Edward S Perkins, MD, PhD (1919-2015): In the vanguard of ophthalmic physician-scientists.

British-American ophthalmologist Edward Perkins, MD, PhD (1919-2015) held wide-ranging research interests during his career at the Institute of Ophthalmology in London, the University of Iowa, and as a military doctor stationed in Kenya. With his PhD and a medical degree, Perkins was in the vanguard of clinician-scientists who possessed such dual credentials, enabling him to perform noteworthy experimental and clinical research. Perkins' glaucoma research included early work on acetazolamide and prostaglandins, laser iridotomy, and large-scale glaucoma surveys such as the Bedford Glaucoma Survey. In 1957, Perkins earned a PhD with a thesis on cranial nerve influences on rabbit intraocular pressure. Perkins also invented a handheld applanation tonometer; wrote an entire volume on uveitis for Duke-Elder's system of Ophthalmology; co-founded the Association for Eye Research (the European Association for Vision and Eye Research forerunner); and was a charter member of the Glaucoma Research Society. In 1961, Perkins became the first Professor of Experimental Ophthalmology at the Institute of Ophthalmology in London. In 1979, Perkins and his family emigrated to the United States, where he became a Professor of Ophthalmology at the University of Iowa. Perkins' understated personality masked a legacy of extensive contributions to the field of ophthalmology.

Novel Insights Into the 1969 Whole-Eye Transplant: Medical Ethics and Evolving Safety Mechanisms.

PURPOSE: The controversial whole-eye transplant (WET) of 1969 performed by Texas Medical Center (TMC) eye surgeon Conard Moore, MD, is examined to determine whether he performed a WET or a different operation. New materials are reviewed to evaluate the conflicting historical WET reports: Moore claimed that he performed the world's first WET, then retracted his claim amid criticism. Medical and ethical factors are explored. The parameters for experimental surgery of that era are compared to current policies. DESIGN: Retrospective study. METHODS: This is a retrospective analysis of a single patient's ophthalmic operations performed in April 1969 and the controversial claim of the world's first WET. Oral and written interviews with witnesses were conducted. Primary and secondary literature sources were reviewed. Ocular illustrations provided by the surgeon in 1969 were reviewed and compared to verbal reports. RESULTS: A newly uncovered book chapter by Moore's departmental chairman Louis Girard, MD, supports the initial claim of a WET, as do recent interviews with medical journalist Miriam Kass, JD. Ophthalmic pathologist Milton Boniuk, MD, states that he did not receive the whole eye for examination. Moore made his claim of a WET amid the intense attention to TMC's aggressive heart transplantation operations. Moore retracted his claim after professional criticism. CONCLUSIONS: New evidence supports Moore's initial claim that he performed a WET, although other scenarios remain plausible. This case highlights the boundary between accepted and experimental operations, and underscores the need for modern bioethics oversight to provide safeguards for novel surgical procedures.

The Dynamic History of the Ophthalmology Residency Matching Program.

Background The ophthalmology residency matching program is the first successful medical specialty match, dating back to 1979. This article reviews the impetus for starting the match and the roles that ophthalmologists Bruce Spivey, MD, and August Colenbrander, MD, PhD, played in establishing the match and developing the machinery to make it possible. Challenges to the match's operations over the years have improved the process. Objective This article aims to research the roles of key individuals and institutions in establishing and maintaining the ophthalmology residency matching program. Methods Oral and written interviews with key participants in establishing and maintaining the match were conducted. Primary and secondary written materials were reviewed. Results Two physicians played key roles in establishing the ophthalmology residency matching program. Bruce Spivey, MD, spearheaded the drive to persuade the Association of University Professors of Ophthalmology (AUPO) to support and sponsor the match. August Colenbrander, MD, PhD, created the original match algorithm and single-handedly ran the match process in the early years. Obstacles were overcome, including resistance from the Association of American Medical College's National Resident Matching Program, a challenge to the validity of the algorithm, and the threat that antitrust laws might prohibit all graduate medical education residency match programs. The ophthalmology match evolved over time to become a more formal entity, the San Francisco Matching Program (SF Match). With continued support of the AUPO, the process of matching applicants to residency programs has flourished despite contemporary challenges related to electronic applications and social media. Conclusion The ophthalmology residency matching program has benefited applicants and teaching programs for more than four decades due to visionary founders, ongoing support of the AUPO, and strong leadership within SF Match.

Spontaneous hyphema associated with ocular syphilis.

The purpose of this case series is to illustrate a novel presentation of ocular syphilis. Two cases of ocular syphilis presenting with spontaneous hyphema are described, demonstrating that spontaneous hyphema can be caused by ocular syphilis. This association has not previously been reported.

Fundus autofluorescence in choroidal metastatic lesions: a pilot study.

PURPOSE: To correlate fundus autofluorescence (FAF) in choroidal metastases with clinical changes overlying the lesions using confocal scanning laser ophthalmoscope. METHODS: Retrospective chart review of 15 metastatic tumors in 14 eyes of 11 consecutive patients. The patients underwent confocal scanning laser ophthalmoscope to compare the clinical findings and FAF. Correlation between increased FAF and clinical changes was defined as complete, partial, or no correlation. RESULTS: Of 11 patients, 8 (73%) were women, and the average age was 56 years. All 15 metastases were amelanotic, focal hyperpigmentation was present in 8 (53%), subretinal fluid in eleven (73%), whereas drusen and orange pigment were absent. Of 8 tumors that were visualized by scanning laser ophthalmoscope, 7 tumors (87%) showed correlation between FAF and hyperpigmentation, no correlation in 1 (13%). A complete correlation between hyperpigmentation and FAF was found in 5 (70%) tumors and a partial correlation in 2 (30%). There was partial correlation between subretinal fluid and FAF in 6 metastases (46%), no correlation in 5 (39%). Three metastases without hyperpigmentation had FAF, one showed the presence of subretinal fluid. CONCLUSION: Amelanotic choroidal metastases with hyperpigmentation are associated with increased FAF in most cases. Subretinal fluid overlying choroidal metastases may cause FAF as well.

David Kasner, MD, and the Road to Pars Plana Vitrectomy.

David Kasner, MD (1927-2001), used his extensive dissections of eye bank eyes and experiences in teaching cataract surgery to resident physicians to realize that excision of vitreous when present in the anterior chamber of eyes undergoing cataract surgery was preferable to prior intraoperative procedures. Noting that eyes tolerated his maneuvers, he then performed planned subtotal open-sky vitrectomies; first on a traumatized eye in 1961, then on two eyes of patients with amyloidosis (1966-1967). The success of these operations was noted by others, most particularly Robert Machemer, MD. Kasner's work directly led to further surgical developments, including closed pars plana vitrectomy.

Paul Sullivan: catalyst in the history and use of intraocular sulfur hexafluoride.

The use of air to attempt to reattach the retina dates back to 1909. However, despite the widespread use of intraocular air in the 1950s and 1960s, retinal surgeons struggled with the main limitation of the device (ie, the relatively short duration of the gas within the vitreous cavity). Fortuitous events in the late 1960s allowed Paul Sullivan, MD, to introduce the first expansile gas, sulfur hexafluoride, to Edward W.D. Norton, MD, and his colleagues at the University of Miami. The use of sulfur hexafluoride helped revolutionize retinal detachment surgery and allowed for further advances in treating other posterior segment diseases.

Paul A. Cibis, MD: a pioneer of modern vitreoretinal surgery.

Paul Anton Cibis (1911-1965) was one of the pioneers of modern vitreoretinal surgery. He reasoned that the pathology of complex retinal detachments was intravitreal fibrosis and concluded that the optimum surgery was the injection of liquid silicone oil into the vitreous cavity to dissect fibrous membranes from the retinal surface and use the silicone for retinal tamponade. Prior to the invention of pars plana vitrectomy, such surgery was innovative, even daring. These surgical techniques were an important advance in directly operating on the vitreous in retinal detachment surgery. However, Cibis' contributions to vitreoretinal surgery only occupied the last 10 years of his tragically short life. Prior to his practice in retinal surgery, he made contributions to basic research in physiologic optics, local retinal adaptation, and the effect of ionizing radiation and atomic energy on the globe.

INTERFERON-ß-ASSOCIATED RETINOPATHY.

BACKGROUND: Interferon-associated retinopathy is a rare complication of interferon treatment. It has been well described with the use of interferon-α. METHODS: This study reports a retrospective case series of interferon-ß-associated retinopathy in three patients that were being treated for multiple sclerosis. RESULTS: All cases were characterized by cotton-wool spots or peripheral microaneurysms. One central retinal artery occlusion was observed associated with interferon-ß treatment. Findings improved spontaneously in two of three cases; all three patients elected to continue interferon treatment. CONCLUSION: Patients being treated with interferon-ß should have periodic fundus examinations to determine if they have evidence of interferon-associated retinopathy.