The Founder of IOL Pathology
David was the first IOL pathologist. He was an “IOL doctor’s doctor”, as pathologists often are. He taught us to respect our heritage – those whose struggles to innovate enriched our abilities to care for our patients, but to remember: Most innovations fail. He also taught us to be cautious with the latest innovation, and to study the long-term effects of each new IOL or gadget, before fully accepting it. – Steve Arshinoff, MD. Toronto, Canada.*
David Joseph Apple, MD was a world-renowned expert in the fields of ocular pathology, cataract surgery, intraocular lens (IOL) implantation and refractive surgery. As an ophthalmic pathologist Apple pioneered research into the pathology of IOL complications. In addition to these professional accomplishments he was a medical historian and the official biographer of Sir Harold Ridley (1906 to 2001), the inventor of the intraocular lens (IOL).
In 1980 he joined Dr. Randal Olson’s group at University of Utah, Salt Lake City and with Dr. Olson he founded the Center for Intraocular Lens Research in Salt Lake City. During the 1980’s he perfected the Miyake-Apple technique – a method of sectioning the cadaver eye that had been initially developed by Kansatu Miyake MD. The eye is sectioned posterior to the posterior lens capsule and the anterior segment is mounted above a camera, which allows observation of the IOL in the capsule from a posterior view looking out on the world through the lens and cornea. In cadaver eyes, Apple and his colleagues were able to analyse the performance since implantation of IOLs made of different biomaterials and different lens designs.
His publications concerning the IOL studies and his review of the history of IOLs led to the publication of two major textbooks: Evolution of Intraocular Lenses in 1985 and Intraocular Lenses. Evolution, Designs, Complications, and Pathology in 1989.
Dr. Apple moved to South Carolina in 1988 to become Professor of Ophthalmology and Pathology, Professor and Chairman at the Storm Eye Institute, Medical University of South Carolina in Charleston. He held the Pawek-Vallotton Chair of Biomedical Engineering and was Director of the Center or Research on Ocular Therapeutics and Biodevices until 2002. During his Chairmanship of the Department of Ophthalmology in Charleston from 1988 to 1996 he successfully led the effort to raise $8.8 million to complete a three-floor expansion and general renovation of the Eye Institute.
Apple returned to Utah in 2002. He transferred his Center for Intraocular Lens Research back to Salt Lake City, Utah: the city where he had begun his career in the field of intraocular lens research.
His laboratory in Charleston (and at later sites: Salt Lake City, Sullivan’s Island and Heidelberg) was and remains an official Collaborating Center of the World Health Organisation’s Prevention of Blindness Programme. David Apple’s meeting in 1990 with WHO Programme director Dr. Bjorn Thylefors of the Prevent Blindness Division, eventually proved instrumental in providing information to WHO on the best type of intraocular lens should be used in cataract surgery in developing countries.
In co-authorship with Prof. Dr. Gottfried O.H. Naumann he published in 1990 Pathologie des Auges, a German-language ocular pathology textbook. He published the English version as Pathology of the Eye, in 1986. This opus led to one of his most favoured academic honours, his election in 2003 to the German Academy of Research in the Natural Sciences – Deutsche Akademie der Naturforscher (Leopoldina).
The Apple Korps
In what may prove the most enduring legacy, Prof. Apple trained over 200 students and doctors at the Charleston and Salt Lake City sites. These “students” are now in key positions in ophthalmic education and private practice throughout the world.
Apple himself counted that he had trained 211 research fellows and other researchers and he called them The Apple Korps.
- George Wyhinny, MD, from Chicago was the first member of this elite group.
- Guy Kleinmann, MD from Israel and Andreas Borkenstein MD of Graz, Austria were his last research fellows, at No.s 210 and 211 respectively.
The Amon-Apple Enhanced Square Edge
This IOL design feature is a mechanical barrier to cell proliferation at the haptic-optic junction of single-piece IOLs. Engineers at the renowned IOL-manufacturer Rayner first developed the Edge in 2003, after taking advice from the Austrian surgeon Prof. Michael Amon together with David Apple.
The design feature reduces Posterior Capsular Opacification (PCO) by creating an insurmountable physical barrier to lens epithelial cell migration from the haptic surface to the optic surface of the lens. Both Amon and Apple recognized in 2002 (through respectively a laboratory study on Centerflex minus power lenses and a clinical study of the regular power Centerflex lenses) that the Centerflex and all the modern single-piece IOLs in 2002 had such a weakness (which Apple termed the “Achilles heel”) at the haptic-optic junction: where there is no square edge and thus an incomplete barrier to PCO.
*Commemorative Lecture: David J. Apple The Father of IOL Pathology (at the 2012 annual meeting of ESCRS in Milan, Italy.)
Apple, David J (2006). Sir Harold Ridley and his fight for sight. Thorofare, NJ. SLACK Incorporated. ISBN 1-55642-786-7
David J Apple entry in Wikipedia.com