Eyeworld

EW CATARACT 40 September 2011 Steven P. Shearing, M.D.: A pioneer to remember John Stanley, M.D.: A graduate of the UCSF residency program, Steve Shearing was a Las Vegas ophthal- mologist in solo private practice who conceived of a posterior cham- ber IOL that he tested in a single eye bank eye. IOLAB, a small Pasadena, Calif.-company, made the first ex- perimental models, which Steve im- planted in 27 patients. In the summer of 1977, I examined all of these initial patients and realized the superiority of the design and saw the excellence of the visual results. We became friends at that time, and he eventually asked me to be a witness in a lawsuit against Johnson & John- son that established Steve Shearing as the inventor of the first successful posterior chamber in- traocular lens—a milestone in the history of eye surgery. I am sad- dened by his death. Robert M. Sinskey, M.D.: Steve Shearing took one of my earliest courses in phacoemulsification and intraocular lenses in 1975. In 1977, Dick Kratz called to tell me about a doctor in Las Vegas who had devel- oped an idea to take the Barraquer anterior chamber lens and put it in the posterior chamber. It had flexi- ble J-loops and he called it the Shearing Lens. I called Steve Shear- ing in Las Vegas and asked him to bring two of his patients to my course, at my expense, in whom he had implanted his lens into the cil- iary sulcus. When we saw Steve's pa- tients, the lens implant was not visible and the eyes looked like they had not been implanted with an IOL, which was remarkable at the time. Dick Kratz and I ordered 300 lenses from Pete LaHaye, who was the president of IOLAB at the time. From that point on I added Steve to my faculty and he came down monthly for our courses. Naturally we ran into a lot of resistance from academics around the country at the time about putting an anterior lens or an iris-supported lens into the O f ophthalmology's most important intraocular lens pioneers, the University of California, San Francisco (UCSF) has been blessed to have had Steven Shearing, M.D., as a former resident and Tom Mazzocco, M.D., as a former clinical faculty member. Steve passed away suddenly on July 10, 2011 at the age of 76. He earned his undergraduate and master's degrees in history before changing his focus and career path to medicine. After his ophthalmology residency, he established a flourishing private prac- tice in Las Vegas. I was fortunate to get to know Steve through our UCSF ties and was honored when he chose me to operate on his wife. Because of the early staunch opposition of academic ophthalmology to intraocular lenses and phacoemulsification, innovative clinicians in private practice spawned the most important advances in cataract surgery. Like others who had adopted ECCE, Steve found himself having to weigh the disadvantages of anterior chamber versus iris-fixated IOLs. He decided to revisit Harold Ridley's since discredited idea of a posterior chamber lens. Years later, I was able to coax a reluctant Steve to write about how he came up with the design of the open-looped posterior chamber IOL. "A careful review of the early literature suggested that Ridley's operation had been technically difficult. He had been caught on the horns of a dilemma. The shorter or smaller his posterior chamber lens, the easier it was to insert atraumatically through the pupil and into the posterior chamber. The larger the lens, the closer it came to achieving centration and then fixation (but at the price of increased trauma). By compromising, Ridley failed to achieve either goal; the surgery was difficult, and the lens did not fixate. "The posterior chamber lens needed to be short for the purposes of insertion but long for centration and fixation. These seemingly incompatible goals led to the concept of compressibility. I theorized that, if a lens could be compressed for insertion but had the memory to expand to its original shape once safely inside the posterior chamber, it would fill the space left by the extracted natural lens. Because the lens would be stable, capsular fixation would also be likely." Lacking access to engineers and research grants, Steve approached IOLAB Corpora- tion about prototyping his three-piece IOL design with polypropylene haptics. To overcome their reluctance, he funded the development costs himself. "Within a few weeks, I was testing IOL prototypes in cadaver eyes. In March 1977, with great trepidation and hesitation, I implanted the first compressible posterior chamber IOL in the eye of a living patient. Insertion proved relatively easy, and the lens immediately achieved fixation. Post-operatively, the eye was quiet, and the patient saw well. During a routine slit-lamp examination, it was easy not to notice the presence of the IOL. My idea had become reality." The Shearing 101 Lens (IOLAB Corporation) became the first commercially success- ful FDA-approved posterior chamber IOL. More importantly, Steve's J-loop haptic design and its successors established the posterior chamber with posterior capsular fixation as the safest location for the IOL. This ultimately converted remaining ICCE proponents to ECCE. Among many honors, he was the second ASCRS Innovator Lecturer (1986), follow- ing Charles Kelman, M.D. My memories of Steve are of a thoughtful and inquisitive oph- thalmologist whose gentle and unassuming demeanor belied his historic stature as the inventor of the three-piece posterior chamber IOL. Steve was passionate about cataract surgery and even in his retirement kept abreast of the field. He shunned the spotlight and regrettably, very few from my generation ever met him. I invited several of Steve's con- temporaries and colleagues to share their memories of him with EyeWorld readers. David F. Chang, M.D., chief medical editor Reference Shearing SP. Recreating the Posterior Chamber Lens. In: Cataract Surgery Today, Chang DF Editor. Bryn Mawr Communications. 2009 p. 30-31. Chief medical editor's corner of the world Dr. Shearing was well known for his innvoations in the area of the posterior chamber lens Source: Amar Agarwal, M.S., F.R.C.S., F.R.C.Opth.

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