Table of Contents and Excerpt From Chapter One

Chapter One
LUCKY

Chapter Two | “This operation should never be done.”
HAROLD RIDLEY AND THE INTRAOCULAR LENS

Chapter Three | “The delicious sensation of that ultrasonic probe against my teeth…”
CHARLES KELMAN AND PHACOEMULSIFICATION

Chapter Four | “I did not want to be considered a military hero.”
CHARLES SCHEPENS AND THE BINOCULAR INDIRECT OPHTHALMOSCOPE

Chapter Five | Eighteen out of Twenty-one.
ARNALL PATZ, RETINOPATHY OF PREMATURITY, AND A LOOMING CRISIS

Chapter Six | “Whaddya mean it’s a shot? In my eye?”
JUDAH FOLKMAN, ANGIOGENESIS, AND THE TREATMENT OF WET MACULAR DEGENERATION

Chapter Seven | “I really do want to see the alarm clock in the morning.”
THE EVOLUTION OF REFRACTIVE SURGERY

Chapter Eight | “If I cannot discover a way to read and write… I shall kill myself.”
LOUIS BRAILLE AND NIGHTWRITING

Chapter Nine
VISIONARIES

ACKNOWLEDGEMENTS
NOTES
BIBLIOGRAPHY

Chapter One | LUCKY

I was still outside, but I could hear her yelling.

“I knew something like this would happen! Why’d you tell him to go work at that place? Why?”

An African American couple, huddled close at the center of the deserted hospital lobby.

Glass doors slid apart and I walked in from a cold, dark February night in Philadelphia.

“Do you realize he’s gonna be BLIND?” the woman shouted.

I couldn’t keep myself from looking. She was petite. Little clumps of unmelted snow lined the furrows between her tightly braided cornrows. Her harsh stare bore into the chastened man, and now, up close, I could see the tears running down her cheeks.

“Why’d they let him use that machine? Didn’t he wear safety glasses? Oh my God! My son’s gonna be blind!”

Even at a distance, her diatribe made the few people in the Emergency Room’s waiting area cringe. I cringed too, because now I knew this woman’s son was the one I had been called in to see.

I entered the treatment area and steeled myself.

Our hospital was an eye hospital, and our Emergency Room was one of the few in the country solely dedicated to eye care. Normally, the scene inside was hectic, with nurses trotting back and forth and residents rushing between rooms or to the phone to accept referrals from outside hospitals. And even when it wasn’t crowded with patients, there was always an energetic vibe about the place, buoyed by the upbeat nurses and a close camaraderie among residents who labored through the intense training program together.

This time, however, everything was different.

The space was deathly still and silent, except for the isolated shouts of the mother in the lobby. The door to exam room two was shut. Madeline, a wise-cracking nurse in her sixties who’d worked here for years and seen all manner of horrific eye injuries, now looked serious and sullen. She glanced at me sympathetically as she walked by.

“Hi Andrew, thanks for coming,” said Theresa, the first year ophthalmology resident. Her hair was disheveled. I could tell she was tired from being on duty for over twelve hours already.

“What’s going on?”

“It looks really bad…” She pointed to the closed door. “Auto mechanic. Definitely ruptured.”

I sighed. It was late on a Saturday night. I was not going to get much sleep.

“How?”

“He was grinding metal. No safety glasses.”

I nodded. Behind me I heard Madeline call the patient’s parents in from the lobby. She took them into room two and closed the door, which did little to mute the sound of the mother’s exclamations. She was really upset. I was about to enter a lion’s den.

I knocked, opened the door. Jacob was a stocky thirty-four year old. His name was stitched onto an oval patch affixed to the chest of his gray, grease-stained overalls. I couldn’t see his face at first because he was bent forward in the exam chair, moaning quietly. I came closer. Rivulets of blood and tears ran down his cheek from under the plastic shield that had been taped over his left eye.

“Hello everyone. I’m Doctor Lam, the retina fellow.” I’d already completed my ophthalmology residency but was in the middle of specialty training for retinal surgery.

The woman grasped my outstretched hand. “Please, save my son’s eye,” she pleaded. Even though there was an extra chair, the father stood in one corner with his arms tightly crossed and his shoulders drawn in as if bracing himself for a grenade blast.

“I’m very sorry we’re having to meet like this,” I said, turning to Jacob. “I understand you were hit in the eye with a piece of metal this afternoon. Let me take a look and see what’s going on.”

I gently removed the shield and immediately saw that the left eye was ruptured. It looked like a squashed grape.
“Jacob, I’m going to check your vision now.”

He struggled to open his eyelids a little. “It’s really dark, Doc.”

“Let’s just see what it is.” I covered his good eye and held two fingers in front of his face. “Can you see how many fingers I’m holding up?”

Jacob shook his head.

I waved my hand in front of him.

“Can you see my hand moving?”

He squinted, then nodded. “I can see a shadow moving.”

I sat down facing him and carefully positioned his head into the frame of a table-mounted microscope called a slit lamp. I gently opened his lids and looked through the scope.

Oh crap.

At first I thought the cornea was missing. All I saw was a black blob mixed with some dark brown iris tissue. Had the contents of the eye been expulsed? I’d never seen that before, but I knew it could happen if the patient coughed violently or vomited while his eye was ruptured like this.

I drew a deep breath and looked closer. Wait. Now I could make out the torn edges of a huge laceration, starting in the center of the cornea and extending laterally, beyond the edge of the cornea and into the sclera. How far back did it go? I couldn’t tell; it was a bloody mess. The normally white sclera and conjunctiva of the eye were torn, swollen, and beefy red. I realized the dark blob in the center was mostly clotted blood. It was impossible to see the lens or anything else in the back of the eye.

Can this eye be saved?

I wasn’t optimistic.

“Did you happen to find the piece of metal that hit you?” I asked. “I mean, was it a big piece that might have bounced off, or a tiny piece that could have gone into the eye?”

There was an uncomfortable moment of silence.

“Well, what was it?” the mother abruptly lashed out. Her husband winced. He was shorter than his son, with “Elvis” sideburns and a receding hairline. Staring at the floor, he muttered, “I don’t know. I didn’t see it. I didn’t look.”
The mother threw up her hands and groaned.

The father looked at me with quiet, desperate eyes. “Do you need me to go back and try to find it?”

“Don’t worry about it. We’ll get a CT scan to see if there’s anything in the eye now.”

I answered some of their questions and went back out to make sure Theresa had started antibiotics and anti-nausea medications.

Forty-five minutes later, we slapped the CT films up on the light box. In the middle of the eye cavity, on practically every cut of the scan, there was a large reflective object, shining bright like an exploding supernova. A child could have diagnosed it. The metal was still in the eye. I didn’t see a posterior exit wound, damage to the optic nerve, or any brain injury.

Can this eye be saved? I asked myself again. Nine out of ten ophthalmologists would have probably said, No, don’t even bother trying to put it back together. Just go straight to enucleation. Removing the eye entirely would eliminate the risk of sympathetic ophthalmia, a rare inflammatory condition in which severe trauma to one eye induces the body’s immune system to attack the fellow eye. Plus, artificial eyes look so good these days, many might say. It’s true that a prosthetic eye would probably look far better than whatever I might be able to do with Jacob’s shredded eye. No one would fault me for telling the resident to call in the oculoplastic surgeon to remove the eye. Enucleation was almost inevitable in cases like this. I could be home and back in bed in less than an hour.

Except that we were at the famous Wills Eye Hospital. The nation’s first eye hospital and the institution of last resort for countless patients. The culture of the place was to always try to save the eye. If nothing else, this would give Jacob some time to psychologically prepare for the loss of his eye.

Except that this was probably the worst rupture I’d ever seen.

I went back in to talk to the family.

“Jacob has a ruptured eyeball,” I told them. “The metal is still in there. I’ve got to be honest, I’m not sure we can save this eye – ” The mother gasped. I slid closer to her and put my hand on her shoulder. “But we’re willing to try. We can do a surgery tonight to try to remove the metal and sew up the wound. I promise we’ll do everything we can.”

The mother cried softly as I patted her shoulder, thinking it odd to be comforting her while her injured son sat in stoic silence. Then I thought about how I would feel if my son was about to go into surgery, against long odds, and we sat there, all of us, in silence for a while.

Before I left Jacob said only one other thing. “I trust you, Doc. Thanks for helping me.”