Albert Lasker
Clinical Medical Research Award

Award Presentation by Joseph Goldstein

More than half of us here today will eventually develop impaired vision caused by cataracts. There are no drugs, no eyedrops, and no "Eyekins" diet that will make a cataract disappear; the only treatment is surgical removal. Historically, cataract surgery is one of the oldest operations, second only to circumcision.

Prior to 1970, cataracts were the leading cause of blindness in the United States. Today, cataracts are no longer a significant cause of blindness—thanks to Charles Kelman, this year's recipient of the Lasker Clinical Medical Research Award.

As recently as 20 years ago, cataract surgery was a major ordeal, requiring a hospital stay of 10 days and a post-hospital convalescence of several months. In a typical operation, the patient underwent general anesthesia, after which a large semicircular incision of 180-degrees was made in the cornea to allow the entire lens to be grasped with a forceps and pulled from the eye in one piece. The incision was closed with 8 or 9 sutures, and the patient was kept at absolute bed rest for 3 to 5 days with both eyes occluded with patches. To prevent the patient from moving his or her head, sandbags were placed along both sides of the head, and both wrists were bound with restraints to the bed. This enforced immobilization often led to mental disorientation, prostatic obstruction, bed sores, and blood clots to the lung. As many as 20 percent of patients developed eye infections, bleeding, macular edema, and retinal detachment. After discharge from the hospital, the eyes and lids remained red, swollen, and irritated for as long as 6 weeks. The operated eye had to be patched for several months, and the aphakic patient had to wait for six months to be fitted with ultra thick, unattractive glasses that rarely restored vision to normal.

In 1967, while Charles Kelman was a practicing ophthalmologist at the Manhattan Eye, Ear, and Throat Hospital here in New York City, he invented a totally new procedure for removing cataracts, which he called phacoemulsification (phako being Greek for lens; emulsi being Greek for milk out). In its currently practiced form, phacoemulsification involves making a small incision in the cornea (only 3-degrees rather than the traditional 180-degrees), after which a tiny ultrasonic probe is inserted through the incision. The vibrations of the probe break and liquefy the cataractous lens without damaging the surrounding tissues. The emulsified fragments of the lens are then suctioned through the sonic tip, and a foldable intraocular lens is inserted through the small incision. Once inside the eye, the flexible lens unfolds like a parachute, and vision is restored to 20/20 or 20/40. There is no longer a need for the thick spectacle glasses of the pre-Kelman era.

The entire procedure, which can be done in 5-10 minutes, is performed on an outpatient basis under topical anesthesia. Because the eyelids are not anesthetized, no eye patch is required, and recovery is almost immediate. Many patients go in for their cataract extraction in the morning and return to work in the afternoon.

The genius of Charles Kelman was to recognize the need for a rapid and painless way to remove cataracts. This is reminiscent of the genius of Ray Kroc, the founder of McDonalds. Kroc discovered that people like to be served in 60 seconds—a discovery that changed the eating habits of the world. Charles Kelman's discovery changed the operating habits of ophthalmologists.

The idea for phacoemulsification came to Kelman in 1964 while sitting in his dentist's chair and having his teeth cleaned. As Kelman writes in his memoir, "As I sat in his chair, he reached over, took a long silver instrument out of its cradle and turned it on. A fine mist came off the tip but the tip didn't seem to be moving. He applied the tip to my teeth, and I felt an exquisite vibration and heard a high-pitched sound." Kelman asked, "What is that thing?" The dentist replied, "An ultrasonic probe." "I knew this was the moment," Kelman wrote.

This moment must surely be the only moment in history in which a jolt from a dental drill produced a bolt from the blue. Kelman's epiphanous moment was followed by several years of intensive research on the eyes of cats and human cadavers before phacoemulsification was first applied to a patient in 1967. By 1969, Kelman had used his procedure to remove cataracts in 12 patients. Between 1967 and 1973, 3500 cataract removals were done by phacoemulsification, 500 of them by Kelman. The vast majority of ophthalmologists viewed phacoemulsification as a radical procedure that totally challenged their conventional wisdom. They were shocked by Kelman's audacity to discharge his patients on the same day of surgery and permit them to return to full activity on the first or second postoperative day. For many years, Kelman, the practicing eye surgeon without proper academic credentials, was treated with overt hostility by the established academic surgical community. Today, we take outpatient cataract surgery for granted, but it took 25 years for Kelman's phacoemulsification to become the definitive technique for removing cataracts. 1996 was the first year in which 97 percent of all cataract operations in the U.S. were done by phacoemulsification.

Largely owing to Kelman's ingenuity, dedication, and inspiration, phacoemulsification has become not only the most common, but also the most successful, surgical procedure in history. Last year 3 million Kelman-type cataract operations were performed in the U.S. and 6 million worldwide.

Kelman's vision extended beyond the eye. Phacoemulsification was the first minimally invasive surgical technique, and it stimulated the development of other "keyhole" surgeries, such as fiberoptic removal of the gall bladder, lumpectomy of the breast, and repair of vertebral discs. Kelman clearly had the knack for seeing beyond the cataract.

Kelman's legendary contributions have been widely recognized. In 1992 he was awarded the National Medal of Technology by President George H. Bush. In 1994, his peers named him "Ophthalmologist of the Century," and earlier this year he was inducted into the National Inventors Hall of Fame, whose elite members include the likes of Alexander Graham Bell, Orville Wright, Henry Ford, Enrico Fermi, and Leo Szilard.

Charlie Kelman was the ultimate extrovert and the quintessential bon viveur. He flew his own helicopter, jetting from hospital roof to hospital roof all over Manhattan and Long Island. He also traveled the world, saving the eyesight of hundreds of famous people—from Hedy Lamar to Golda Meir. He was an accomplished saxophonist who played with jazz stars like Lionel Hampton and Dizzy Gillespie. He once rented Carnegie Hall to give his own concert. He produced several Broadway plays, entertained in clubs as a stand-up comedian, and was a frequent guest on the Tonight Show, Merv Griffin Show, Barbara Walters Show, David Letterman Show, and the mother of all shows—the Oprah Winfrey Show.

It's a real tragedy that Charlie Kelman is not here today to bask and revel in the glory of his medical accomplishments. He died 4 months ago on June 1 at the age of 74. It's extremely rare for the Lasker Jury to present a posthumous award. We made an exception in this case because Kelman's work was so extraordinary and because he was at the top of our list at the time of his death. One might ask, Why were we so slow in recognizing Charlie Kelman? The answer is obvious: We didn't have his vision.