Time Machine: Chapter 30

Ophthalmology was revolutionized by the use of phacoemulsification to perform small-incision cataract surgery in the later decades of the 20th century. The ophthalmic phacoemulsification probe was a modification of the Cavitron ultrasonic dental cleaner. The technique of phacoemulsification was first published by Charles Kelman in July 1967 (1-3).

The events leading up to the 1967 publication have been shrouded in mystery, partly because, rather than stating the year that events occurred, Kelman dated them relative to when he received funding from the John A. Hartford Foundation. Moreover, he was awarded funding in December 1963, with the grant becoming active January 15, 1964, but in his writings he stated that these events occurred one year earlier (2,3).

Kelman wrote that his epiphany that the Cavitron ultrasonic cleaner could be used for eye surgery occurred at the office of his dentist, Larry Kuhn, who had employed his wife as a dental assistant prior to their marriage (2,3). Moreover, Kuhn assisted Kelman with early testing of the device.

Interestingly, at the time Kelman developed phacoemulsification in 1965, periodontist Ronald Odrich worked in the Kelman lab one day per week (2,3). Kelman and Odrich met because they were both jazz musicians. The same year (1967) that Kelman published that a dental tool (the Cavitron) could be modified and used for eye surgery, he and Odrich also published that an ophthalmic tool (the cryoprobe) could be used for dental applications (1,4). In fact, there are varying accounts regarding where and how Kelman’s epiphany occurred, who was in the room, and who said what (2,3). We may never know precisely what happened.

Although the story of Kelman’s epiphany has taken on somewhat mythic proportions in the minds of ophthalmologists and even among lay people, the epiphany was perhaps not Kelman’s greatest accomplishment. There were few people on the planet who could have turned that epiphany into a working product. Kelman received multiple rounds of significant funding from a nonprofit foundation. He got the Cavitron company to invest personnel and resources to the project. He worked with the engineers to modify the device based on his surgical experiments. He kept the project secret to prevent competitors from scooping him. He navigated some very tricky intellectual property issues. And after publication, he personally trained a generation of thought leaders (2,3).

Moreover, the story speaks to the importance of unsung heroes. Even though some details remain in doubt, it is undisputed that both dentists – Kuhn and Odrich – made contributions to the early phases of the phacoemulsification project. Neither of them sought to capitalize on their involvement for personal gain, and both of them supported and celebrated Kelman’s accomplishment.