Eyeworld

EW SECONDARY FEATURE 138 Phaco turns 50 • April 2017 He was alive to be the beneficiary of knowing that that's what the world thought of what he accomplished," Dr. Dodick said. Forward thinking Dr. Lindstrom said there is still plenty of opportunity to improve cataract surgery in terms of reducing intraoperative complications, such as better protecting the capsule and corneal endothelium and prevent- ing cystoid macular edema. What's more, Dr. Lindstrom said that while the vast majority of cataract surger- ies in the United States and devel- oped countries are performed using phacoemulsification, developing countries still perform extracapsular cataract extraction techniques due to the cost of phaco and a lack of training. "There are all kinds of ways to get this better and will still have to keep training the next generation of surgeons," Dr. Lindstrom said. Treatment of cataracts could someday, however, move beyond phacoemulsification. In his 1994 paper, Dr. Kelman proposed a device that could cut or emulsify from outside the eye using an externally produced magnetic field that spins an internal magnet. "Imagine a tiny magnetic bead suspended in space and spinning on its own axis," Dr. Kelman described. "External magnets alter the speed of rotation and change the position of the bead in three dimensions. The spinning bead, placed within the lens, liquefies the nucleus. As the capsule is approached, the rotations more surgeons, the momentum grew, and the Phaco Pioneers, many of whom became his very close friends, were just as determined and persistent to see phaco suc- ceed. The same is true for the early manufacturers. It was an amazing, dedicated group of people who faced similar resistance from peers in their own communities," Mrs. Kelman said. But when his work did start to gain acceptance, changing the lives of millions of patients, and he begun to be recognized for his innovation, it made him feel good, Dr. Dodick said. Dr. Kelman was awarded the National Medal of Technology by President George H. W. Bush in 1992 for his work on phacoemulsi- fication. He was also inducted into the National Inventors Hall of Fame in 2004, received the Albert Lasker Award for Clinical Research in 2004, and has received recognition from countless ophthalmic organizations for this contribution, including "the Most Influential Ophthalmologist of the Century" at the International Congress on Cataract and Refractive Surgery. "The American Society of Cat- aract and Refractive Surgery under- took a worldwide survey of all their membership and asked the question, 'What do you think has been the most important contribution to ophthalmology in the past century?' And there were many, many import- ant contributions in retina, cataract, and glaucoma, and unanimously the vote was the introduction of small incision cataract surgery in the eye. Kerry Solomon: My first phacoemulsification M y first phaco was in animal and cadaver eyes, and that was in Salt Lake City, Utah, when I was working with David Apple in 1987 and 1988. We were working on a technique called the Miyake technique. We would wait all night on call and when a cadaver eye came in, we would come in at 3 in the morning and do phaco and video with the Miyake technique. At the lab, we were learning phaco from each other, but we would also have guest surgeons from all over—really the who's who of phaco back in that day— and we would assist them in surgery. When I was learning phaco, the machines were not nearly what they are today. Incision sizes were much bigger. We weren't as informed about energy and fluidics. We were just starting to research capsulorhexis. Overall, the surgery itself was much more challenging back then, and we were in our infancy of techniques in terms of what's the safest and easiest way to reliably and reproducibly perform phaco. My first patient was in 1989 at the University of Kentucky Med- ical Center, Lexington, at a time when phaco still wasn't commonly performed at a lot of universities. That was a fun time for me because most residents in training are just learning to do phaco, and I had already done hundreds of cases between rabbit eyes and cadaver eyes. I think because I already had so much experience, my attendings at the time were giving me a lot more freedom. I didn't have to go through the process of needing to do so many extracapsular proce- dures before you can move up to phaco; I went right to phaco. I was pretty confident with my technique by the time I entered fellowship, having done a fair amount of cases and refining my technique through my mentors—Woody Van Meter in Kentucky helped bring me to another level. But I still had my own technique, which was really not conventional. When I got to Johns Hopkins in Baltimore and was working with Walter Stark, his first question was "Where did you learn to do that?" I very proudly said I learned this from this doctor as they came through Utah and I learned this from this, and he pretty much said, "OK, we're going to start over, and you're going to learn to do it the way that I do it." At the time, it took the wind out of my sails because I thought I was really doing pretty well; but in reality, he was absolutely correct because my technique got so much better, learning a more traditional method. Phaco has totally changed how we deliver eyecare and specifically cataract surgery. When I first started seeing patients, I wasn't in the day of sandbags, but we would remove sutures after several weeks, and patients were fitted with glasses. We would use retrobulbar blocks and IV anesthesia. We really didn't keep them as in patients, but they would refrain from returning to their normal activities for a certain period of time. Fast forward to today, I don't even use an IV; we use oral and topical anesthesia. Most patients resume their normal activities that day or the next day, and not only is their vision restored but they can see better than ever without the need for glasses. The era of now truly refractive cataract surgery has certainly come of age, and I can't think of another surgical procedure that has had such an impact on the quality of someone's life. Phacoemulsification was the genesis for all of this. We owe Charlie Kelman and phacoemulsification so much. EW Contact information Solomon: Kerry.solomon@carolinaeyecare.com Kerry Solomon, MD Carolina Eyecare Physicians Charleston, South Carolina ASCRS President, 2016–17 Phaco continued from page 136 continued on page 140 Dr. Kelman stands with one of the early phaco units during a 25th anniversary celebration hosted by ASCRS in 1999. Source: ASCRS C e l eb r a t i n g 5 0 Y e a r s o f P h a c o e m u l s i c a ti o n 1967–2017

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