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Remembering the "Radicals"

While we celebrate the 35th anniversary of phacoemulsification, the youngsters among us might not know that its introduction also led to one of the most infamous, ugly periods in ophthalmology's history. For a few years, surgeons who performed phacoemulsification and (gasp!) lens implantation were the victims of unbelievable hysteria.

Almost every early phaco surgeon has a story to tell about intolerance among his colleagues. They usually share the same themes. The surgeon is convinced small-incision cataract surgery is the way to go. Some of his patients have problems and seek second opinions from other doctors who until then had never seen a phaco post-op. Word gets out that phaco destroys eyes and so is an abomination. Sometimes this led to reputation-destroying whispers and innuendo. Sometimes it led to wide-open accusations at medical meetings, hospital committees, and state license boards.

In some areas, the community doctors told each patient they saw who had had phacoemulsification that they should sue their surgeon, simply for performing that procedure. This was exacerbated by their frustration that some patients would hop on airplanes to have phacoemulsification performed by a surgeon they had never met, and then seek post-op care back home. "Unethical itinerancy," cried the local doctors, and perhaps correctly, but it was also an unrecognized free-market force proving what the public wanted.

One of America's most respected surgeons and statesmen was ordered by his state board to get a second opinion for every operation he performed. Our Academy fought for mandatory 90-day waiting periods between eyes in some states just to slow down flight to major cataract centers and to try to keep patients local. I was blackballed by my state society for a while.

Lessons Learned?

There are hundreds of similar stories, many involving surgeons who are now retired or deceased. The details of some would turn your stomach; others would make you laugh. But by 1990, phaco was mainstream and all was peaceful again. We managed to get through the laser vision revolution without much antagonism, so perhaps the lessons were learned, or maybe society has changed.

Still, amongst the celebrations, we should also pause to remember the suffering of Dr. Kelman and his early pioneers, for they changed our specialty forever and we owe them much.