Eyeworld

74 | EYEWORLD | AUGUST 2019 O UTSIDE THE OR and hydrodissection, capsular staining, pupillary expansion devices, foldable IOLs, methods for astigmatism correction, and changes to anes- thesia. "Visionary pioneers set the stage," Dr. Newman said, "but subtle changes in practice reduced incidence of complications and allowed the procedure to become routine." Did Leonardo da Vinci have strabismus? Michael Marmor, MD, Palo Alto, California, addressed this question in light of a paper published by Christopher Tyler, PhD, in JAMA Ophthalmology in early 2019, which suggested that the Italian Renaissance man had strabis- mus, based on portraits and analysis of pupil alignment and other features. Dr. Marmor, who ultimately does not think there is evidence to support that da Vinci had strabismus, addressed many of Dr. Tyler's points. First, Dr. Marmor said, there are no known official portraits of da Vinci; one that is most likely of him is a profile (thus not showing both eyes) by Francesco Melzi. The works in Dr. Tyler's paper, Dr. Mar- mor said, are only thought to represent da Vinci (they're hypothetical). Some argue that da Vinci might have represented himself in some of his own works, but Dr. Marmor noted that one has to critically look at the images thought to be da Vinci and ask if it's even the same face (to Dr. Marmor, it's clear that it's not). Do the eyes in the pieces used by Dr. Tyler to make his argument even diverge? At first glance, maybe some, Dr. Marmor said, but he noted that the gaze shifted slightly to the side in many of the images vs. a direct view can give the appearance of divergence that doesn't necessarily exist. What about artistic license? Artists, Dr. Marmor said, often painted the eyes of the subject long after the studio sitting. Thus, how can you trust their portrayal of eye position or the liberties they might take otherwise? "Hypotheses should drive data, data should not drive hypotheses, or at least conclusions," Dr. Marmor said, adding later, "I think it's doubtful Leonardo had strabismus, but I can't prove it. I suggest it wouldn't make a bit of difference to his art one way or another." Dr. Bullock said Euler's illnesses and sub- sequent ocular issues were likely due to brucel- losis, a bacterial infection that has been traced to raw milk. Though he was severely affected physically by his illness, it did not affect his mental agency, Dr. Bullock noted. "Euler had severe bilateral ocular disability but was able to continue mathematical stud- ies," Dr. Bullock said, attributing this to Euler's photographic memory, tireless diligence, and astounding powers of concentration. Electrotherapeutics in ophthalmology Kieu-Yen Luu, a third-year medical student at University of California, Davis, presenting on behalf of Mark Mannis, MD, gave an over- view of the use of electricity as a therapeutic agent in medicine and ophthalmology. There are three modes of electricity in medicine, she said: Franklinism, Galvanism, and Faradism. Electrotherapy in ophthalmology was described as early as 1779, Ms. Luu said, noting that there then was a decline in the use of electricity in the specialty until the 1970s. Since then, it has had applications in optic atrophy, retinitis pigmento- sa, retinal detachments, intraocular hemorrhag- es, opacities of the cornea, trachoma, trichiasis, foreign body removal, lacrimal obstruction, and more. Some of these techniques include iontophoresis, electrocautery, transcorneal electro-stimulation, and electromagnetism. Ms. Luu also described research on the potential to speed healing by enhancing the electrical fields of wounds—"electroceutical manipulation"— by sensitizing cells with pharmaceutical agents. Evolution of modern cataract surgery There have been revolutionary changes in cataract surgery, from couching to extracapsular cataract surgery to intracapsular to the invention of the intraocular lens and phacoemulsifica- tion, but Steven Newman, MD, Charlottesville, Virginia, wanted to address the evolutionary changes that have made cataract surgery the most successful surgery performed in medi- cine. These included posterior chamber lenses, viscoelastic, creation of the continuous curvilin- ear capsulorhexis, lens disassembly techniques continued from page 72

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