Canopy Lenses

Episode 4

Mayday! Mayday! This episode is more than meets the eye. When General Gordon Cleaver crash landed and met Dr. Harold Ridley, the world of eye surgery was forever changed. 

Bonus Episode! 

In this episode, we sit down with Dr. Kenneth Hovland, a retired Retina specialist with a vested interested in the history of Ophthalmology and preservation of historical eye artifacts. 

Special thanks to him for sharing his extensive knowledge and personal experience. 

Dr. Kenneth Hovland demonstrating the use of an Ophthalmoscope next to his display cases at the Rocky Mountain Lyon's Eye Institute.  Photograph courtesy of the UC Health Central Insider.

Meet Harold 

     Nicholas Harold Lloyd Ridley was born July 10, 1906 in Kibworth, England. Harold pursued medicine first as a general surgeon, eventually specializing in the eye, training at St Thomas' and Moorsfield Eye Hospital. In his earlier years as a practicing physician, he helped treat soldiers during WW2 and was eventually posted to West Africa and India through the Royal Army Medical Corps (RAMC). It was in his adventures abroad that he did important research in Onchocerciasis (commonly referred to as 'river blindness'), which called attention to the poorly understood disease. Additionally while in Africa, he experimented with dilute snake venom as a possible ocular anesthetic, eventually publishing his findings in the British Journal in 1944. Given his propensity for innovation and research, it is hardly a surprise that Harold went on to pioneer the first Intraocular Lens Implant (IOL), which we discuss in detail in the episode above. After much scrutiny from the Ophthalmological world, his invention was eventually widely accepted and implemented. Today, cataract removal is the most commonly performed surgery around the world; it is estimated that some 3.6 million occur yearly. This iconic physician died Sir Harold Ridley on May 25, 2001 at the age of 94. 

Dr. Harold Lloyd Ridley (1906 - 2001)

Clinical Vignette

A 28 year-old female presents at her Ophthalmology clinic for a routine eye exam. She has recently moved from North Carolina and is establishing care. She complains of gradual decrease in vision in her right eye over the course of the past year. 

 

Clinical Presentation:

 - Glare at night 

 - Difficulty seeing at distance (i.e. driving and watching TV)

 - Vision is 20/70 right eye, 20/20 left eye without correction 

 - IOP (intraocular pressure) 21/14 

 - History of trauma to the right eye  

 

You add 1 drop of Tropicamide into each eye to dilate the pupils. Upon reviewing her medical history, you note the childhood history of trauma in the right eye and inquire further as you wait for the patient's eyes to dilate. 

 

Patient: "Yes, lacrosse ball hit me in the right eye" 

Physician: "Were you treated at the time?"

Patient: "They did some sort of laser, I can't remember what"

Physician: "For the back of the eye?"

Patient: "I think so, something to do with my retina, but I can't remember the exact name of the procedure" 

Physician: "That's no problem, how old were you about?"

Patient: "Oh, I must have been around 14 years old" 

You suspect she had retinal laser procedure performed at the time and ask her to send records from her old office to confirm. In the meantime, you explain to her that she has cataracts obstructing her vision in the right eye. Her current vision meets the insurance requirement for cataract surgery in the right eye only; however, you explain to her that she will lose the natural accommodating power that allows her right eye to focus objects at both near and far. You review all the lens options with her: monofocal at distance, monofocal at near, multifocal, and monovision (https://www.aao.org/eye-health/diseases/cataracts-iol-implants to review these lenses). She is unsure and would like to review her options before deciding. 

Additionally, you explain to her that you cannot guarantee 20/20 vision, in part because of possible risks of surgery and especially given that the retina itself may be damaged from the prior lacrosse injury. She shows clear understanding of this. Finally, you discuss that her eye pressure is slightly above normal and that cataract removal may help with this. You diagnose her with "Ocular Hypertension" for the time being and explain that you will do some baseline testing to monitor her eye pressure and optic nerve following cataract surgery.

Further Reading

For more information on the disease itself: 

https://nei.nih.gov/health/cataract/cataract_facts

For more information on Harold Ridley himself:

1) https://www.ncbi.nlm.nih.gov/pubmed/8658339

2) https://bjo.bmj.com/content/85/9/1022

To watch cataract surgery

1) https://www.youtube.com/watch?v=2fnZCdtihG0

2) https://www.youtube.com/watch?v=icYLMmENk_c

Note: the youtube link shows the surgical operation and may be upsetting to some audiences. 

For images on this page:

1) http://eyesurgeon.sg/wp-content/uploads/2015/02/Harold-Ridley.jpg

2) http://www.ucdenver.edu/academics/colleges/medicalschool/departments/Ophthalmology/Documents/Eye%20Center%20Display%20Hovland.pdf

Images on this page are not the property of Medicalization

Credits

Hosts: Wafik and Jessica Sedhom

Guest appearances: Nate Zeile as Gordon Cleaver, Alex Moersen as Dr. Harold Ridley, and Dr. Kenneth Hovland as himself 

Written and Produced by: Wafik and Jessica Sedhom

Edited by: Wafik Sedhom

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