What is your perspective on ophthalmology now that you are no longer practicing?
Ophthalmology offered me just the right combination of interaction with patients, surgery, and opportunities for product innovation. After 35 years of activity within the same profession, I felt it was appropriate to leave on a high note, rather than when my surgical skills were declining or when I had stopped learning new techniques and ideas. Improving ocular function and decreasing the incidence of ocular disease are a higher calling that will never become obsolete. The opportunities to combine new technologies in the surgical and biological arenas in order to improve eye care are breathtaking.
Of which of your contributions to the field are you the most proud?
When I was a corneal fellow at the Jules Stein Eye Institute in Los Angeles in 1978, I attended a lecture by José Barraquer, MD, during which he showed a film of a surgery named keratomileusis. During the procedure, he removed the front half of the cornea, lathed the frozen corneal disc according to the dictates of a programmable calculator to correct myopia, and then sutured the tissue back in place. I thought that this intricate and innovative surgery was the natural solution to the problem of refractive error, and I knew immediately that I had found my calling. Instinctively, I was attracted to the mechanical precision of the surgery instead of fearing its complexity. No one had ingrained in my mind that eye surgery had to be simple! Yet, within a few months of performing keratomileusis in San Diego, my team had converted keratomileusis into a routine 15-minute procedure.
I followed in the giant footsteps of Dr. Barraquer and Thomas Pettit, MD, my corneal fellowship mentor, who taught me the art and substance of corneal lamellar surgery. Refractive surgery has become an important aspect of ophthalmic surgery, because a small group of dedicated ophthalmologists fought for their dream by creative thinking and quality. Progress is difficult. Not all of the surgical techniques have stood the test of time, and frankly, a few of the refractive surgeons in the 1980s might not have had the best judgment.
I fought hard for my point of view, taught my techniques to other members of the profession who were interested, and never knowingly had a lapse in integrity within the profession or industry. I am proud of that record.
What was the biggest surprise of your career?
The biggest surprise of my career was the slow adoption of better surgical techniques by the majority of eye surgeons. For example, Kelman phacoemulsification took roughly 20 years (1972-1992) to be adopted by a majority of surgeons. A significant minority of surgeons still does not correct 2.00 to 3.00 D of astigmatism during or after a phaco procedure. The goal of modern anterior segment surgery should be best uncorrected visual acuity for the patient. For at least 15 years, PRK has been used successfully as the most effective means of correcting mild irregular astigmatism and improving the quality of visual function. I am surprised that the majority of refractive surgeons still does not use PRK for this purpose.
What was your most memorable international experience?
Once, I was asked to “assist” a surgeon with a new refractive technique in Europe. The surgeon promised to practice in advance, but when I arrived, the instrument was still in the wooden box with the packing straw sticking out. He took me to dinner at midnight. The next morning, we unpacked the instrument, the patient came into the OR, and television cameras rolled in. The surgeon left and went to a bar, drank wine, and watched the surgery on live national television while I performed it!
My hosts at the Barraquer Institute in Bogotá, Colombia, as well as those in Italy, Argentina, Israel, Saudi Arabia, Spain, Japan, Greece, and all the many other countries in which I have performed surgery and lectured were extremely gracious. I have great memories!
How do you spend your leisure time?
I have a barbeque area outside with a full-sized teppanyaki grill. I enjoy cooking fried rice for a group, followed by watching and performing sleight of hand up close magic tricks with coins, cards, beer bottles, business cards, rubber bands, etc. It is lots of fun.