António Champalimaud Vision Award Winners

Dr Claes H Dohlman and Dr Gerrit RJ Melles were celebrated as recipients of the 2022 António Champalimaud Vision Award during a special session at ARVO 2023.

In opening remarks, Leonor Beleza said the Champalimaud Foundation was honoured and proud to recognise the two European physician-scientists whose work embodied the spirit of the United Nations Vision for Everyone resolution and opened new paths for treating those affected by corneal disease worldwide, giving sight back to millions of people.

New concepts on the corneal endothelium

In his award lecture, Dr Melles reflected on the question, “How would nature see our corneal triumphs?”.¹ He introduced new concepts on corneal physiology and Fuchs’ endothelial corneal dystrophy that he developed, recognising discrepancies between conventional teachings and clinical observation.

“More and more, I have come to believe the literature and textbooks do not agree with clinical observation,” Dr Melles said. “Clinical observation is something you cannot fake, and in the end, it is the truth.”

Dr Melles began his talk by challenging attendees to look at the cornea in a slightly different way after hearing his presentation. He discussed a new concept to describe corneal endothelial flow mechanisms involving a vertically oriented static flow and a horizontal dynamic flow perfusing the endothelium from limbus to limbus.

He also outlined evidence to support the idea Fuchs’ dystrophy is not an endothelial disease but rather a corneal glaucoma characterised by an exceptionally high imbibition pressure level. Dr Melles suggested the name may be a “framing error” that implies the condition is “an endothelial problem.” Regarding Fuchs’ dystrophy as a corneal glaucoma may not only be the correct perspective, he said, but understanding the mechanism underlying the corneal disorder may also be the key to understanding the mechanism of primary open-angle glaucoma.

The artificial cornea and other accomplishments

Dr Dohlman, who turned 100 years old in September 2022, appeared in a video presentation to summarise 50 years of translational work on the Boston Keratoprosthesis (B-KPro) artificial cornea. He recognised the award he was receiving was based on work done by his teams at Massachusetts Eye and Ear Hospital, Schepens Research Institute, and Harvard University in Boston.

The award recipient described the B-KPro as “a relatively new procedure” when considered in the history of attempts to create an artificial cornea. Its development began in the 1960s, and to date, about 20,000 B-KPros have been implanted worldwide.

After outlining selected design features and their value for improving outcomes, Dr Dohlman noted that certain complications remain a limiting factor in providing patients with good vision.

“The long-term sensitivity to secondary glaucoma, particularly in connection to any severe injury or corneal surgery, is concerning. Secondary glaucoma is, of course, irreversible,” he said.

He outlined how animal experiments led to the idea glaucoma development was mediated by intraocular inflammation with its associated increases in inflammatory cytokines, especially tumour necrosis factor alpha (TNFα). Preclinical research from his team also showed treatment with monoclonal antibodies directed against TNFα protected against retinal ganglion cell death, a major hallmark of glaucoma.

Dr Dohlman further posited rapid inflammation inside the eye after trauma and surgery has been underestimated as a major factor in long-term glaucoma development. Monoclonal antibodies should have great promise in preventing complications after surgery and trauma, which is no longer a minor matter.

Dr Reza Dana concluded the session with a tribute to Dr Dohlman.

Listing just some of Dr Dohlman’s accomplishments, Dr Dana recognised him for establishing the first cornea subspecialty clinic and training programme founded in science. He also highlighted how the environment created by Dr Dohlman and the generations of scientists he assembled led to major innovations that transformed ophthalmology.

Dr Dana went on to enumerate some of the contributions, including understanding the pathophysiology and management of herpetic keratitis; understanding the concept of stem cells for epithelial healing; the first clinical application in any tissue of stem cell transplantation; viscoelastic use in ocular surgery; cultivation of endothelial cells leading to cutting-edge technological alternatives to conventional transplants; development of drugs for ocular allergy; new contact lens technologies; elucidation of the pathophysiology of dry eye and the development of new treatments for dry eye; development of drug-eluting contact lenses and new biomaterials; expansion of corneal epithelial cells for clinical applications; new surgical techniques for refractive surgery; and development of novel treatments for reversing corneal scarring.

“Let us ask, ‘Where would we be today without these contributions?’” Dr Dana said.

ARVO 2023 took place in New Orleans, Louisiana, US.

For citation notes, see page 55.

Leonor Beleza is president of the board of directors of the Champalimaud Foundation.

Claes Dohlman MD, PhD is Professor of Ophthalmology, Emeritus, Harvard Medical School, Boston, Massachusetts, US. claes_dohlman@meei.harvard.edu

Gerrit RJ Melles MD, PhD is Director of the Netherlands Institute for Innovative Ocular Surgery, Rotterdam, Netherlands. melles@niios.nl

Reza Dana MD, MSc, MPH is Claes H Dohlman Professor of Ophthalmology, Harvard Medical School, Boston, Massachusetts, US. reza_dana@meei.harvard.edu