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Looking back on the innovation, insight of Charles Kelman
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Ophthalmology lost one of its greatest innovators and most unique personalities, Charles D. Kelman, MD, in 2004.
I was 17 years younger than Charlie but adopted phacoemulsification as my primary method of cataract removal in 1977, immediately following my residency and just 10 years after he performed the first procedure.
Phacoemulsification was preferred by far less than 1% of surgeons at this time, and intracapsular cataract extraction remained the procedure of choice. Innovation in cataract surgery was exploding with the first posterior chamber lenses, a very synergistic driver of phacoemulsification, being developed in the U.S. by the likes of Steve Shearing, John Sheets, William Harris, John Pearce, Bill Simcoe, Robert Sinskey and Richard Kratz. It was a very exciting time to be a young ophthalmologist interested in advancing the art and science of cataract surgery. Each of these luminaries became a friend and served as a teacher, mentor and inspiration to me.
In an issue of Ocular Surgery News immediately following Charlie’s death, representing our publication as chief medical editor, I wrote a brief tribute that his wife, Ann, later told me she felt captured his essence well. I will repeat those paragraphs here.
“Charles Kelman was an extraordinary man. An outstanding surgeon with the dexterity and skills to attract and treat the rich and famous and earn the respect of even his harshest critics. An inventive mind, he generated 100 patents and seminal work in cryoextraction of the human cataract, retinal cryopexy, small-incision cataract extraction by phacoemulsification, and phakic and aphakic lens implantation to name only a few.
“An entrepreneur par excellence. A leader and advocate for ophthalmology. A talented musician and entertainer. A skilled athlete excelling in his chosen sport, golf. A loyal and generous friend and teacher. A loving husband and father. A unique and special person.
“It was a joy to be a small part of his life. His legacy will be carried forward for generations by all of us whom he touched. We will miss him but he will always be a part of us.”
In 2003, just 1 year before his death, I moderated a round table published in OSN titled, “Courageous acts of curiosity spurred ophthalmologists as they developed specialty.” Charles Kelman was a participant in this round table, and I would like to share a few of his thoughts.
I asked him about his training at Wills Eye Hospital. He said: “The phrase that keeps coming to my mind is, ‘Life is what happens to you when you’re making other plans.’ Boy, that was sure true of me and my training. … I only wanted to play the saxophone or be a standup comic. And I was making my plans to do that, but life interfered and those things never happened, and so I continued along in my training.”
He continued: “The first thing that impressed me at Wills was the cataract wards. We had 20 to 30 patients on a ward. I saw vital, vigorous men and women in their 60s and 70s come in for cataract surgery. After a 10-day hospitalization, they walked out of the ward vegetables. … That was my impetus for trying to find a way to make cataract surgery an outpatient procedure. All of the cataracts I did at Wills I was always thinking, ‘Gee, there’s got to be a better way.’”
A psychologist might describe Charlie’s response to his unexpected entry into ophthalmology training as a perfect example of the classic teaching “bloom where you are planted.”
Later I asked him what it was like to introduce phacoemulsification to his fellow ophthalmologists. His response: “I can do it in one word: hell.” That he persisted in the face of severe personal and professional criticism is a testament to his character.
I asked him about how he started to train others in phacoemulsification and what were his main concerns. He stated: “My first concern, frankly, was not to let people perform the operation who I didn’t think were capable of doing it. … I gave three courses a month. Each was a week long. … There were 9 to 12 people in a class for a total of 36 per month. I did this for about 4 years, enabling a lot of people to go through the course.”
Today, we might call that a controlled launch, but in this case, it was all under the careful and direct supervision of the inventor himself.
In our closing paragraphs, I asked him what he saw in the future. He predicted refractive cataract surgery, multifocal and accommodating IOLs, and microincision cataract surgery through a 1-mm incision, all realities today.
His closing statement concerning the final arbiter of successful innovation has become a classic. Charles Kelman said to close out the round table: “I say, ‘While doctors debate, patients decide.’” That statement in my opinion rings as true today as ever in the past.