Harold Ridley (ophthalmologist)

Sir Nicholas Harold Lloyd Ridley^[1][2] (10 July 1906, Kibworth Harcourt, Leicestershire – 25 May 2001, Salisbury, Wiltshire) was an English ophthalmologist who invented the intraocular lens and pioneered intraocular lens surgery for cataract patients.^[3][4][5]

Early years

Nicholas Harold Lloyd Ridley was the son of Nicholas Charles Ridley and his wife Margaret, née Parker; he had a younger brother, Olden. Harold had a stammer which he largely managed to cure. As a child he met and sat on the lap of Florence Nightingale, a close friend of his mother.^[3] He was educated at Charterhouse School before studying at Pembroke College, Cambridge from 1924–1927, and completed his medical training in 1930 at St Thomas' Hospital. Subsequently he worked as a surgeon at both St Thomas' Hospital and Moorfields Eye Hospital in London, specialising in ophthalmology. In 1938 Ridley was appointed full surgeon and consultant at Moorfields Hospital and later appointed consultant surgeon in 1946.

Cataract operations and intraocular lenses

First permanent insertion of intraocular lens, 8 February 1950

During World War II, Ridley saw Royal Air Force casualties with eye injuries, including Squadron Leader Gordon "Mouse" Cleaver of 601 Squadron. Ridley observed that when splinters of acrylic plastic from aircraft cockpit canopies became lodged in their eyes, this did not trigger inflammatory rejection as did glass splinters.

This led him to propose the use of artificial lenses made of Perspex in the eye, to treat cataract. He had a lens manufactured using the same material – brand name Perspex made by ICI – and on 29 November 1949 at St Thomas' Hospital, Harold Ridley achieved the first implant of an intraocular lens, although it was not until 8 February 1950 that he left an artificial lens permanently in place in an eye. The first lens was manufactured by the Rayner company of Brighton & Hove, East Sussex, a company which continues to manufacture and market modern, small-incision intraocular lenses today.

The first IOL implant in the United States was performed in 1952, a Ridley-Rayner lens implanted at the Wills Eye Hospital in Philadelphia.^[6]

Ridley pioneered this treatment in the face of prolonged strong opposition from the medical community. He worked hard to overcome complications, and had refined his technique by the late 1960s. With his pupil Peter Choyce he eventually achieved worldwide support for the technique. The intraocular lens was finally approved as "safe and effective" and approved for use in the US by the Food and Drug Administration in 1981. The first US Food and Drug Administration (FDA) approved lenses, (Choyce Mark VIII and Choyce Mark IX Anterior Chamber lenses) were manufactured by Rayner.^[7]

Cataract extraction surgery with intraocular lens implantation is now the most common type of eye surgery.

In 1987, Gordon "Mouse" Cleaver, whose injury in 1940 helped Ridley conceive the idea of using an acrylic intraocular lens, underwent cataract surgery and the implantation of such a lens to restore his sight.^[8]

Wartime service and ophthalmic research in wartime

Harold Ridley was in civilian hospital services in South East England during the early years of in World War II.- the time when saw injured pilots from the Battle of Britain.

In the middle years of the war he was with the R.A.M.C (Royal Army Medical Corps). and posted to West Africa and South East Asia.

• Onchocerciasis (River Blindness). While in Africa, Harold Ridley led important research^[9] into onchocerciasis when he was stationed in the Gold Coast, now Ghana, for part of his war service. In 1941 while Ridley acted as part-time sanitation officer at the capital city of Accra, he met Brigadier G. M. Findlay, AMS, who stimulated Ridley's interest to study River Blindness, an endemic disease in parts of the country. To find onchocerciasis patients, Ridley left the coastal city and travelled overland with Captain John Holden to north west Ghana. He worked in Funsi in the Wa East District of the Upper West Region for two weeks, examining patients with a slit-lamp, which ran off a 12-volt battery. Most (90%) had onchocerciasis; ten percent of them were blind. Conditions were primitive and Ridley recorded his observations of the retinal fundus by water-colour painting and photography. His painting of the fundus (sometimes termed the "Ridley fundus" of onchocerciasis) was completed in Accra upon his return from Funsi. "The attention he called to this disease constitutes one of Mr. Ridley's major contributions. His monograph "Ocular Onchocerciasis," published in 1945 in a supplement of the British Journal of Ophthalmology was a landmark."^[3][9]
• Snake Venom Ophthalmia. Writing as Major Harold Ridley, he published in 1944 a short paper in the British Journal of Ophthalmology on spitting snakes and an account on the composition and action of snake venom in general. From his own experiences in the Gold Coast, Ridley described snake venom ophthalmia in a 30 year old labourer, named Gogi Kumasi, who was cutting grass when a Black-necked cobra Naja nigricollis raised its head from the grass and forcibly spat venom toward the man’s right eye from a four or five feet distance. Ridley treated the man and followed his case until the eye had fully recovered - after about a week. After discussion on the therapeutic uses of snake venom, he conjectured that in the future diluted venom or a constituent of venom might be used as a powerful anaesthetic in some cases of ophthalmic surgery.^[10]
• Nutritional amblyopia. In 1944 Ridley was shifted to India after finishing 18-month service in Ghana. Just as in Africa, where he had made good use of his talents for medical observation in patients with onchocerciasis, in Burma he studied and treated malnourished former prisoners of war. His biographer David Apple reports Ridley’s own words: “In Calcutta, we basically had nothing to do with no assignments—a situation which continued after transfer to Parragan, near Calcutta. Finally, I was transferred to Rangoon, Burma, where life began again. I treated over 200 released allied prisoners of war in Rangoon and Singapore who suffered from nutritional amblyopia while Japanese prisoners of war. Many of the prisoners had worked on the Burma Railway. Starved and ill treated, they had developed sudden central scotoma, relieved by good diet if available. Some developed optic atrophy, some of whom made a partial recovery within 6 weeks of release. However, the advanced cases, though given a vitamin-rich diet were irreversible. I subsequently wrote an article on the topic of nutritional amblyopia.” His paper was published in 1945 with observations that were prescient. “It is uncertain whether disturbance in a visual pathway originates in the retina or optic nerve. Failure of the cortical capillaris to nourish the outer retinal layers at the macula may be significant.”^[11] The therapy he used anticipates the use today of multivitamins in ARMD patients. A logical therapy since the problems arise from malnutrition, Ridley used multivitamin therapy, returned them to a normal diet and then noted improvement in the prisoners’ condition. The Burma theatre of war permitted the first large population study of individuals with nutritional amblyopia - a total of over 500 within his region of which about 200 he personally examined and treated.^[11]

The International Intra-Ocular Implant Club (IIIC)

The Club was founded in 1966 by Ridley and Peter Choyce,^[7] to promote research in the field of IOL implantation.^[12][13] At that time there was widespread opposition in the profession to the use of IOLs.^[3] The founders saw the club as a forum to allow free and unhindered exchange of ideas about IOLs and implantation surgical techniques. From the outset it was international in its membership and set itself a parental and advisory role for the then nascent national societies to develop in each country for intraocular implant surgeons. However, this global role was only acknowledged in the name change in July 1975, when the Intra-Ocular Implant Club became The International Intra-Ocular Implant Club. (IIIC).^[12]

The Ridley Eye Foundation

In 1967 Ridley set up the Ridley Eye Foundation,^[14] to raise funds for cataract surgery in developing countries and to treat avoidable blindness.^[3] A registered charity under English law,^[15] this charitable organisation continues to be active in these fields today, notably in the Middle East.

Later life

Ridley retired from NHS hospital service in 1971.^[3]

In the 1990s he underwent successful bilateral intraocular lens implantation at St Thomas's Hospital by surgeon Mr. Michael Falcon. Thus Harold Ridley benefitted from his own invention and the operational procedure he had pioneered but what was most pleasing to him was that he had it done in the same hospital where he performed the first operation.^[4]

Sir Harold Ridley resided in Stapleford near Salisbury, Wiltshire until his death on 25 May 2001.

Recognition, Honours and awards

In the thirty years after implanting the first intraocular lens Ridley received scant thanks and recognition from his peers. That began to change in the last twenty years of his life when he finally received recognition as an inventor whose invention had restored the sight of millions of patients worldwide; finally he was honoured with a knighthood.^[16]

• In 1986 Harold Ridley was elected a Fellow of the Royal Society.^[1][3]
• His first academic honour was an honorary doctorate degree, Doctor of Humane Letters (DHL), conferred in 1989 by the Medical University of South Carolina, Charleston.
• In 1992, Ridley received the Gullstrand Medal (conferred by the Swedish Society of Medicine) named after the famous Swedish ophthalmic surgeon Allvar Gullstrand
• In 1994, he received the Gonin Medal (conferred by the Club Jules Gonin, Lausanne Switzerland) named after the renowned Swiss retinal surgeon Jules Gonin.
• In April 1999, at the annual meeting of the American Society of Cataract and Refractive Surgery in Seattle, Washington, Ridley was honoured in a special anniversary session as one of the most outstanding and influential ophthalmologists of the 20th century.
• Later the same year at the 1999 meeting of the European Society of Ophthalmology (Stockholm, July 1999) he was honoured and at the annual meeting of the European Society of Cataract and Refractive Surgery (Vienna, September 1999).
• Announced on 31 December 1999, the New Year Honours 2000 list for the United Kingdom and New Zealand included Harold Ridley as one of forty-five people accorded with the honour of Knight Bachelor, "for pioneering services to Cataract Surgery".^[17] Subsequently, at a ceremony in February 2000, he was knighted by HM Queen Elizabeth II at Buckingham Palace in London. This Millennium Honour was the culmination of years of lobbying work by Ridley's biographer (David J Apple), prominent surgeon friends such as Emanuel Rosen and Thomas Neuhann with leaders of industry such as Donald J Munro, Chairman and managing director of Rayner company of Brighton & Hove, UK.^[3]
• A Heritage Blue plaque to commemorate his groundbreaking work was installed in Kibworth Harcourt on 18 February 2012, thanks to the research carried out by Bob Haggerty, a local resident who has himself had an intraocular lens fitted, and supported by Kibworth Improvement Team (KiT), the local community partnership.^[18]
• A plaque in memory of Ridley is installed in the gardens of his alma mater Pembroke College, Cambridge, which plaque reads: “RIDLEY’S WALK / This plaque is placed in memory of Sir Harold Ridley FRS 1906-2001 / pioneer of intraocular lens surgery, graduate & benefactor of this College / after whose ancestor Bishop Nicholas Ridley, Master 1540-1553, / martyred 1555, this path is traditionally named”.
• In 2013, a biographical profile of Harold Ridley was included in a book called Saving Sight: An eye surgeon's look at life behind the mask and the heroes who changed the way we see, by Andrew Lam (author), M.D.^[19]

Film and TV

On 6 January 2016, during the television programme The One Show on BBC 1 a short film was shown about the link between Gordon Cleaver and Sir Harold Ridley. Using archive film and photographic material and an interview with Sir Harold’s son Nicholas Ridley, the Chairman of the Ridley Eye Foundation, Michael Mosely reported on the “Eureka moment” that led to the invention of the intraocular lens. The film was made by ICON FILMS, based in Bristol England

References

External links

• haroldridley.com site about the biography by David J. Apple, M.D.
• The Ridley Eye Foundation
• "A visionary recognised" profile marking the centenary of his birth in The Times 22 September 2006
• "A pioneer in the quest to eradicate world blindness" in the Bulletin of the World Health Organization 2003
• "He changed the world – So that we might better see it" in the Arquivos Brasileiros de Oftalmologia February 2002
• The Birth of the IOL part of the history of Rayner, manufacturer of the first IOL
• "Harold Ridley and the Invention of the IOL" in Survey of Ophthalmology January 1996