Eyeworld

3 EW NEWS & OPINION by Eric Donnenfeld EyeWorld Chief Medical Editor 50 years of phaco April 2017 lie Kelman. Thanks Charlie, for phacoemulsification and so much more. EW Contact information Donnenfeld: ericdonnenfeld@gmail.com T here are very few people who are truly larger than life. Charlie Kelman was one of these rare individu- als. He was a man, a myth, and a legend. Charlie was equally adept flying his helicopter, playing saxophone at Carnegie Hall, or per- forming cataract surgery on a head of state. In this edition of EyeWorld we celebrate 50 years of phacoemulsifi- cation in a special secondary feature. At ASCRS in Los Angeles this May, we will hold seminars celebrating his contributions to ophthalmology. As we celebrate Charlie and his contributions at this 50-year mark, it seems to me that there might not even be an ASCRS if it were not for Charlie, among many others. His ideas about cataract surgery and IOL implantation were not embraced by mainstream ophthalmology. He was instrumental in developing and growing our organization as a safe haven for pioneering ophthalmol- ogists to share new ideas, develop innovative concepts, and question authority in a protected, supportive environment. Charlie went on to become president of ASCRS. The story behind phacoemul- sification is well known, but it's worth sharing again. As I under- stand it, Charlie was in the dentist's chair and thought if the ultrasound of a dental drill could be used on a tooth, it could also be used to emulsify a cataract. He decided to perform the first case at Manhattan Eye and Ear Hospital behind closed doors, and legend has it the first case took almost an hour. Fifty years later, phacoemulsifi- cation has advanced to an extraor- dinary degree both in safety and efficacy, but at its heart it remains the same surgery. There are very few surgical procedures in all of medicine that have survived as the treatment of choice for 50 years. However, longevity is not the most impressive aspect of phacoemulsi- fication. Phacoemulsification was the first small-incision surgery ever performed and was the harbinger to every other small-incision surgery performed today that has revolu- tionized the morbidity and safety of almost every specialty. The common ancestor of laparoscopic gall blad- der, spine, hip, and knee surgery is Charlie Kelman. His contributions to medicine were disruptive in every respect and are unmatched. Every ophthalmologist has a story about cataract surgery. As you read this issue of EyeWorld, think about your own experiences as you hear stories and insights from many notable colleagues in our field. To kick it off, I'd like to share my story. I grew up next to a farm and came home when I was 7 years old with a pig eye in my hand. My father and I dissected the eye, and I learned the anatomy and kept it in formaldehyde next to my bed. Side note: When I told my son this story he asked me if I had any friends growing up. Fast forward 15 years, when I had finished my first year of medical school and was home on Long Island for the summer. I was visiting my pediatrician. Yes, I was 22, and while I was not proud of it, I still saw my pediatrician. He asked me what area of medicine interested me. I said I wasn't certain, but I had always thought—based solely on my experience with the pig eye—that ophthalmology might be interesting. It turned out that his cousin was an ophthalmologist on Long Island, and he arranged for me to spend a day with him in the operating room. The cousin turned out to be an extremely friendly man, and he welcomed me into the world of ophthalmology. As a first-year medical student I watched in awe and was inspired while he spoke to patients, told stories, and performed what turned out to be the first phacoemulsification I ever observed. I knew after that day that all I wanted to do was become an ophthalmologist. And that pediatrician's cousin I spent the day with was Char- IMPORTANT PRODUCT INFORMATION FOR THE ACRYSOF ® IQ RESTOR ® FAMILY OF IOLs CAUTION: Federal (USA) law restricts this device to the sale by or on the order of a physician. INDICATIONS: The AcrySof ® IQ ReSTOR ® Posterior Chamber Intraocular Lens (IOL) is intended for primary implantation for the visual correction of aphakia secondary to removal of a cataractous lens in adult patients with and without presbyopia, who desire near, intermediate and distance vision with increased spectacle independence. The lens is intended to be placed in the capsular bag. WARNINGS/PRECAUTIONS: Careful preoperative evaluation and sound clinical judgment should be used by the surgeon to decide the risk/benefit ratio before implanting a lens in a patient with any of the conditions described in the Directions for Use labeling. Physicians should target emmetropia, and ensure that IOL centration is achieved. Care should be taken to remove viscoelastic from the eye at the close of surgery. Some patients may experience visual disturbances and/or discomfort due to multifocality, especially under dim light conditions. As with other multifocal IOLs, visual symptoms may be significant enough that the patient will request explant of the multifocal IOL. Spectacle independence rates vary with all multifocal IOLs; as such, some patients may need glasses when reading small print or looking at small objects. Clinical studies with the AcrySof ® ReSTOR ® lens indicated that posterior capsule opacification (PCO), when present, developed earlier into clinically significant PCO. Prior to surgery, physicians should provide prospective patients with a copy of the Patient Information Brochure available from Alcon for this product informing them of possible risks and benefits associated with the AcrySof ® IQ ReSTOR ® IOLs. Studies have shown that color vision discrimination is not adversely affected in individuals with the AcrySof ® Natural IOL and normal color vision. The effect on vision of the AcrySof ® Natural IOL in subjects with hereditary color vision defects and acquired color vision defects secondary to ocular disease (e.g., glaucoma, diabetic retinopathy, chronic uveitis, and other retinal or optic nerve diseases) has not been studied. Do not resterilize; do not store over 45° C; use only sterile irrigating solutions such as BSS ® or BSS PLUS ® Sterile Intraocular Irrigating Solutions. ATTENTION: Reference the Directions for Use labeling for a complete listing of indications, warnings and precautions. © 2016 Novartis 10/16 US-RES-16-E-4014 96756 US-RES-16-E-4014_PI EW.indd 1 2/8/17 3:37 PM 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 Celebrating this milestone in EyeWorld and at ASCRS in Los Angeles

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