© Springer International Publishing AG 2018Jean-Luc Febbraro, Hamza N. Khan and Douglas D. Koch (eds.)Surgical Correction of Astigmatismhttps://doi.org/10.1007/978-3-319-56565-1_1
1. Combining Astigmatism Correction with Cataract Surgery: A Personal Crusade
Professor of Ophthalmology, University of Cincinnati and Medical Director Emeritus Cincinnati Eye Institute, University of Cincinnati, Cincinnati, OH, USA
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KeywordsAstigmatismAstigmatic keratotomyCorneal incisionsRefractive cataract surgeryEmmetropia
This chapter dealing with the birth of astigmatic keratotomy with cataract surgery is a reasonable way to begin a book devoted to this surgical correction of astigmatism. Although it has some scientific merit and historical accuracy, the most invaluable lesson that can be gained is to understand human emotional response to change.
After nearly 40 years in ophthalmology, I still find it incredible that new ideas are inevitably met by the law of resistance. Even though the public perceives medicine as a rapidly changing field with technology breakthroughs and advances in surgical technique, most would be surprised by how reluctant individual physicians are to embrace change. While I had the good fortune of talking to and learning from legendary innovators, Sir Harold Ridley and Dr. Charles Kelman, I was ill prepared for what happened to me in the early 1980s.
Perhaps, I should begin with a few background comments. I had completed my residency at the Bascom Palmer Eye Institute in Miami in addition to multiple fellowships at Bascom Palmer and the Wills Eye Hospital in Philadelphia. I was enthusiastic about almost everything in ophthalmology and showed an early addiction to anything that was new in the field of ophthalmic surgery. I can vividly remember hearing a presentation from Russian pioneer Dr. Svyatoslav Fyodorov about radial keratotomy then dashing to the animal lab where I began placing incisions on rabbit corneas with fragments of a carbon shaving blade. I informed my Chief, Dr. Edward Norton (president of the AAO), that I was going to spend my week of vacation observing one of the first American surgeons performing radial keratotomy. Dr. Norton promptly told me that I was “throwing away my career” and he strongly discouraged me. Naturally, I was even more incentivized and spent my week evaluating all of Dr. Albert Neumann’s patients which resulted in a scholarly publication rejected by every peer-reviewed ophthalmic journal in America! Every detail, even the central iron lines, was described, and the study was eventually published in Documenta Ophthalmologica several years later .
At around this time, I heard a brilliant ophthalmologist from Nashville, Tennessee, Dr. Spencer Thornton, discussing the coupling effect of arcuate incisions for myopia. He proved that if one meridian flattened, there was a proportional steepening of the meridian 90° away. I also visited the office of Dr. George Tate in Pinehurst, North Carolina, who I observed in the operating room correcting residual high astigmatism following cataract surgery with astigmatic keratotomy. It struck me with the force of a tsunami: why not combine these incisions with routine phacoemulsification for the reduction of pre-existing astigmatism!