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Remember 29th November!

Donald Munro Donald Munro Follow Nov 29, 2020 · 6 mins read
Remember 29th November!
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Today, 29th November 2020, marks the 71st anniversary of the first implantation of an intraocular lens (IOL) by Sir Harold Ridley in 1949.

The lens implantation took place at St Thomas’s Hospital in London on 29th November 1949. Harold Ridley always referred to this as the date of the first implantation. Mrs Doreen Ogg (née Clark) recalled assisting Mr Ridley as his theatre nurse on this date. Ridley had told her that the operation should be kept secret and not note it in the theatre logbook.

1949.

From Left to right, Mrs D Choyce, Peter Choyce, Harold Ridley, David Apple, Eric Arnott, Ian Collins and Donald Munro at ASCRS 1999 in Seattle - when the American Society marked 50 years of IOLs.

Here is David Apple’s account (from the notes for his biography of Harold Ridley - in our AppleLab archives) of what happened on that day.

Everything was ready and plans for the first implant were made for November 29, 1949. Although Harold was on the consulting staff of Moorfields and St. Thomas’s Hospital, he chose the latter for the first implant. There are varying theories as to why he did this. Some of his detractors feel that he was trying to hide his work from others. Ridley himself provides a more credible reason, namely that he could do his work in a quieter scientific fashion without interruption and he had chosen a staff that he approved of, including most importantly, his operating theatre nurse, Mrs Ogg (nee Clark). …

… it was a quiet day in London, with unusually good weather for November. Miss Clark, a young Florence Nightingale Nurse, was chosen by Ridley to play a pivotal role… In those days there were no fancy, modern operating microscopes, and the person who held the flashlight (torch).

Ridley’s absolute respect for the patients … is exemplified by a short quote that he penned for the foreword of my 1989 book on intraocular lenses as follows:

“We must not fail those two brave Londoners who, though well aware of the dangers, risk the loss of an eye so that our future patients might benefit. To them, ophthalmology owes a great debt: for all of us involved in the history of intraocular lenses, they are the true pioneers”.

Harold had planned on perhaps a two-year follow-up before publicizing his surgery. However, this was disrupted by a patient’s misreading of the telephone book. Seeking a postoperative visit, one of his patients came across the number of the office of Mr Frederick Ridley, (also an ophthalmologist, but no relation to Harold). When he presented himself to Frederick Ridley as a follow-up IOL patient, Frederick Ridley was, of course, surprised and indeed the secret was broken from then on. Therefore, Harold submitted his first publication in the proceedings of the St. Thomas’s hospital in order to assume priority and then proceeded to publish two important articles, one in the Lancet and the other in the transaction of the Ophthalmological Society of the U.K.

The correct date?

David Apple then talked of the date itself,

There is one slight matter regarding the timing of the operation that has been discussed and bears mentioning. Mr Ridley specifically asked Miss Clark to simply write the following in the operative logbook, “extracapsular ext”. He instructed her not to mention the IOL. He intended to keep the entire project under wraps at that time, both for scientific reasons and also, as he explained to me later, out of fear of some sort of retribution or legal process if things had gone wrong. This was probably the incorrect thing to do, but at that time, that was his decision and it turned out not to be problematic. Ridley always considered the first date of his surgery, therefore to be November 29, 1949, and indeed until his death, every publication he was involved stated this to be the date and this has been entrenched in the literature.

I myself was the first to possibly entertain a different date. Dr John Sims and I had noted that the implant had been a two-step procedure, the first step being the extracapsular extraction on November 29 and the second one a later insertion of the IOL after the eye had quieted down. However, Ridley apparently had lumped this together as one procedure and we left it as such. In 2001, the staff of St. Thomas’s noted the lack of mention of the lens implantation on November 29, 1949, but also the presence of a second operation on the same patient, on February 8, 1950, described as a lenticular graft. They considered this to be the date of the actual implant and a plaque was mounted on the wall at St. Thomas’s Hospital to this effect.

I would have left this totally at rest except for the fact that during my interviews with Mrs Ogg, she strongly insisted that an actual lens was implanted in the eye on the first date. It is difficult to doubt her statement since I found her to be an intelligent, reliable lady with an excellent memory. … It is clear that the operation started on the earlier date and that Ridley wished this to be the official date.

1999: the 50th anniversary

In 1999 Rayner (joint Managing Directors: Ian Collins and Donald Munro) held a scientific meeting followed by a banquet at the London Science Museum to mark the 50th of the IOL. For Rayners, 1999 was certainly the year to hold the event because it was fifty years after the first lens had been made for Ridley’s patient. In the summer and autumn of 1999, when we met with Harold Ridley, we asked him when we should the meeting take place. Ridley was clear that it had to be 29th November.

Thus fifty years after the first operation, on 29th November 1999, Harold and Elizabeth Ridely were the guests of honour at the London Science Museum. It was also the last formal occasion for a meeting of the pioneers of IOL surgery - Peter Choyce, Edward Epstein, Svyatoslav Fyodorov and Harold Ridley under one roof.

Also for Ridley, 1949 was the year he operated on his first IOL patient. There was no question about it or suggestion from him that another date would be the official date for the 50th celebrations,

The lens

The first lens was made of PMMA and manufactured by Rayner (it was not until 1978 that it became Rayner Intraocular Lenses Limited). This remarkable firm continues to make excellent IOLs, remains British and thrives as an independent, privately-owned company.

End.

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Donald Munro
Written by Donald Munro Follow
Donald J. Munro is the Business Development Director of the Laboratory, University of Heidelberg.