In 1949, Sir Harold Ridley, an English ophthalmologist, performed the world’s first successful artificial intraocular lens (IOL) transplant surgery on a patient with cataracts. When he died in 2001, theDaily Telegraphobituary told of the ophthalmic surgeon’s perseverance to revolutionize cataract surgery and his undeterred work toward his goal.
Today, the IOL procedure is commonly performed in cataract surgery. The operation has restored vision to approximately 200 million people around the globe.
An Innovative Procedure
Ridley was renowned for his brilliant surgical techniques, and earned a reputation for his insight and ability to make quick inferences and snap decisions that usually proved correct.
According to the American Academy of Ophthalmology, Ridley became a surgeon at the Royal London Ophthalmic Hospital at Moorfields in 1939 after serving with the Royal Navy.
He found the inspiration for his revolutionary cataract procedure during the World War II Battle of Britain. He noticed that wounded fighter pilots he treated for fragments of Perspex — the acrylic plastic used in cockpit canopies — lodged in theireyesdid not experience an inflammatory reaction as they did with glass splinters.
Ridley realized the tiny Perspex splinters rested, relatively inert, in the eye. He developed the idea of creating an artificial lens composed of the same material.
A Secret Operation
However, Ridley lost the time he needed to further develop his idea after he received orders to assist British troops in Africa in 1941. While stationed in Ghana, he researched the parasite-induced disease onchocerciasis, or river blindness, which was then pervasive in many parts of the developing world.
After the war, Ridley contemplated what he had learned about the properties of Perspex and its potential for intraocular lens implants. According to the American Academy of Ophthalmology, after a resident physician spoke about the potential benefits that could result from the ability to replace a diseased lens, Ridley became determined to create a solution.
TheTelegraphreported that Ridley secretly worked with optical scientist John Pike from Rayner Intraocular Lenses. Ridley discovered the company could manufacture the type of intraocular lens he believed the procedure would require. In designing the product, Ridley and Pike agreed not to personally derive any financial benefit from their work.
In 1946, Ridley accepted a position with St. Thomas’ Hospital in London, and it was there the world’s first IOL transplant was performed in 1949. The operation was broadcast on television to an audience of his colleagues, and all those who viewed it were sworn to secrecy for a period of three years.
The First Advancement in Two Centuries
Most often, a person develops cataracts when aging or injury changes the tissue that makes up the lens of the eye. As a result, the lens becomes hard and cloudy. Unless corrected through surgery, cataracts often result in blindness.
According to the American Academy of Ophthalmology, the mid-18th century French ophthalmologist Jacques Daviel became the first known physician to perform a successful operation to remove cataracts. The procedure involved extracting a patient’s lens using a corneal knife, finely constructed scissors, a blunt needle, spatula and a spoon. After the operation, Daviel’s patient lied down in a darkened room for eight days to heal.
The American Society of Cataract and Refractive Surgery noted that Daviel’s work represented the first significant advancement in the treatment of cataracts since ancient times.
Prior to his innovation, couching, a procedure first described by the ancient Roman medical writer Aulus Cornelius Celsus around 25 BCE, was the main means of treatment. Couching involved the use of a curved needle used by the surgeon to make the lens loose and move the cataract away from a patient’s line of sight. The origins of couching most likely started in India, where the physician Sushruta wrote about the topic in the 6th century BCE.
However, even after undergoing Daviel’s operation, patients still experienced difficulty in focusing, which at that the time could only be partially solved through the use of thick glasses.
Throughout the 1800s, ophthalmologists experimented with various methods to replace the lens of the eye. Many in the medical community believed lens replacement was impossible and any artificial lens introduced into the eye would be rejected by the immune system.
Initially, Ridley chose to remain silent about the procedure until he was satisfied it would yield long-term results. However, after his first patient inadvertently appeared at the offices of a different Dr. Ridley for a follow-up visit, the physician knew he needed to make a public announcement about his operation. In 1951, Ridley gave the first lecture about the procedure at the Oxford Congress.
Ridley, who did not retire until the age of 85, lived to see the procedure become widely adopted, due in part to advancements in microtechnology and instrumentation in the 1970s that made it simpler and safer. In the 1980s, he underwent an IOL transplant, which led him to remark that he was the first physician to have invented his own operation.