In his new book, Saving Sight, ophthalmologist Andrew Lam, MD, writes, “Always, every single day, I appreciate what those who came before me dreamed, discovered, and suffered to enable me, and doctors like me, to save sight today.”
Author/ophthalmologist Andrew Lam, MD
Part history, part memoir, Dr. Lam’s book explores ophthalmologists’ debt to an oftentimes overlooked past as he chronicles the accomplishments — and fates — of 20th-century giants whose full stories are mostly lost to all but a few of the most curious ophthalmologists.
At the same time, Dr. Lam shares his own story — providing the reader with an inside look at the trials, tribulations and ultimate joy that defines the life of today’s eye surgeon.
This month, YO Info sat down with the author/ophthalmologist to discuss his interest in history, the benefits of challenging the status quo and how today’s golden age of ophthalmology will come to define our future.
YO Info: How did you first become interested in ophthalmology’s innovators?
As an historically minded resident, I was curious about the people who had invented the tools we use to save sight. I marveled at the things we take for granted today: the elegance of phacoemusification, the miracle of LASIK, the beauty of the retina when viewed through an indirect ophthalmoscope. Who actually invented these amazing devices and techniques? What had been tried before, and how did we arrive at where we are today?
So, I began to learn about doctors like Harold Ridley, Charles Kelman, Charles Schepens, Arnall Patz, Judah Folkman and others, and I was blown away by their stories of courage and perseverance. Each of them experienced severe setbacks. Many endured ridicule and scorn. These were stories that could be made into blockbuster movies. I couldn’t believe how few people knew about them and thought that everyone should.
YO Info: How did your previous education in history inform your decision to write Saving Sight? For both ophthalmologist and layperson alike, why do you think it’s worth knowing the stories of these pioneers?
I’ve always wanted to write books that would make history more accessible to the public and to share stories that deserve to be more widely known. The first book I wrote was an historical novel of World War II called Two Sons of China, which is being released by Bondfire Books on the anniversary of Pearl Harbor. With my interest in history and my expertise in ophthalmology, a book about ophthalmology’s heroes seemed like a natural fit.
And I think everyone benefits from knowing these stories because they reflect the best of the human spirit: dedication, altruism, tenacity and the ability to get back up when you’ve been knocked down.
For example, Harold Ridley was inspired to invent the intraocular lens after seeing inert plexiglass in the eyes of a downed World War II fighter pilot. But this incredible achievement ruined his career, negatively affected his family life and later caused him to go into deep depression. Many ophthalmologists don’t know this. Real people suffered greatly so that we could have the tools to save sight today. Thank goodness Dr. Ridley never gave up or succumbed to his detractors.
YO Info: Why did you choose an audience of both the physician and the general reader?
Though I knew ophthalmologists would enjoy learning about these heroes, it was my great hope that the book would catch fire with the general public. I thought that everyone would love these underdog stories of sacrifice and ultimate victory.
Trouble was, I knew I’d have to do something to draw the public in, because most people might not be inclined to pick up a book about medical history alone. I talked it over with my agent, and I decided to blend the history with my own story as a surgeon — to take the reader behind the mask and into the operating room and, for example, to show what it’s like to learn phaco and LASIK, extract a metal foreign body from the vitreous and fix a retinal detachment. People are particularly curious about what surgeons do when they face difficult situations, or fail despite trying their best, and the book includes several anecdotes that reflect these types of situations.
And I think being honest about life as a surgeon is really what has caught on with general readers and made the book such a success. Although my first goal was to get people to appreciate the history of our field, I’ve been delighted to find how much readers enjoy learning about what we as ophthalmologists actually do. It’s been gratifying to receive letters and emails from readers as far away as Europe, Africa and India — people who just want to tell me how much they’ve enjoyed the book.
YO Info: In the book’s introduction, you write, “…academic, establishment types were more often guilty of hindering the young innovators who were challenging the status quo with their new ideas.” Do you believe this tension persists today in medicine?
I think resistance to change has always played a role in the rate of medical progress. I don’t necessarily think skepticism to a new idea is a bad thing, because many new ideas aren’t good and plenty of new treatments are not efficacious.
But, in the mid-20th century, ophthalmology was a more staid profession than it is now. The stories of Drs. Ridley and Kelman exemplify how the established elite’s reluctance to embrace new ideas significantly delayed the development of sight-saving treatments.
Today, I think this is much less of a problem. Society is more forward thinking, corporations are anxious to discover the next moneymaking breakthrough and all of us are aware of the benefits of medical progress — and hope the trajectory of that progress will continue to rise.
In my mind, the greatest threat to our future progress is a lack of interest in science and technology among today’s youth, whose role models may be more likely to be entertainers and professional athletes than inventors and scientists. One of the reasons I wrote the book was to inspire young people to see how “ordinary” and hard-working people can have a profound and positive impact on humanity.
YO Info: Given today’s legal and bureaucratic environment, you write that the practice of medicine can sometimes be more “defensive than curative” and “driven by fear of litigation and sometimes financial gain.” Do you find these forces to have a major dampening effect on innovation at this current historical moment?
I think most doctors can identify with the thoughts I convey in the book: that the practice of medicine has become far more complicated than in decades past.
Some of the changes have been positive, such as greater accountability and standards of documentation. But there are many problems with our medical system. I write about how doctors’ reimbursement has inexorably fallen over the last two decades, while our workload has increased. I write about the hoops we jump through to ensure we get paid for our services. I write about how we practice defensive medicine, largely because we know our chances of getting sued at some point in our careers is very high, possibly almost inevitable.
On the other hand, some topics in the book cast doctors in a less sympathetic light. I describe our reluctance to screen and treat for retinopathy of prematurity and how many of our decisions as individual practitioners can be profit driven.
I don’t think these factors have a direct impact on innovation, per se, but they certainly affect the exploding cost of health care in our country, which can negatively impact funding for the research that leads to tomorrow’s cures.
YO Info: You mention throughout Saving Sight that we live in the golden age of ophthalmology. Where do you see the profession in 40 years? Will 2013 be as unrecognizable to future physicians as 1950 is to today’s?
Possibly. Let’s hope that 40 years from now, ophthalmologists will find it barbaric that we subject patients to intravitreal injections every month or two! I think we all hope for future innovations that will be more effective than what we have today.
The future promise of gene therapy, stem cell research and even artificial sight is very exciting. For example, finding new therapeutic targets that affect the development of macular degeneration, and devising new molecules to influence them, may someday lead to a way to prevent macular degeneration altogether. The implanted retinal microchip that has returned some sight to the blind was approved by the FDA this year, and it can only get better. Someday, someone may devise a way to preserve accommodation into old age. That would be incredible.
Certainly, ophthalmologists such as Jose Barraquer and Tsutomu Sato could not have imagined that something like the excimer laser and photorefractive keratectomy might exist one day. In the same way, our future may include the advent of some game-changing new technology that we cannot even begin to fathom today.
But again, past progress is not a guarantee of future success. If you were an American in 1969 and saw Neil Armstrong walk on the moon, you would have marveled at this stunning success that had occurred less than 10 years after the Mercury astronauts had first ventured into space. And if someone asked you what you thought might be achieved in space over the next 40 years, you probably would have said we’d be on Mars by now.
That time has elapsed. Progress doesn’t always continue at the rate we hope for. It depends on passionate individuals like the doctors in Saving Sight. That’s why I think it’s so important to impress upon young people the importance of grit and hard work. That’s why science and technology need to be “cool” in schools. Our future depends on how well we can inspire today’s youth to emulate the kind of people I’ve had the privilege to write about in this book.
YO Info: As a busy surgeon, how do you find the time to write?
Sometimes I feel raising our four kids is actually far more time-consuming than my work as a retinal surgeon, but I think that when you're passionate about something, you just make time. I simply write whenever I can — after the kids go to bed, during lunchtime or even poolside at my son’s swim meets. I only write about subjects that fascinate me, so it never feels like work. And having a wonderful, supportive wife helps a lot too!
YO Info: Do you have any pearls you’d like to impart on YOs?
Spend your time and energy doing the things you love.
We’re so lucky that our day job is so fulfilling and gratifying — we help people and save sight! Never take that for granted. And if you have a passion for something outside of ophthalmology, make time for it. It might be coaching soccer, playing in a band or serving with medical missions overseas. People who follow their passions will be happier and are usually the ones who change the world for the better.
What’s the common trait among the heroes of Saving Sight? They followed their twin passions for helping others and discovering new things. Doing what they loved gave them a single-minded determination that adversity and ridicule could not derail — to the ultimate benefit of us all.
Issue Index | Related Articles | YO Info Archive
* * *
About the author: Dr. Lam is currently a practicing retinal surgeon in Springfield, Mass. and an assistant professor of ophthalmology at Tufts University School of Medicine. After receiving a history degree at Yale University, he attended medical school at the University of Pennsylvania and completed his residency and retina fellowship at the Wills Eye Hospital. For a review of Saving Sight, check out EyeNet’s July issue. Saving Sight is available at Amazon.com. Learn more at www.AndrewLamMD.com.