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Up Front | May 2005

David J. Apple, MD

Dr. Apple remarks on his special relationship with the late Sir Harold Ridley.

What was Sir Harold Ridley's impact on you, both as a physician and a person? Sir Harold Ridley invented the IOL in the 1940s, based on his WWII experience with airplane pilots' eye injuries. I did not hear of him until the early 1980s. My colleagues and I began working with IOLs in 1981, almost by serendipity. Our published research findings contributed to improvements in the quality of IOLs and helped them survive at a time when they were facing much criticism. In 1985, Ridley became aware of our articles and summoned me to visit him. That summer, while in Europe, I took a train to his retirement cottage near Salisbury. We became good personal and professional friends. Working with Rayner, Ltd. (Brighton Hove, England), the manufacturer of his first IOL, I helped him gain recognition, including the knighthood. His invention was changing the world, and I thought it was an incredible injustice that he was not being honored.

When did you begin working on Sir Harold Ridley's biography? I started thinking about it the day I met him. I visited his home two to three times per year. He would often retreat to his office and fetch different memorabilia and papers, which I collected over 15 years. About 5 years before he died, he asked me to pen his biographical memoirs for the Royal Society and to be his official biographer. After he passed, I worked with his son and spoke with many different people, especially those connected with WWII. We located the original airport near where Ridley had worked and found the medical records for the injured pilots. The book is the most exciting thing on which I am currently working. Publishing it will benefit ophthalmology; it will educate physicians as well as the public because the text will be disseminated to the general public as opposed to only ophthalmologists.

What led you to focus on posterior capsular opacification (PCO), and where do newer IOLs fit in? The incidence of PCO has gone down from approximately 50% to less than 10%. My colleagues and I have learned from our studies on 6,000 cadaver eyes that, whenever PCO is present, the surgeon has often done something wrong during the surgery that may cause additional, unrelated problems. Proper fixation of the lens in the capsular bag, effective cortical clean-up, and an intact capsulorhexis that is sized and shaped correctly all contribute to lowering the incidence of PCO. The surgeon also needs a biocompatible IOL that properly fits against the posterior capsule and has square edges. Observing PCO from behind in a cadaver eye with the Miyake-Apple video/photographic technique is like a technicolor picture that shows that something else important has gone wrong with the treatment. It is not simply a matter of zapping patients with a YAG laser. I am trying to elevate the importance of this concept.

What compelled you to become actively involved in tackling blindness on an international scope? I spent 3 months doing surgery in Nigeria during vacation periods of my residency and became aware of how problematic the affliction of blindness was, and remains, in developing countries. I was asked to join the board of the World Health Organization Center for the Prevention of Blindness. We had a major conference in Geneva, in 1990, where the issue of IOLs finally gained attention. I have made around 20 trips to developing countries. My biggest frustration is that the organizations dealing with some aspects of ophthalmology in the developing world are so bureaucratic that it is often difficult to obtain the appropriate authorizations to be permitted to work there and to apply correct techniques. I have cut back my involvement during the last few years because of my health. However, progress is being made as surgical techniques and IOLs are improving and more people are receiving better care.

What is your advice for the next generation of ophthalmic researchers? Many researchers work in chemistry, physiology, immunology, molecular biology (ie, the standard fields of investigation). Not much work is being done on the actual devices, prostheses, and artificial tissues that need to be developed. One of my concerns is that, when I retire, we may not have enough trained people in the field of biodevices. For example, to continue with the work we have begun would require an individual trained in three subspecialties: clinical ophthalmology, anatomic pathology, and biomedical engineering. I hope we can keep interesting young people to train in these fields. That would make me feel much better about my legacy.

For a downloadable pdf of this article, including Tables and Figures, click here.
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