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EW NEWS & OPINION 30 March 2015 by Paul Honan, MD, and Tom Mazzocco, MD Tribute to Richard "Dick" P. Kratz, MD R ichard "Dick" P. Kratz, MD, a world renowned and revered ophthalmol- ogist, passed away Feb. 16 at the age of 95. A native Californian, he in- formed his physician mother when he was just 4 years old that he want- ed to become an eye specialist when he grew up. He received a BA degree from Occidental College in 1942 and an MD degree from the University of Southern California in 1946. He was chief of ophthalmology and ENT in the U.S. Army General Hospital in Tokyo, Japan and finished that post in 1947. His patients included Gen. Douglas MacArthur and his family. He smiled with pleasure when he related that his intense desire to return home was facilitated by his Army General giving him orders to care for and accompany a soldier with a severe eye injury on a plane across the Pacific to a hospital in California. Dr. Kratz received a diploma in ophthalmology and surgery course at Moorfields Hospital in London in 1948, where he studied under Harold Ridley, MD, and Stewart Duke-Elder, MD, PhD, with Peter Choyce, MD, as a classmate. He fin- ished his residency in ophthalmol- ogy and ENT at Duke in 1951 with classmates Robert Sinskey, MD, and Robert Welsh, MD. I n the space of a few weeks, ophthalmology recently lost 3 of its most venerated giants in the fields of cataract and refractive surgery. Richard "Dick" Kratz, MD, Norman Jaffe, MD, and George Waring III, MD, were each surgical pioneers and key figures in the advancement and adoption of phaco, IOL, and keratorefractive surgery. Imagine a time when most ophthalmologists thought that phaco was a treacherous technology that was far more likely to cause corneal decompensation than manual ECCE. Dr. Kratz introduced 2 key concepts that not only saved phaco, but paved the way for it to become the leading technique. The first concept was performing nuclear emulsification in the iris plane—equidistant from the cornea and the posterior capsule. The second was to use a second hand instrument to maneuver the nucleus. Imagine a time when most ophthalmologists thought it sacrilegious to implant an IOL into the eye. Dr. Jaffe was one of the very first American ophthalmologists to implant an IOL (1967). 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 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." Facing objections from both sides, Drs. Jaffe and Norton led a national study to assess the safety of this controversial device. Imagine a time when most ophthalmologists thought that it was heretical to operate on a healthy eye to reduce myopia. Like Dr. Jaffe, Dr. Waring headed a national landmark study to prospectively evaluate the safety of radial keratotomy (PERK). As with the IOL study, ardent criticism also came from RK proponents who objected to the self-imposed moratorium on performing RK until the study was completed. Both of these landmark studies ultimately provided evidence reassuring enough to allow IOL and keratorefractive surgery to further evolve and improve. Drs. Kratz, Jaffe, and Waring were cutting-edge surgeons who were well respected and trusted within the academic community. This balance of clinical expertise and scientific cred- ibility made them ideal leaders to steer ophthalmology out of these polarizing controversies. Thanks to their courage, conviction, and leadership, phaco, IOLs, and refractive surgery not only gained acceptance, but now rank among our profession's most impactful achievements. To honor these 3 remarkable luminaries, EyeWorld has invited several of their col- leagues and friends to share their thoughts and memories. We thank Paul Honan, MD, and Tom Mazzocco, MD, Kenneth Hoffer, MD, and Eric Donnenfeld, MD, for writing the lead tributes. David F. Chang, MD, chief medical editor Dr. Kratz (left) was inducted into the ASCRS Ophthalmology Hall of Fame in 2013. Dr. Mazzocco presents the award. Source: ASCRS Following his training, Dr. Kratz entered into practice in Beverly Hills, Calif., with John Lordan, MD. Shortly after that, he moved to Van Nuys, Calif., where he practiced for nearly 3 decades. Patient care was extremely important to Dr. Kratz, and he spent much time with each patient and often worked into the evening hours. He had the ability to perform even the most intricate maneuvers with ease. Although he was known primarily for his work with cataracts and implants, he also did excellent work in strabismus and corneal surgery. Dr. Kratz was a member of 15 professional societies and a founding member of the American Society of Cataract & Refractive Surgery (ASCRS), the Contact Lens Associa- tion of Ophthalmologists (CLAO), the Joint Commission of Allied Health Personnel in Ophthalmology (JCAHPO), and the National Oph- thalmological Society. He served as president, chairman, or board mem- ber of several societies and received numerous awards and gave many honorary lectures. He was admit- ted into the ASCRS Hall of Fame in 2013. In 1965, Dr. Kratz testified at a U.S. Senate hearing and helped defeat a bill that would have made it illegal for ophthalmologists to fit contact lenses or to dispense glasses in their offices and would require patients to go to optometrists or opticians for those services. Despite opposition after the invention of phacoemulsification, Dr. Kratz helped to pioneer its use. Despite objections from Medicare, the Food and Drug Administration, and some senior academic ophthal- mologists, he helped to develop, teach, and defend the use of both phaco and intraocular lenses. Along with Dr. Sinskey, he was a cofounder of a course that taught the pha- co technique to more than 4,000 ophthalmologists from all over the world. The course simplified the procedure by moving the emulsifi- cation from the anterior chamber to the plane of the iris to protect the corneal endothelium. Dr. Kratz and Dr. Sinskey developed the two-hand- ed technique, the scleral tunnel inci- sion, hydrodissection of the nucleus, and the polishing of the posterior capsule. They also made many mod- ifications of the phaco machine and surgical instruments. Dr. Kratz was clinical professor of ophthalmology at the University of Southern California, Los Angeles, and University of California, Irvine. He never patented any intraocular lenses, devices, or instruments and declined the honor of being chairman of the Department of Ophthalmology at the University of California and president of ASCRS.

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