2014 Jan F. Worst Lectureship and Dinner
Saturday, April 27, 2014
The Harvard Club
Mission and History of the IIIC
The Intra-Ocular Implant Club was founded in 1966 to
– promote research in the field of intraocular lens implantation;
– allow for the free and unhindered exchange of ideas concerning anterior segment intraocular implantation;
– provide an international forum to improve the understanding of intraocular lens implants and
– promote implantation surgery; and
– sponsor and advise national societies as they develop.
The inaugural meeting on July 14, 1966 in London, England, was organized by Sir Harold Ridley and D. Peter Choyce. The photograph below shows 14 founders and 2 guests who were attending the meeting:
John Pike (Rayner, UK), Robert Murto (USA) - guest, Michael Roper-Hall (Birmingham, UK), Svyatoslav Fyodorov (Moscow, USSR), Neil Dallas (Bristol, UK), C. A. (Sandy) Brown (Bristol, UK), Alexander Rubinstein (Birmingham, UK), Warren S. Reese (Wills Eye Hospital, Philadelphia, USA), Leonard Lurie (London, UK).
Jörn Boberg-Ans (Charlottenlund, Denmark), Cees Binkhorst (Terneuzen, Netherlands), D. Peter Choyce (Moorfields, London,UK), Harold Ridley (Moorfields, London, UK), Benedetto Strampelli (Rome, Italy), Edward Epstein (Johannesburg, South Africa), Sonja Boberg-Ans (Charlottenlund, Denmark) - guest.
In July 1975, the Intra-Ocular Implant Club is re-named The International Intra-Ocular Implant Club.
In November of 2011, The International Intra-Ocular Implant Club became incorporated as a Private Limited Company.
by Michael J. Roper-Hall
Excerpts from his 2007 IIIC Medal Lecture given at the IIIC dinner meeting in Stockholm
Harold Ridley broke the news of his "intra-ocular acrylic lens” in 1950. I remember the excitement this caused in London at the first post-war International Ophthalmological Congress. I was at that meeting and at the Oxford Ophthalmological Congress when he spoke of the results of his first 8 cases. Later that year he permitted me see him operate at St Thomas’ Hospital. I was receptive to his concept as I had been working on the prognosis in a large series of intra-ocular foreign bodies, which was my thesis for a ChM degree awarded in 1952 and knew that some FBs were retained indefinitely without late complications.
During the following years my main interest was the management of ocular trauma. Damage often involved the cornea and lens of one eye with consequent loss of binocular vision. A contact lens was not proving to be a satisfactory solution for the correction of unilateral aphakia, but an intraocular lens or keratoprosthesis would offer a better prospect of recovery of binocular vision. I was using polymethylmethacrylate (PMMA) for orbital implants to give movement to an artificial eye, so I knew that this material was clinically inert in tissue. In 1957 I was, by a few months, the first ophthalmic surgeon in England to use an operating microscope ( OpMi I).
I attended the Oxford Congress in 1958 when Cornelius Binkhorst read a paper introducing his iris supported lens, and Joaquin Barraquer described excellent results in over 300 of his own patients using Strampelli and modified Dannheim anterior chamber lenses.
In 1965 at the IIIrd Barraquer Course, Joaquin Barraquer reported disastrous complications which caused him and many other surgeons to abandon Intraocular Lens surgery. I was disappointed with my own small experience using intraocular lenses of the Choyce/Strampelli type. At the same time Binkhorst alone was reporting favourable results, but was heavily criticized during a panel discussion on Intraocular Lenses. I talked with him sympathetically during the coffee break afterwards and he assured me that he was encouraged by getting good results with his 4-loop Intraocular Lens.
This was a time when established ophthalmology was hostile to the use of intraocular implants and led to an invitation by Harold Ridley and Peter Choyce for a group of us to meet at the Royal Society of Medicine in London on 14th July 1966 to discuss our experiences. The program included papers with almost equal emphasis on intra-ocular lenses and keratoprosthesis. At the end of the meeting we all agreed to establish the Intra-Ocular Implant Club (IIC), which later became the International Intra-Ocular Implant Club (IIIC). The group was then mutually supportive against the hostility of the establishment. 1966 was an important year; it saw the beginning of 2 pioneering groups. Only Boberg Ans and I participated at both. One was the IIC; the other was the International Ophthalmic Microsurgery Group which had its first meeting at Tübingen, Germany in August. Both were catalytic in introducing a substantial change to established ophthalmic surgery. It took time. Intraocular Lenses were controversial and Microsurgery considered an unnecessary super-specialisation. 10 years later they were both generally accepted.
IOLs and KPros held equal attention at the first implant meeting in 1966. IOLs had serious setbacks with over-enthusiasm and faulty designs, but came through to be the universally accepted management of cataract in wealthy countries. KPro deals with a different cohort; many patients are deprived. There is little or no commercial reward; thus no incentive for manufacturers to produce the implants.
I was fortunate to be in the right place at the right time. I was already using the operating microscope. In Birmingham my seniors were open-minded about implants. I never had to face the hostility and isolation suffered by Ridley, Strampelli, Binkhorst, Boberg Ans, Epstein, and Choyce, but I was in contact with them before and after the IIIC was founded in 1966.
I have already mentioned that my established interests were in intraocular foreign bodies, trauma and corneal surgery, including KPro, before Intraocular Lens implants. My substantial interest in IO implants grew after the IIIC was founded in 1966 and I became editorial secretary. Between 1966 and 1976 I was heavily involved in travelling to lecture on ocular trauma and microsurgery. I was also active in many other societies, becoming President of the Ophthalmological Society of the U.K., the Association for Eye Research, the ophthalmic section of the Royal Society of Medicine, and the Faculty of ophthalmology; as well as Examiner and co-opted member of the Council of the Royal College of Surgeons.
In fact, my function in the IIIC was nominal with very little editorial work; the only example that comes to mind is making an audiotape report of the 2nd IIC meeting in Budapest in 1970, Strampelli should have succeeded Ridley as President, but declined because of local hostility in Italy. So Ridley remained President for a further 2 years until succeeded by Binkhorst in 1972. I sent a report to Harold Ridley and had a very nice letter in response. Having had my own poor experience with anterior chamber lenses and heard of the bad reports presented in 1965, I was unwilling to use any intraocular lenses until I was able to see published reports with a 5 year follow up period. So I did not implant intraocular lenses in earnest until after 1970 when I had encouraged John Pearce (with Binkhorst’s consent) to make an independent report on a consecutive series of his cases. Pearce's long-term review of Binkhorst's cases proved that the 4-loop lens was a reliable and safe design. For more than 8 years iris fixation lenses remained the most popular among implant surgeons. My own results were satisfactory thereafter using a loop suture to give peripheral iris support.
The 3rd IIIC meeting was held in Paris in June 1972. I was unable to attend. The minutes show that the morning session was on Intraocular Lenses. After lunch there was a ‘continued lengthy and vigorous discussion’, followed by one devoted to KPro. This was the same pattern as at the foundation meeting. Binkhorst followed Ridley as President. Membership should be limited to 100!
The IIIC communications became quite disorganised between 1972 and 1976 during Binkhorst’s Presidency. Not his fault. Strampelli should have followed Ridley as President in 1970, but had declined; Epstein was out of touch because of Apartheid in South Africa; Fyodorov had told Choyce that he would not be able to obtain support from his Ministry of Health to take office. Two meetings were arranged in 1975 and 1976 without committee discussion. A call for papers was not sent to all members. Dates were changed at very short notice. Somewhere there was a hidden agenda. Might it have been to promote a particular type of Intraocular Lens?
At the 4th meeting in 1976 the IIC was renamed IIIC. This was 10 years after its foundation and was also the 10th year of the IOMSG. Around this time emerged the 3rd revival of enthusiasm for Intraocular Lenses and founding of National Intraocular Lens societies. I was able to attend the 5th IIIC meeting held in Nagoya in May 1978 and spoke on KPro! The situation at that time was remarkably similar to the late 1950s. Many surgeons were entering the field and designing their own lens or modifying others. Extravagant claims were being made with insufficient assessment of results. Only 1 in 3 ophthalmic surgeons in developed countries and less than 1 in 10 in developing countries routinely used an operating microscope. Early enthusiasm in 1950 had been dashed by problems of lens material and sterilization; it took some time for recovery only to be dashed again by serious complications in 1965.
By 1978, some lenses were showing better long-term success and the quality of vision obtained was very evident to patients and more of the ‘establishment’.
Now, in 2007, the IIIC is very different and its original purpose has diminished. The club has kept its name, but the program and exotic venues are becoming indistinguishable from the national societies that have changed their names to emphasize the spread of refractive surgery. That has not happened to the KPro study group which still has the characteristics of the first IIC and needs continued support in advancing a neglected field in which prejudices are similar to those in the early years of Intraocular Lens development. As I conclude my talk, I ask myself, “Why me” and “Why now”? I suspect it is because I can go back to the inception of implant surgery and can report much of this first hand. I realize that this may be the last chance to recognize some of the major hurdles that were overcome in the early days and to acknowledge the people who strove to bring us to the acceptance we have today.
Just for the record:
I was a founder member of the IIC, joint secretary for 10 years, wrote the first constitution, and despite some recent assumptions am still alive. (I have recently found old patients greeting me after several years, saying ‘I used to see your father’.)
Michael J. Roper-Hall, Stockholm, 2007