August 2019


Cogan Ophthalmic History Society Annual Meeting

by Liz Hillman EyeWorld Senior Staff Writer

The 32nd Cogan Ophthalmic History Society Annual Meeting took place March 15–17 in Washington, D.C. Topics ranged from the history of ophthalmic procedures to ocular disorders of famous historical individuals. Here is an overview of a few of the presentations from the meeting.

The science and sociology of refractive errors

The society’s Annual Snyder Lecture was given by David Harper, MD, Ashland, Wisconsin. Dr. Harper focused his lecture on myopia, noting that its origin was with Aristotle in 350 BC. Pliny the Elder, he said, described big eyes as being “dimmer” and deep set ones were thought to see more clearly. Dr. Harper mentioned several historical texts where the perceived inattention of myopes was described as making them seem dull or stupid. He then discussed how children not only learn language with their ears but also with their eyes. He described the observation by others that societies with a lot of reading have more cases of myopia than those without this emphasis.
Jacob Raphaelson, OD, began researching school myopia in the 1930s as he, like others, noticed that children seemed to become nearsighted after entering school. If they were prescribed glasses, they became even more nearsighted. As such, Dr. Raphaelson advocated plus lenses for schoolwork and reading, thinking it would prevent myopia. Ultimately, Dr. Harper said, research has shown that plus lenses for near work can reduce myopia progression. He mentioned a spectacle technology licensed to Carl Zeiss Meditec that is set to launch in Asia and said multifocal contact lenses can reduce or prevent axial elongation as well.
“If you look at what works in prevention of myopia, it turns out virtually everything does,” Dr. Harper said, mentioning atropine drops, orthokeratology, peripheral defocus modifying contact lenses, pirenzepine, progressive addition of spectacle lenses, and more.

Speculation of mathematician Leonhard Euler’s oculopathy

Famed mathematician Leonhard Euler—a man who published 886 papers and books, has 96 eponymous math terms, and had more than 200 papers published after his death—progressively lost his sight throughout his career. But to what? John Bullock, MD, Winchester, Massachusetts, offered his speculation on a posthumous diagnosis based on portraiture and other sources of information. We know that Euler suffered headaches and several life-threatening febrile illnesses. We also know that raw milk product consumption was common in Russia, where Euler lived in adulthood and a point that Dr. Bullock came back to later.
There are only four known portraits of Euler. One showed normal appearance of his eyes. A second, completed after a second febrile illness and beginning loss of vision in the right eye, showed partial ptosis in the right eyelid with miosis and right hypertropia. Euler eventually developed cataract, deafness, and had more febrile illnesses. He underwent ECCE for what was described as a beeswax cataract, Dr. Bullock said. This was initially successful, but days later he was blind and in pain. By the early 1770s, he could only write large symbols on the chalkboard but was still producing one mathematical paper per week.
Dr. Bullock said Euler’s illnesses and subsequent ocular issues were likely due to brucellosis, a bacterial infection that has been traced to raw milk. Though he was severely affected physically by his illness, it did not affect his mental agency, Dr. Bullock noted.
“Euler had severe bilateral ocular disability but was able to continue mathematical studies,” Dr. Bullock said, attributing this to Euler’s photographic memory, tireless diligence, and astounding powers of concentration.

Electrotherapeutics in ophthalmology

Kieu-Yen Luu, a third-year medical student at University of California, Davis, presenting on behalf of Mark Mannis, MD, gave an overview of the use of electricity as a therapeutic agent in medicine and ophthalmology. There are three modes of electricity in medicine, she said: Franklinism, Galvanism, and Faradism. Electrotherapy in ophthalmology was described as early as 1779, Ms. Luu said, noting that there then was a decline in the use of electricity in the specialty until the 1970s. Since then, it has had applications in optic atrophy, retinitis pigmentosa, retinal detachments, intraocular hemorrhages, opacities of the cornea, trachoma, trichiasis, foreign body removal, lacrimal obstruction, and more. Some of these techniques include iontophoresis, electrocautery, transcorneal electro-stimulation, and electromagnetism. Ms. Luu also described research on the potential to speed healing by enhancing the electrical fields of wounds—“electroceutical manipulation”—by sensitizing cells with pharmaceutical agents.

Evolution of modern cataract surgery

There have been revolutionary changes in cataract surgery, from couching to extracapsular cataract surgery to intracapsular to the invention of the intraocular lens and phacoemulsification, but Steven Newman, MD, Charlottesville, Virginia, wanted to address the evolutionary changes that have made cataract surgery the most successful surgery performed in medicine. These included posterior chamber lenses, viscoelastic, creation of the continuous curvilinear capsulorhexis, lens disassembly techniques and hydrodissection, capsular staining, pupillary expansion devices, foldable IOLs, methods for astigmatism correction, and changes to anesthesia. “Visionary pioneers set the stage,” Dr. Newman said, “but subtle changes in practice reduced incidence of complications and allowed the procedure to become routine.”

Did Leonardo da Vinci have strabismus?

Michael Marmor, MD, Palo Alto, California, addressed this question in light of a paper published by Christopher Tyler, PhD, in JAMA Ophthalmology in early 2019, which suggested that the Italian Renaissance man had strabismus, based on portraits and analysis of pupil alignment and other features. Dr. Marmor, who ultimately does not think there is evidence to support that da Vinci had strabismus, addressed many of Dr. Tyler’s points. First, Dr. Marmor said, there are no known official portraits of da Vinci; one that is most likely of him is a profile (thus not showing both eyes) by Francesco Melzi. The works in Dr. Tyler’s paper, Dr. Marmor said, are only thought to represent da Vinci (they’re hypothetical). Some argue that da Vinci might have represented himself in some of his own works, but Dr. Marmor noted that one has to critically look at the images thought to be da Vinci and ask if it’s even the same face (to Dr. Marmor, it’s clear that it’s not).
Do the eyes in the pieces used by Dr. Tyler to make his argument even diverge? At first glance, maybe some, Dr. Marmor said, but he noted that the gaze shifted slightly to the side in many of the images vs. a direct view can give the appearance of divergence that doesn’t necessarily exist.
What about artistic license? Artists, Dr. Marmor said, often painted the eyes of the subject long after the studio sitting. Thus, how can you trust their portrayal of eye position or the liberties they might take otherwise?
“Hypotheses should drive data, data should not drive hypotheses, or at least conclusions,” Dr. Marmor said, adding later, “I think it’s doubtful Leonardo had strabismus, but I can’t prove it. I suggest it wouldn’t make a bit of difference to his art one way or another.”

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