans Administration Medical Center in Wichita. He has given anesthesia for more than 20,000 cataract/IOL procedures and taught anesthesia for cataract surgery at numerous ophthalmology meetings.
Kenneth J. Hoffer, MD, FACS, of Santa Monica, Calif, is Clinical Professor of Ophthalmology at the University of California at Los Angeles, and Jules Stein Eye Institute. He was the founder and first president of the American Intra-Ocular Implant Society (AIOIS) (which later became ASCRS) and founding editor of the organization's peer-reviewed journal (Journal of Cataract and Refractive Surgery). He chaired the first six scientific meetings of the society. He performed the first ultrasound IOL power calculation and IOL combined with phacoemulsification in the United States and invented the Hoffer laser-ridge lens design, the Hoffer Q IOL power formula and developed the first computer software for IOL power calculation. He is a recipient of the Binkhorst Medal from the American Society of Cataract and Refractive Surgery.
Jerald Jacobs, JD, of Washington, DC, had a role in putting together the January 1980 presentation to the U.S. Food and Drug Administration (FDA), which convinced the FDA not to prohibit IOL studies until more data were developed.7
Norman Jaffe, MD, of Aventura, Fla., is voluntary Professor of Ophthalmology at Bascom Palmer Eye Institute, University of Miami School of Medicine. When the Miami area became a focus of national controversy during the early U.S. experience with IOLs, Dr. Jaffe's leadership helped carry the technology forward to widespread acceptance.
Charles D. Kelman, MD (dec), of New York and Florida, passed away on June 1, 2004. He was Clinical Professor of Ophthalmology, New York Medical College. Dr. Kelman is recognized throughout the world as the inventor of phacoemulsification and an innovator who made huge contributions to IOL design. He was awarded the National Medal of Technology by the president of the United States in 1992, was president of the American Society of Cataract and Refractive Surgery 1995–1997, voted the Most Influential Ophthalmologist of the Twentieth Century in 1999 and recipient of the Laureate Award from the American Academy of Ophthalmology, 2003. In 2004 Dr. Kelman was inducted into the National Inventors Hall of Fame and received the Albert Lasker Award for Clinical Medical Research.
Guy E. Knolle, Jr., MD, FACS, of Austin, Texas, past president of the American Society of Cataract and Refractive Surgery (1989–1991) and Honor Award recipient of the American Academy of Ophthalmology, studied phacoemulsification under Dr. Charles Kelman and intraocular lens implantation under Dr. Henry Hirschman in the early 1970s. He was a clinical instructor at the Baylor College of Medicine in Houston, Texas and developed many surgical instruments and his own intraocular lens. He first used multifocal intraocular lenses in 1989 in clinical research. Because of his later success with multifocal lens implants in his cataract patients, in 2003 he elected to have bilateral Array lenses implanted to correct his hyperopia and presbyopia.
Richard Kratz, MD, DSci, is retired and lives in Fullerton, California. He took the DOMS course under Harold Ridley in 1948 and Peter Choyce was his classmate. He began performing phacoemulsification in 1971 and, with Robert Sinskey, MD, established phacoemulsification courses in California in 1972. He developed the concept of iris-plane phaco, using a two-handed maneuver that made phacoemulsification easier and safer for surgeons to learn. He is a Clinical Professor of Ophthalmology at University of California, Irvine and formely Clinical Professor of Ophthalmology at University of Southern California.
Geoffrey M. Kwitko, MD, FACS, of Tampa, Fla., is Clinical Assistant Professor of Ophthalmology at the University of South Florida. His father, Marvin Kwitko, MD, now deceased, was president and founder of the Canadian Implant Society and one of the first two surgeons to implant IOLs in Canada.
Walter J. Levy, MD, FACS, FRCS, of Albuquerque, NM, was chief resident, Moorfields Eye Hospital in London, and worked to promote the understanding and use of IOLs in Africa and the southwestern United States.
Thomas R. Mazzocco, MD, of Healdsburg, California, founded Valley Eye Center in Van Nuys, California, invented the folding IOL, and cofounded STAAR Surgical. He was formerly a clinical professor of ophthalmology at the University of California at San Francisco.
Robert H. Osher, MD, is Professor of Ophthalmology at the University of Cincinnati and Medical Director Emeritus of the Cincinnati Eye Institute. He has designed many IOLs, instruments, and techniques used in cataract surgery. His surgical videos have won the Grand Prize at ASCRS and ESCRS and he serves as the founder and editor of the Video Journal of Cataract and Refractive Surgery. He is the recipient of the Maumenee Award, Sheets Award, Nordan Award, Rayner Award (England), Canon Award (Japan), Lim Award (China), Gold Award (Australia), Mooney Award (Ireland), Senior Honor Award from AAO, Kelman Award (Greece) and the Binkhorst Medal from the ASCRS.8
Dennis Shepard, MD, FACS, of Santa Maria, Calif., is Professor of Ophthalmology at Autonomous University, Baja, Calif. An early IOL advocate, Dr. Shepard implanted more than 15,000 IOLs since opening his practice in 1967. He authored the first U.S. IOL text, The Intraocular Lens Manual (492 pages). He developed 44 surgical instruments, introduced Betadine as an eye prep, and holds 11 medical device patents. He is a recipient of the Honors Award of the American Academy of Ophthalmology, the Gold Medal of Ophthalmology of India, and the first Honorary Member of the South African Society of Cataract and Refractive Surgery.
C. William Simcoe, MD, of Tulsa, Okla, served as Associate Professor of Ophthalmology, University of Oklahoma Health Sciences Center, Oklahoma City, and University of Oklahoma College of Medicine, Tulsa. He has also served on the boards of the American Society of Cataract and Refractive Surgery and its journal in addition to several other organizations and publications. He invented the compressible open C-loop posterior chamber IOL and more than 27 ophthalmic surgical instruments; his designs for a twin-barrel irrigation/aspiration cannula and other instruments are widely used throughout the world today.
Jack A. Singer, MD, President, Singer Eye Center of Randolph, Vermont, has contributed numerous techniques used in cataract/IOL surgery. His surgical videos have won several awards at ASCRS and in Germany, and he has performed live surgery demonstrations throughout the world. In 1996, Dr. Singer was instrumental in amending the U.S. Patent Law to prohibit the enforcement of medical method patents against physicians, thereby ensuring that new medical discoveries will be freely shared within the medical profession and widely available to the public.
Jan G.F. Worst, MD, of the Netherlands, was the second ophthalmologist in the Netherlands, after Cornelius Binkhorst, to implant an iris-supported IOL. He has written many ophthalmic subjects, and invented a number of IOL designs and ophthalmic instruments. He is a recipient of the Binkhorst Award and the Snellen Medal.
9PREFACE
In the fall of 2002, Dick Kratz called me and suggested that I edit a book describing the real history of intraocular implant surgery in this country. He had heard that I stopped seeing patients and probably thought that I was retired and bored. Little did Dick know that I had transitioned into an ophthalmic consultant for new and exciting companies. In this new life, I was busier than I had ever been in practice. He suggested that I contact the “IOL pioneers” and ask them to write their personal involvement in this magnificent contribution to useful vision after cataract surgery. I thought about his suggestion and realized that no such book had ever been written. So I called the first resident I ever trained in the early 1960s, Henry Hirschman, one of the early pioneers, and asked him if he wanted to work with me on this exciting project. Since Henry was really retired and bored, he jumped at the opportunity.
Most drivers of today's automobiles don't have any idea of what cars were like in the “old” days. At the first World's Fair in Flushing, New York, General Motors displayed a futuristic car with air conditioning, automatic transmission, and power steering and windows. Everyone thought it was a pipedream that would never materialize. Fast-forward to the modern automobile in which everything is power-driven and built-in: climate controls for comfort, phone and satellite systems for directions, AM/FM and satellite radio, tape and CD players for musical enjoyment—even television for viewing pleasure. The dashboards of these cars resemble the control panel of a jetliner. The manuals that come with these cars usually contain 30 or 40 pages of instructions. Some dealerships actually give new owners 3-hour lectures that teach them how to use all the equipment. And yet, new drivers assume that this was always the way cars were manufactured. They have no idea of what the first Model-T Ford was like or how engines were originally started with a hand crank or how they took a couple of minutes to attain their top speed of 10 to 15 miles per hour.
The past three decades have seen the most incredible improvements in the entire history of cataract surgery. These tumultuous advances started with the insertion of crudely made intraocular implants at the time of the extraction. Phacoemulsification revolutionized the actual removal of the cataract; extracapsular extraction through a smaller incision changed the postoperative management of the patient allowing for quicker return to normal functioning. A viscoelastic substance called Healon®, developed in Sweden, made its way across the Atlantic and was subsequently approved by our Food and Drug Administration. Healon added an immeasurable degree of safety to the operation, reducing the incidence of serious postoperative corneal complications resulting from the destruction of endothelial cells. The importance of these endothelial cells prompted the development of instruments to preoperatively measure the number of these vital cells. Ambulatory surgical centers began to spring up because they provided both the patient and the surgeon a more pleasant and efficient environment than hospital operating rooms. Newly designed posterior chamber implants burst onto the scene and quickly replaced the older-style anterior chamber implants. Ultrasonic measurements preoperatively provided data to select the precise 10desired implant power. The goal of the operation was no longer just creating useful vision but rather emmetropia. The next phase of miraculous technological improvements is well known to the newer generation of cataract surgeons, so that's where this historic story ends.
We dedicate this book to the newer generation of cataract surgeons so that they can appreciate those pioneers who fought long and hard to have implant surgery approved by the federal government and the academic world. In one of the chapters, I will describe the first malpractice case against an implant surgeon who was charged with deviating from accepted community standards by inserting an implant after the cataract had been removed. This was a landmark case that changed the definition of “community.”
For those of us who believed in implant surgery and fought the battle, our profound satisfaction comes from the fact that it is now malpractice not to insert an implant at the time of surgery. We created an operation that has improved the quality of life for more human beings than any other in the history of medicine and surgery.
Herve M. Byron
Chandrappa S. Reshmi
Terneuzen is not on the tour of capitals. I don't know of anything remarkable about it—except for Dr. C.D. Binkhorst.
Few people in the world know of the existence of this town of 55,000 on the Zuider Zee. It's a very ordinary place, really. Except that one of its citizens has changed the world! Dr. C.D. Binkhorst has made possible the realization of a centuries-old dream: the replacement of the natural lens of the eye.
In 1949, Sir Harold Ridley of London was the first to replace the crystalline lens. Ridley's lens was far too heavy and secondary problems such as glaucoma, uveitis, corneal dystrophy, and dislocation occurred with such frequency that it's use was never very popular.
Dr. Binkhorst designed a lens that worked. Kurt Morcher made the first lenses for Dr. Binkhorst and they were perfect! Flawless! So naturally the FDA regulated Herr Morcher out of the USA. They required Morcher to open his facility to FDA inspectors, which, Morcher, to protect his trade secrets, refused to do. So we had to use other manufactures and in a while the quality of the European and American manufacturers got to be quite good.
Dr. Jan Worst occupies a special place in this story and has a chapter in this book.
We described to our patients that “everyone who lives long enough will develop cataracts.” Postop (before Binkhorst), the story was not so easily handled. Yes, in the exam room, most of the patients could read small print, but driving, shopping, walking, or finding those glasses made it impossible to resume what anyone would consider the normal activities of daily life. One of Dr. Bjorn Boberg-Ans' early patients was a catcher in a trapeze act. There's a test for you!
By now, millions of people have had the benefit of Dr. Binkhorst's intellect and surgical skills. Cataract is no longer the beginning of a life of limitations, but rather new adventures. Almost a second life.
Thank you, Dr. Binkhorst.
Henry Hirschman
11ACKNOWLEDGEMENT
The editors would like to acknowledge the efforts of Keith Croes, whose invaluable assistance over several years helped make this book possible. This was truly a labor of love on his part, knowing what an important contribution this book would make to the appreciation of future implant surgeons for those pioneers who made this landmark surgery possible.
Herve M. Byron, MD