OSN Associate Medical Editors discuss most important innovations of 1980s
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To celebrate the 40th anniversary of Healio/Ocular Surgery News, the Associate Medical Editors are sharing what they think are the most important ophthalmic innovations of the 1980s.
Glaucoma pharmacology
Leon W. Herndon Jr., MD: The history of glaucoma pharmacology begins in 1862 with the isolation of physostigmine from the West African Calabar bean, which caused pupils to constrict. It was initially used for miosis in iridectomy cases and was then found to lower IOP and break angle-closure attacks.
However, there were not many medical options for patients with glaucoma until the later part of the 20th century when drug discovery and development accelerated.
Propranolol was the first beta-blocker, introduced in 1967, and was quickly noted to lower IOP after oral, topical or intravenous administration. The drug was not viable as a topical agent, however, because of both corneal anesthetic properties and a negative effect on tear production. Other candidate beta-blockers had additional limitations, such as profound dry eye syndrome, subconjunctival fibrosis, corneal ulcers and tachyphylaxis.
In 1976, Merck’s timolol was shown to lower IOP in healthy volunteers, and over the next 2 years, Thom Zimmerman and Herb Kaufman spearheaded the development of topical timolol as a treatment for glaucoma after an initial report by Katz and colleagues that the drug lowered IOP in healthy volunteers. Merck’s Timoptic was approved by the FDA in 1978 and heralded the beginning of the modern age of glaucoma pharmacology.
For the next 20 years, timolol and similar compounds levobunolol, metipranolol and carteolol became the mainstay of initial clinical treatment for lowering IOP in glaucoma patients. These agents worked by suppression of aqueous humor formation and reduced IOP by about 20% to 25%. Timolol was used at once or twice daily dosing, there was no associated miosis, and there was no staining of the conjunctiva, all attributes that positioned timolol ahead of pilocarpine and epinephrine for most prescribers.
Soon after timolol’s debut, in the early 1980s, the relatively cardioselective beta-blocker betaxolol was approved for use in the United States. Betaxolol has a somewhat more favorable safety profile in patients with pulmonary disease, but the drug is generally regarded as less effective in lowering IOP compared with the nonselective beta-blockers.
Although these drugs have largely been displaced as first-line therapy by the prostaglandin analogs, they remain in common use as adjunctive therapy, and to this day, timolol remains an important glaucoma drug comparator in clinical trials.
- References:
- Katz IM, et al. Invest Ophthalmol. 1976;15(6):489-492.
- Krupin T. Autonomic drugs: controlling the inflow. In: van Buskirk EM, Shields MB, eds. 100 Years of Progress in Glaucoma. Lippincott-Raven; 1997:262-271.
- Takáts I, et al. Albrecht Von Graefes Arch Klin Exp Ophthalmol. 1972;doi:10.1007/BF00410765.
- Wettrell K, et al. Exp Eye Res. 1975;doi:10.1016/0014-4835(75)90126-8.
- Zimmerman TJ, et al. Arch Ophthalmol. 1977;doi:10.1001/archopht.1977.04450040071009.
IOLs
John A. Hovanesian, MD, FACS: In the 1980s, I needed hair gel. I don’t remember what that feels like anymore, but it was a wonderful decade to be in high school and college. I was pursuing medicine but was only vaguely aware of ophthalmology as a specialty because my mother had cataract surgery in about 1983 because of posterior subcapsular cataracts that developed in her early 50s. Her surgeon, a skilled private practitioner named Larry Hoffman in Farmington Hills, Michigan, used an exciting new technology called a posterior chamber IOL (PCIOL). Without any discussion, he targeted her dominant eye for distance and her other eye for near. It was the best gift she could have ever received. Until she passed away almost 3 decades later, she continuously sung his praises and almost never wore glasses.
Dr. Hoffman was well ahead of his time by using a PCIOL and targeting spectacle freedom. Although Harold Ridley’s first IOL was implanted more than 30 years earlier in 1949, these devices were not well accepted by the ophthalmic community until the 1980s; indeed, their acceptance was the most important development of the decade.
Unlike today, in which most private practices working with technology companies bring new technology to light, in those days it was academic institutions that gave “permission” for new clinical trends. The slowness of those institutions to adopt new technologies was the driving force for the formation of the organization that became today’s American Society of Cataract and Refractive Surgery.
The academics were certainly not all wrong. The first lens implants were fraught with complications such as pseudophakic bullous keratopathy, uveitis-glaucoma-hyphema syndrome and pain. We did not have the SRK formula — the simplest linear regression equation — until 1980. That Larry Hoffman gave my mother such satisfactory vision was not only a testament to his skill but also a bit of luck. That IOLs grew in popularity was a glimpse of medicine’s future megatrend of drugs and devices to keep us young.
Corneal refractive surgery
Elizabeth Yeu, MD: The 1980s brought forth truly game-changing medical and surgical disruptive innovations in the area of refractive eye care. Medically, disposable soft contact lenses were a brainchild innovation of the ’80s, as was the addition of plastic to spectacle eyewear.
A huge disruption occurred, spanning the 1980s, with corneal refractive surgery. While Fyodorov created and popularized radial keratotomy surgery in the late 1970s, this spread through the 1980s and spawned the next generation of corneal-based refractive surgery. Upon creation of lasers in general, this was then applied through excimer laser ablative surgery, with PRK trials being performed in the U.S. and Canada in the late 1980s, with FDA approval received in 1995. Furthermore, the first U.S. patent for LASIK surgery is credited to Dr. Gholam Peyman in 1989.
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