• How Do You Tell Who's Right When Ophthalmologists Disagree?


    Forty years ago, the Wilmer resident’s meeting was one of the relatively few ophthalmic meetings apart from the Academy and state society meetings and attracted a large regional audience. At the kickoff to one such meeting when I was a third-year resident, I got an early exposure to disagreements within the profession.

    Our chairman Edward Maumenee, MD, began the meeting by waving around a fresh copy of the New York Magazine with Charles Kelman, MD, on the cover and a lead story discussing the new procedure of phacoemulsification. Naturally, the article had only positive remarks and was in no way in no way a balanced discussion of the landmark surgical procedure.

    Some of the audience concluded that Dr. Maumenee was condemning the procedure and questioned his ability to do so since phaco was available only in New York. But he was not condemning the procedure itself, but the fact that marketing and promotion had preceded scientific study. He believed the reverse should hold: first, let others study and perform the procedure, note outcomes and confirm or disagree with the findings of Dr. Kelman. Then let the promotional activities begin.

    At that time, Dr. Maumenee was a leading figure in American ophthalmology. There were a few major training programs, among which there were rivalries. There was a big rivalry between Wilmer and the Massachusetts Eye and Ear Infirmary. Dr. Maumenee broke ground when he appointed a Mass. Eye and Ear graduate, Don Nicholson, MD, as the Wilmer chief resident for the 1971 academic year. That was my first year of residency. Heretofore, the chief had always come from within the ranks of Wilmer residents.

    The fireworks caused by Dr. Maumenee at the resident’s meeting, muted and respectful as they were, began. Wilmer dogma vs. Boston dogma started, believe it or not, with limbal-based flap vs. fornix-based flap for intracapsular cataract extraction. Later differences included the approach to certain types of strabismus surgery and Koeppe lens gonioscopy vs. Goldman lens. Each stated their case with equal conviction. Neither convinced the other and the debates went on.

    The lesson for me as a lowly first year resident was valuable: there’s more than one way to skin a cat. Different approaches and techniques can achieve good results. Keep an open mind when someone tells you there’s only one way to go. 

    Looking back and reflecting on the stupendous medical and surgical advances in our field, I wonder what vigorous debates going on today will soon seem totally moot and inconsequential as is which way to cut the conjunctiva in a now outdated operation.