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A Tribute To The Father of Modern Day IOL Implantation - Sir Harold Ridley

How far can a child born with stammer, shy of communication, and overcast in the shadows of a more meritorious elder brother, go ? Well, far enough to earn him respect, admiration, and remembrance the world over even after a decade and half after his death.

Sir Harold Ridley, born in Leicestershire in 1906, was perhaps destined to be drawn in the service of mankind when he started his journey as a small child playing with Florence Nightangle, a close friend of his mother, Nee Parker. The infant Ridley dandled on Florence Nightangle's knees, as Florence played gleefully with her friends child.

His father, Charles Ridley, who was a brilliant student himself aspired to be a General Surgeon. Unfortunately, with a very crippling arthritis, his father was compelled to shift to eye practice, a profession less attractive in those days. Born of an accomplished eye professional, Sir Ridley had to become an eye surgeon, though he was more fascinated to be a Barrister as an young. The question of an artificial lens played in Sir Ridleys mind ever since he graduated and earned his basic medical degrees. An evidence to this is found in his biography, where the young Ridley is recorded to have questioned his father of the possibility of replacing his cataractous lens when he was accompanying Charles for the later's lecture in Oxford in the year 1930-31. In July 1932, Ridley earned his FRCS at the youngest eligible age of 25, and thereafter travelled as a ship doctor for a year or two.

Perhaps the exposure as a ship doctor travelling to unknown places, infused in the young a sense of innovation - to see beyond the horizon. During this time, and due to his stammer, his communication suffered, though he started to blossom as an eye surgeon. Surgery became his art of communication with patients and beyond. His surgical skills started winning him name all over. Later joining an eighteen month residency in the famous Moorfields Eye Hospital, the young Ridley became the blue eyed boy of the institute. He became a very early consultant of Moorfields at a young age of 32 years. But little did he know, that he would be destined to oppose the views of his more illustrious senior, Sir Stewart Duke Elder, when he would start experimenting with a concept, little acknowledged during the time - the concept of replacing aphakia with pseudophakia.

During the war of Britain dragged against Germany, Flight Lt Clever rushed to his aircraft, but his aircraft would not start. Sensing his time was running out, he rushed to another, forgetting the goggles in a hurry. His aircraft was fired at, an the splinter from the canopies damaged the eye. Lt Clever was rushed to Moorefields and referred to Sir Stuart Duke Elder. Sir Duke Elder referred for surgery to the junior - Harlod Ridley.

What was a destructive piece of foreign body for anybody else, was a source of inspiration and hope for the young Ridley. He found that the piece of canopy did not cause any harm to Lt Clever's eye. He called other fighter pilots with similar injuries and observed them. His observation was similar. The plastic was light and transparent. It occurred to him that why can not the cataract lens be replaced with a lens with similar material. Thus was born the nascent idea of modern day Intra Ocular Lens.

The dark clouds of World War was hovering, and so did an emerging fight between Sir Duke Elder and Harold Ridley, over the later's idea of challenging existing practices. Ridley was posted to Ghana, a place where he could do little to further sharpen his surgical skills. What is exciting for Indians is to know that Ridley travelled to Pune and Calcutta a little after then. He worked in Burma ( now Mynammar ) and cured Chinese prisoners of war suffering from nutritional blindness. Thus was born in Ridley an affection, a sense of belonging and an understanding of the much deprived British colonial world in Asia.

On his return, Ridley established his practice at the 53 Harley Street, now famous for reasons obvious to readers. He worked with Marconi Electronics to televise his surgery in first black and white and then coloured. He developed electronic ophthalmoscopy in association with the company Rayner.

The Intra Ocular Lens during this time of his career was not a new idea to Ridley, but a sense of courage and fight against established aphakic practices was beginning to merge in. The final push came from Steve Perry, a medical student, watching Ridley's cataract surgery. Steve remarked that it was a pity that the cataractous lens could not be replaced by an artificial lens as a compliment to the great surgical hands of Ridley.

Ridley, ICI company, and Rayner joined hands to make the first medical grade PMMA lens to be implanted in an eye. To keep the project living, all of them gave up any financial right and took it as a challenge to the service of mankind, an act which is far from believable in today's world of patents and copyright. The project was delayed by one year in search of the ideal patient - an unilateral traumatic cataract. The patient had to agree to an unknown risk of an amateur experiment. The left eye of a 45 year old lady was choosen as the first case.

A history was scripted at St Thomas Hospital in London, on the 29th of November, 1949. But the result was far from satisfactory. The patient had an huge refractive surprise and the fixation was unstable. The trio was quick to act. They made necessary changes and exchanged the IOL with a new one on 5th February, 1950. This was also the first explantation and re implantation of IOL, all by Ridley. The eye was quiet and had a vision of 6/18. It is recorded that Ridley had done eight operations within an year, with one of the case recording 6/6, unaided. Sir Ridley was born.

Like many other path breaking innovations however, Sir Ridley was ridiculed and criticised in the Oxford Congress of 1951. The criticism was largely led by Sir Duke Elder. Dismissed at home, Sir Ridley was widely accepted in the United States. It started all with the first lecture of Sir Ridley at the annual meeting of Chicago Ophthalmic Congress.

Peace is beautiful, but war brings us change. War relives itself in creation. Destruction preludes creativity. The fight between the Sir Harold Ridley and Sir Duke Elder, gave the world of Ophthalmology two gifts that would help medical science leapfrog towards modernity. While Sir Harold Ridley gave us the Intra Ocular Lens, Sir Duke Elder gifted us with a library of Ophthalmic books- encyclopedia and bible of ophthalmic academicians.

In his career Sir Harold Ridley is said to have implanted over a thousand IOLs. As IOL implantation in the following decades slowly started to get accepted, it remained largely an art. Slowly afterwards, and throughout eighties of the last decade, the art of IOL implantation however was destined to be transformed into a science, through the efforts of another legend in ophthalmic history - Sir David Apple, thus turning the wheel full circle.


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