Spotlight on Charles Kelman – a pioneer of modern cataract surgery

Modern cataract surgery is a modern miracle. A few key surgeons in the ophthalmology world made the amazing techniques we use today possible.

Source: nature.com

One of those innovators was Dr Charles D Kelman MD. His most significant contribution to the technique of modern day cataract surgery was the development of phacoemulsification.

In the late 20th century, cataract surgery was still performed using a large incision in the cornea. The specialist removed the whole cataract through that wound. The technique is known as extracapsular cataract extraction (ECCE).

Charles Kelman wanted to develop a technique that used a smaller incision into the eye. His idea was to insert a machine into a small opening and break up the cataract within the eye.

In the beginning, he took inspiration from dentistry. He saw that dentists used a freezing probe in their work. This technique was adapted for intraocular use. It had limitations with post-operative inflammation and long recovery times.

The idea was that a small high-frequency ultrasound probe could micro-fragment a cataract within the eye. Later, this led Dr Kelman to the groundbreaking development of phacoemulsification and is still used today.

A significant advantage of this new phacoemulsification probe was

• less post-operative inflammation
• quicker recovery times for patients
• fewer complications such as damage to other eye structures
• small surgical wounds

He had discovered a perfectly executed instrument. It matched the small dimensions of the human eye which also had the precision needed to achieve excellent surgical results.

At first, his work was not widely accepted amongst the ophthalmology community. The support for his device lacked in these early days.

Charles Kelman took the bold step of collaborating with the manufacturers of the probe. He used marketing strategies to promote its use – an unheard of approach in the late 1960s but one that is common nowadays.

Through sheer hard work and determination Charles Kelman pushed his new technique. Eye surgeons started to adopt his novel instrument.

It took three decades of research for Dr Kelman to finally earn his respect and recognition. He received some of the highest honours in science and technological innovation. These included the following

• National Medal of Technology and Innovation. This is the highest honour for technological achievement awarded by the President of the United States of America
• the American Academy of Ophthalmology’s prestigious Laureate Award
• a posthumous honour with the Lasker Award, the USA’s highest award for medical science

Dr Kelman’s work did not stop there. He worked on several other projects. These include artificial blood vessels, artificial corneas and the development of intraocular lenses.

The introduction of phacoemulsification by Charles Kelman is a rare technology with a 30-year longevity. More than 100 million successful cataract procedures have been performed. 99% of procedures are using this technique today.

Many millions have benefited from his pioneering work. He will be remembered fondly for his work.