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There are certain names in ophthalmology that have become household terms to those within the ophthalmic community: Sir Harold Ridley, Charles Kelman, Charles Schepens, and Arnall Patz, among many others. Their contributions to ophthalmic innovation are well known, but the detailed stories of the process of innovation and the challenges that they encountered are not common knowledge, even among today’s eye surgeons.
Andrew Lam, MD, a retina specialist in western Massachusetts and an assistant professor at Tufts University School of Medicine, details the stories of these visionaries in his newly released book, Saving Sight. The book is both a memoir of Dr. Lam’s own training and a historical account of groundbreaking developments in ophthalmology and the physicians who were responsible. This is no textbook, however. Dr. Lam’s writing grips the reader immediately with a dramatic account of operating on a patient who, during Dr. Lam’s fellowship at Wills Eye Hospital, presented in the emergency department with severe ocular trauma and an intraocular foreign body. Since its launch in May, the book has become a bestseller on Amazon.com.
I recently spoke to Dr. Lam, who has an undergraduate degree in history from Yale University, about his book release, his journey to authorship, and how he chose his subject matter.
“I have always enjoyed writing,” said Dr. Lam. “With my background in historical research as an undergraduate, and my expertise in ophthalmology, I have thought for a long time about writing a book about the heroes of our field.”
Dr. Lam focused his efforts on a novel set in China during World War II, because he thought that few outside the specialty would be interested in a book about medical history alone. At the time he started thinking about the novel, he had a newborn at home and recalls using the quiet time during nightshifts at Wills Eye Hospital to brainstorm scenarios and, later, work on the book.
“I was thrilled when I finished the novel and I got an agent,” said Dr. Lam. That book, Two Sons of China, was recently acquired by a publisher and will be released in 2014.
Completing the first book, Dr. Lam said, got him over a hurdle of sorts, as he had doubts whether he could really finish a book. Then he brought up his original idea of a book about the innovators in ophthalmic history to his agent, who suggested including some of his own experiences as an eye surgeon to add interest by giving the book a personality. Initially, he assumed that the book would be of little interest to anyone other than ophthalmologists, but his agent thought otherwise—the personalized approach could make the book compelling for any reader.
Saving Sight is written to engage the lay reader as well as those familiar with the intricacies of ophthalmology. “I realized that this would be a great way of conveying to the general public what it is that ophthalmologists actually do,” Dr. Lam said. “Vision is so important to everybody, but many people don’t realize what’s involved with our specialty. My ultimate goal was to share the stories of these doctors, and, if I could use my own story to get people to pick up the book, in my mind, it was worth it.”
Saving Sight had unusual, sometimes fascinating, sometimes tragic lives. When I asked him who was his favorite subject, without hesitation he answered, “Sir Harold Ridley.”
Dr. Ridley, the inventor of the IOL, has a compelling story that is widely known among the ophthalmic community. “Ridley saw a fighter pilot who’d been shot down during the Battle of Britain. Shards of plexiglass from his shattered canopy were embedded in his eyes, and Ridley was surprised to find these remained inert in the eye. Later, he realized this material could potentially be used to make an artificial lens,” Dr. Lam said, “I know that most ophthalmologists are familiar with that part of the story, but what most don’t know is exactly how difficult his career was.”
Dr. Lam explained that Dr. Ridley was labeled a heretic by his peers because many thought that placing a foreign material in the eye was reckless and dangerous. For decades he was shunned, and the burden of this, along with the constant fear of being sued for performing experimental surgery, drove him into a deep depression.
“When you take this part of his story into account, his vision and life should be viewed as even more courageous,” said Dr. Lam.
Part of Dr. Lam’s research involved interviewing family members of the subjects. One of the people he communicated with was Dr. Ridley’s son, Nicolas Ridley, who is now in his 70s. Mr. Ridley told him that his father’s professional struggles and depression “tore our family apart.”
“I think it’s true to say that because cataract surgeons now can perform surgery in 5 to 10 minutes, we take it for granted. You can’t forget, however, that it was considered a crazy idea at the time to put something artificial into the eye and leave it there—it went against everything that they had been taught,” said Dr. Lam.
Perseverance Despite Skepticism
Dr. Lam said a common trait among the heroes in the book is perseverance. Many of them endured failure and suffered setbacks, some of them to a greater degree than others.
“Judah Folkman may have suffered more in this regard than anyone else,” Dr. Lam said. Dr. Folkman’s theory of inhibiting angiogenesis to cut off a tumor’s blood supply later inspired research that led to antivascular endothelial growth factor treatments for wet macular degeneration. “For decades, people were saying he was purifying dirt and making a mockery of research at Harvard. He would get up to talk at the podium, and people in the audience would get up and leave. Doctorate students who were thinking of applying to work in Folkman’s laboratory were told by their mentors not to. The dedication that Dr. Folkman showed to come through this long period of frustration was just incredible.”
For the chapter on Dr. Folkman, who is the only physician featured in Saving Sight who was not an ophthalmologist, Dr. Lam appreciated the help of Joan W. Miller, MD, chief and chair of the Department of Ophthalmology at Massachusetts Eye and Ear Infirmary. Dr. Miller reviewed the manuscript prior to publication and shared insight from her experiences working with Dr. Folkman.
Dr. Lam performed exhaustive research to ensure accuracy, and for this task, he said, his history degree and experience writing peer-reviewed papers were invaluable. For some of the individuals in Saving Sight , such as Louis Braille, Dr. Lam had to rely on other historians’ research, which was challenging because some of the books written about Braille contained information that had varied over the decades.
Dr. Lam credits William Tasman, MD, former ophthalmologist- in-chief at Wills Eye Hospital, with helping him in many ways as the book progressed. “I’m indebted to Dr. Tasman for giving me advice, helping me to connect with individuals such as Mrs. Ann Kelman and Mrs. Ellen Patz, and reviewing the manuscript.”
Dr. Lam said that one of the reasons he wrote this book was to bring together these doctors’ stories that are crucial to ophthalmology and to make their history accessible to those in both the medical field and the general public.
At one point in our conversation, I asked Dr. Lam if he thought the name of Sir Harold Ridley is ever on the minds of cataract surgeons during the approximately 7 minutes that it takes to perform surgery.
“No,” he replied. “But it should be.”
Andrew Lam, MD, is an assistant professor of ophthalmology at Tufts University School of Medicine, a partner at New England Retina Consultants, and an attending retina surgeon at Baystate Medical Center in Springfield, Massachusetts.