Hugh Williams introduces his subject by asking what possible connection there could be between Casanova and the Spitfire pilots. After watching this DVD, you may be none the wiser. This is, however, 47 minutes of education and entertainment on a subject that is of relevance and interest to all ophthalmologists—broadly divided into the history of cataract surgery but also, more particularly, the related development of the lens implant. Younger surgeons may indeed not be aware of the chequered and controversial history of intraocular lens implants, now so universally accepted.
As we would expect, credit for developing the first plausible implants is given to Sir Harold Ridley, described here as one of the most illustrious ophthalmologists that Moorfields Eye Hospital has known, although the first procedure was carried out at St Thomas's Hospital in 1949. As pointed out to us, it is rather extraordinary that a number of Ridley's early implants without supporting haptics were carried out after intracapsular surgery when he must have known that this had been tried in previous centuries with resultant dislocation of the lens into the vitreous cavity in many or most cases. Although in medicine we are sometimes accused of being slow to recognise and embrace new developments, in this case some reluctance was quite well founded, and indeed Hugh Williams tells us that a disheartened Ridley himself stopped implanting lenses in 1964 because of poor results and the hostility of many of his colleagues both here and in the United States.
The subsequent invention of phacoemulsification by Charles Kelman in 1967 had a similar history of clinical horror stories and professional antagonism.
We are told of the ingenuity and perseverance of a small number of surgeons worldwide with the development and use of numerous patterns of lens implants, with many blind alleys. Convergence of these developments with greatly improved phacoemulsification apparatus has resulted in the present day acceptance of these twin technologies.
No one should underestimate the difficulties that aphakic patients endured before reliable lens implants were available. Patients often preferred to put up with the extreme blurring of aphakia than use aphakic glasses or contact lenses. The spectacular advances of phacoemulsification and modern intraocular lenses have brought huge benefits to patients. However, the development of such technology must always be a balance between potential gains for future patients and potential blinding disasters for the early human guinea pigs. The Hippocratic tenet of primum non nocere was clearly suspended where the development of lens implants was concerned. There are parallels here with the development of hip replacements, where first operations were often carried out in secrecy, without any previous laboratory research, with many patients worse off than before their surgery, and large numbers of prostheses needing later removal. Although we may complain about the bureaucracy, we probably deserve the regulatory agencies that have sprung up to monitor the safe introduction of new technologies in medicine.
In this DVD, Peter Choyce, who himself developed a once widely used rigid anterior chamber lens, is quoted as saying that if Sir Harold Ridley had not done what he did when he did it, it is quite possible it may never have been done. This would seem extremely unlikely. Each person watching this DVD will make up her or his mind whether the early countless blinding disasters described by Hugh Williams were worthwhile for the greater good of later generations, or whether they could have been mitigated by better preparatory research and development in a more open and regulated environment.
Hugh Williams presents this saga in a most accomplished and engaging style. Supporting cast is Richard Keeler, archivist of the Royal College of Ophthalmologists, who has a very truncated walk‐on part. Better luck for a bigger part next time, Richard. This DVD is recommended viewing.