NOV 2013

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

Issue link: https://digital.eyeworld.org/i/220233

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Page 20 of 122

18 EW NEWS & OPINION November 2013 Chief medical editor's corner of the world A Guinness World Record? by David F. Chang, MD Dr. Chang: How many years have you been in practice? Dr. Jaffe: I've been in practice for 63 years. I recently started my 30th year in practice. This means I only need to practice another 30 years to reach where Norman S. Jaffe, MD, is now—still seeing patients at the age of 89. Dr. Jaffe practices together with his two ophthalmologist sons Emery and Gary in Aventura, Fla., a suburb of Miami, and is volunteer professor at the Bascom Palmer Eye Institute. Until last April, he had attended every single ASCRS meeting since the inaugural 1975 congress. Just imagine all of the changes that he has observed during a medical career spanning six decades. But it isn't just because of his professional longevity that we consider Dr. Jaffe to be a living ophthalmology legend. He was one of the very first American ophthalmologists to implant an IOL (1967). He was a founding member and past president of ASCRS (1975-1977) and was one of the most important and influential champions of the IOL when academic and regulatory opponents nearly prevailed. To quote the late Herve Byron, MD, "American implant surgery was born in Miami because of two factors: 1) Norman Jaffe was the ideal surgeon with the perfect personality to withstand the severe criticism by his colleagues; and 2) the chief of the Department of Ophthalmology at Bascom Palmer Eye Institute was Ed Norton, MD, the perfect academician to maintain an open mind about the possible benefits to all patients suffering from the disease known as aphakia." In fact, the very first ophthalmology textbook that I purchased as a resident was Dr. Jaffe's Cataract Surgery and its Complications (3rd Edition, Mosby 1981). This was the definitive textbook on cataract surgery, and I read and relied on it as I learned first ICCE, then ECCE, and finally phaco during residency. You can therefore imagine how privileged I felt to have dinner with Dr. Jaffe and his wife Anne earlier this year. It was a memorable and magical evening spent listening to his fascinating stories. I learned that his true calling was not medicine, but rather baseball. For three years he was the third baseman for the New York Giants AAA minor league team, and he has remained an avid, lifelong sports fan. Eventually, he reluctantly heeded the pleas of his disapproving parents to find a more productive profession, and ophthalmology would be forever changed. David F. Chang, MD, chief medical editor Dr. Chang: What do you most enjoy about continuing to see patients when your contemporaries have long since retired? Dr. Jaffe: I feel that when I wake up in the morning and do something useful for a patient, that's my definition of life. The ophthalmologist gets a tremendous amount of respect and is usually held in high regard in his community. For me, it continues to provide an active mind, and I must say that I still look forward to seeing patients and I'm very much excited about it, even to this day. Dr. Jaffe performed his first IOL implantation on December 4, 1967. He placed a Binkhorst iris-clip lens after completing an ICCE. The same eye is shown here on December 15, 1997. Dr. Chang: You have seen the entire evolution of modern cataract and IOL surgery. What has surprised you the most about cataract surgery today, compared to when you retired from active surgery? Dr. Jaffe: I continue to be excited about the dynamism of our specialty. The changes occur so rapidly and are so impressive, I consider the changes in techniques of surgery and the variety of intraocular lenses from the date I retired to be enormous. Dr. Chang: What about cataract surgery today is something that you never would have predicted? Dr. Jaffe: I performed several thousand cataract operations with IOLs before the advent of IOLs in this country. We would perform large incisions, often requiring eight sutures and hospitalization for several days for the patient. I would never have predicted how quick outpatient surgery would become. The operation of the intracapsular cataract extraction—which was the gold standard of cataract surgery—I would never have predicted its complete demise. Dr. Chang: Describe what it was like being among the first in the U.S. to implant an IOL. Dr. Jaffe: I performed my first lens implant on Dec. 4, 1967. I performed six cases on that day and Dr. Jaffe implanted his third IOL on December 4, 1967. The Binkhorst two-loop lens was fashioned by excising the two anterior loops of an iris-clip lens after an ECCE. The eye is shown here 18 years later. five the next day at another hospital. My first patient was the late James Fleming, MD, of Rochester, N.Y., who was then the president of the International College of Surgeons. There was a tremendous battle that occurred among those who opposed intraocular lenses and those of us who used the intraocular lens. Those who opposed it considered the operation to be dangerous, referring to the poor results obtained in Europe in the 1950s and 1960s. Among those in our country was Ralph Nader, who headed an organization called Public Citizen, and one of his associates, Sidney Wolfe, MD, who headed the Health Research Group. He told me that whenever I put an implant in the eye, I was committing an immoral act. We had to gain respect and credibility for the procedure. In 1969, at the Bascom Palmer Eye Institute, I got together with Dr. Edward Norton, who was the chairman of the department, and we agreed that we would declare a moratorium on the use of intraocular lenses for two years, from Oct. 1, 1969 to Oct. 1, 1971. At that time, our community of ophthalmologists had performed 243 cases and we decided to have all of the patients examined, except of course those who had passed on. These examinations would be performed by non-implant cataract surgeons without the surgeon who performed the implant being in the room. continued on page 20

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