Look Back in Wonder

Technology, AI, robotics, big data, implanted intraocular pressure (IOP) sensors, state-of-the-art pumps as a replacement for drainage devices – these were a few of the forward-looking topics covered at the European Glaucoma Society (EGS) Congress in Dublin, Ireland at the beginning of this month (June 1–4, 2024).

A prescient glimpse of the near (and not-so-near) future is something we’ve come to expect from this celebrated glaucoma meeting. But the EGS event also takes time to look back and honor the visionaries whose achievements – sometimes decades-old – are still shaping the present. This year’s Jules François Lecture, for example, was given by ophthalmology legend (and Power List Hall of Famer) George Spaeth. Spaeth used the platform to impart a key lesson from his nearly 70-year career – the importance of remembering that “the entity clinicians ought to care for is not just the IOP, not just the visual field, but the whole person.”

Spaeth received a deserved standing ovation from the audience – as much, of course, for his long list of accomplishments as for his insights from the podium. But what about those innovators who might not be so well remembered?

This was the subject of a keynote speech by Roger Kneebone, Professor of Surgical Education and Engagement Science at Imperial College London. Kneebone has made it his  mission to track down and, where possible, engage with the practitioners who have not always graced the pages of the medical history books, but whose surgical influence has quietly spread far and wide. One such name is urologist John Wickham (1927-2017), whose use of early, self-constructed laparoscopic and Syclix-like devices in the 1980s was key to the development of keyhole surgery – later known as minimally invasive surgery. Wickham’s practices in this area were slow to catch on, however. (So were his endeavors in robotic surgery – he used the PROBOT to remove soft tissue from a patient back in 1991.)

Kneebone’s work highlights the value not just of revisiting the procedures of past surgeons, but also their surgical teams and other cogs in the machine, such as the medical device designers and manufacturers. Alluding to Thomas Kuhn’s seminal 1962 book, The Structure of Scientific Revolutions, he reminds us that progress is not a straightforward, upward trajectory of clean breakthroughs. Innovation is “messy;” it’s only when we read about it later does it become clearer, seemingly more deliberate, even pre-determined. We lose something, Kneebone concludes, if we forget or disregard the procedures of the past. To fuel and contextualize the innovations of the future, it is important to look back – both to the famed visionaries and to those unsung pioneers whose patchwork solutions proved to be ahead of their time.