From the sky to the eye: Fascinating journey of the first intraocular lens
Year: 2025
Type: article
Abstract: Perhaps no other event has had such a huge impact on the evolution of Ophthalmology as the implantation of the first intraocular lens by the British ophthalmologist, Sir Harold Ridley [Figure 1], on November 29, 1949.[1] This edition presents the fascinating story that led to the successful implantation of the first intraocular lens, an event that has made a paradigm shift in the way millions of eyes perceive vision.Figure 1: Sir Nicholas Harold Lloyd RidleyThe era of intraocular lens implantation for cataracts started with the power of an idea, followed by astute observations and relentless pursuit of the idea in the most challenging of times. Harold Ridley, when working as the eye surgeon at St. Thomas Hospital during the Second World War, had the opportunity to examine a young British war pilot, Gordon Cleaver [Figure 2].[2] Machine gun fires had shattered his cockpit canopy, and splinters of perspex had destroyed his one eye and had severely damaged the other. The story goes that it was a chance question by his student, Steve Parry, that aroused in Ridley the inspiration toward an invention that was to mark the century. Steve Parry on seeing his first cataract removal surgery exclaimed, ‘“It’s a pity you can’t replace the cataract with a clear lens!”[1] Ridley began to ponder over this and observed that even when the cockpit pieces of perspex were inside the eye of the pilot Gordon Cleaver as an intraocular foreign body, they did not elicit any untoward reaction inside his eye. Therefore, would it be possible to use the same material to replace the human crystalline lens following cataract surgery? After the war was over, Ridley was toying with this idea and persuaded his partner John Pike, the senior optical scientist at Rayner Intraocular lenses, to design the first implantable intraocular lens.Figure 2: British war pilot Gordon Cleaver who inadvertently inspired Dr. Harold Ridley to invent the first intraocular lensOn November 29, 1949, Ridley performed the first intraocular lens implantation [Figure 3] on a 42-year-old hospital nurse, Elisabeth Atwood, who volunteered for the procedure at St. Thomas Hospital, London,[3] with an intraocular lens made of the material ICI perspex CQ and this event marked a new era in the history of Ophthalmology.[4]Figure 3: Photograph extracted from an original video tape of Ridley’s eighth IOL implantation, performed at St. Thomas’ Hospital, May 8, 1951, showing the intraocular lens being inserted through extracapsular cataract extraction incision. This patient had 20/20 vision postoperativelyHarold Ridley was born on July 10, 1906, as the eldest son of a naval surgeon who specialized in Ophthalmology at Kibworth Harcourt, Leicestershire, England. He studied at Charter-house school and then Natural Sciences at Pembroke College, Cambridge, and qualified as a medical doctor from St. Thomas Hospital Medical School, London. He decided to specialize in Ophthalmology and became a consultant at Moorfields Eye Hospital, London, in 1938. He was commissioned in the Second World War as a Major in the Royal Army Medical Corps and was posted in Ghana in 1942, where he made important observations regarding Onchocerciasis. Before going to Africa, Ridley had made observations about the inert nature of perspex inside the eyes of pilots injured during air strikes. He was debating with the idea of an ‘inert’ lens which could replace the cataractous lens and his observations on Gordon Cleaver’s progress and the observations on many other pilots who had sustained perspex foreign bodies during air strikes, which threw some light on a rather dark path. Ridley envisioned about an intraocular refractive device at a time when the accepted mode of treating cataracts was to remove the cataractous lens and to provide aphakic correction in the form of spectacles. Fearing harsh criticism from the conservative medical professionals, Ridley had kept his work under cover and had repeated the process a few times in 18 months before the news leaked out. He was faced with ridicule, rejection, and professional spite for placing a ‘foreign body’ inside the eye. There was severe opposition to inserting a new foreign body into the eye, and the medical fraternity viewed it as a dangerous, unnatural, and technically impossible idea.[5] However, Ridley had support and commanded respect from some progressive and brilliant young ophthalmologists, including Peter Choyce, Eric Arnott, Neil Dallas, and Michael Roper-Hall, in Europe, the United States, and the Soviet Union, who carried forward the idea of intraocular lens implantation. By 1970s, cataract surgery with intraocular lens had been established as a routine and safe treatment or restoring vision after cataract surgery. Since then, intraocular lenses have changed the way in which millions of people see the world and have been an area with continuous evolution in fine tuning of the design. Today, cataract surgery with intraocular lens implantation is the most frequent surgery with widespread economic implications including improvement in quality of lives of the patients and a billion-dollar industry supporting its manufacturing and refinement. Apart from the invention of intraocular lens, Ridley showed amazing foresight, creativity, and innovation in many other areas. He was a pioneer researcher in the field of Onchocerciasis[6] and ocular involvement in leprosy and the first to televise eye surgeries and to advocate the technique of telediagnosis and to devise a system of posterior segment examination using electronic devices.[7] However, much later, his contributions were eventually recognized by the establishment with the glory it truly deserved. In 1986, 3 years after his 80th birthday, Ridley was elected to the Fellowship of the Royal Society.[5] The following year, he was awarded the Gullstrand Medal by the Swedish Society of Medicine[5] and he was knighted in 2000. In the 1990s, he underwent successful bilateral intraocular lens implantation at St Thomas’s Hospital by the surgeon Michael Falcon, after which he reflected that “I am the only man to have invented his own operation!” The story came to a full circle when Gordon Cleaver, the war pilot who was responsible for inadvertently inspiring the journey toward the first intraocular lens, underwent cataract surgery with intraocular lens implantation in his only eye in 1991 and died in 1997, with good eye sight. Sir Nicholas Harold Lloyd Ridley, whose astute observations and the courage to follow his idea relentlessly despite horrendous opposition, paved the way to the highly specialized cataract surgeries today, died on May 25, 2001, at the ripe age of 95. His wonderful invention still continues to help millions of people across the globe to see the world with astounding clarity. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Source: Kerala Journal of Ophthalmology
Author: Sanitha Sathyan
Language: English
Subfield: Ophthalmology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4409623904