Phaco pioneers

Innovation versus the status quo, phaco surgery’s slow route to acceptance

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Phacoemulsification, now the treatment of choice and standard of care in cataract surgery, was by no means an overnight success. On the contrary, phaco met with considerable professional scepticism and institutional resistance in the early days, first in the US, then in the UK. But perhaps nowhere did the procedure meet with more initial hostility than in Germany. First introduced in the US by Dr Charles Kelman in 1967, phaco next appeared in the UK in the early 70s thanks to Mr Eric Arnott. Subsequently, a German surgeon in Bonn, Dr Michael Ulrich Dardenne, learned the procedure and became the first to perform it on the continent. Dr Dardenne began to perform the surgery in the early 1970s. In spite of having a reputation as an excellent surgeon, Dr Dardenne met a harsh response from the German medical establishment. He was accused of malpractice and unethical behaviour by the board of the Germany Ophthalmological Society (DOG). In 1981, the board took the extreme step of attempting to expel Dr Dardenne and end his career in eye surgery. Professor Thomas Neuhann, then in the early stages of his career, had a ringside seat. “You could write a book about this topic. Dr Dardenne was not the chairman of the department in Bonn. He was a senior staff person. Keep in mind that the German system at that time was extremely authoritarian and hierarchic. By doing something that was not explicitly approved, even clearly disapproved by the chairman, he committed the most deadly sin in the German university system at that time: not subduing to the classic personal and ‘crowd’ authority,” Dr Neuhann, in private practice and head of the eye department of the Re-Cross Hospital, Munich, told EuroTimes. In addition to challenging the status quo, Dr Dardenne’s “crimes” included making money from the new skill he had learned and stating publicly that the new technique was superior to the then state-of-the-art procedure performed by everybody else, namely ICCE, explained Dr Neuhann, a former president of the ESCRS. “There was also a lot of professional jealousy and academic arrogance – ‘If I haven’t invented it, it can’t be good – because, if it were, l would have invented it myself!!’ It seems the more fundamental the innovation, the more the resistance will be. This is not strictly a Teutonic characteristic, but is universally human: Just remember Derrick Vale’s apodictic statement in 1962 (!): ‘Cataract Surgery has been developed to its ultimate state and any improvements from this date on will be insignificant,’ and his outright condemnation of the innovation and the innovator, when Harold Ridley presented the artificial lens in the US,” he commented. Dr Dardenne survived the challenge from the establishment and went on to create a well regarded clinic. After visiting legendary cataract surgeon Richard Kratz, Dr Neuhann helped to legitimise phaco in Germany and is credited with many other important contributions to the field, not least the development of the capsulorhexis. Dr Thomas Neuhann: prof@neuhann.de
Tags: cataractg and refractive, phaco