On the 75th anniversary of the IOL, modern surgeons pay tribute

This year, the IOL turns 75. To recognise the special anniversary, the European Society of Cataract and Refractive Surgeons (ESCRS) created a temporary museum at the annual conference in Barcelona, Spain. The tunnel-style museum focused on the life and legacy of Sir Harold Ridley, the pioneer who defied the odds, and his colleagues’ scepticism, to create the first IOL.

The museum was helmed by several members of the ESCRS, including education committee members Artemis Matsou, MD, MRCP, FEBO, PgDipCRS, and Richard Packard, MD, FRCS, FRCOphth. Here, Ms Matsou and Mr Packard describe the Ridley Museum initiative and reflect on their own careers through Sir Ridley's revolutionary lens.

Artemis Matsou, MD, MRCP, FEBO, PgDipCRS: The creation of the Ridley Museum in this year’s ESCRS conference in Barcelona, Spain, was truly a collective effort, led by the visionary leadership of the ESCRS president, Filomena Ribeiro [MD, PhD, FEBO]. I was fortunate to work alongside an incredibly dedicated group of colleagues who worked together to provide not only historic equipment but also incredible insights into Sir Harold Ridley’s story, ensuring that the museum was both informative and inspiring.

Much of the credit goes to the curators, Mr Richard Packard and Mr David Spalton, whose deep knowledge of the facts, thorough research and many years of experience in the field were instrumental in shaping the museum. Their expertise and dedication were the driving force behind ensuring that the museum not only captured the legacy of Sir Harold Ridley but also presented it with the depth and accuracy that such a landmark deserves.

Richard Packard, MD: We wanted initially to set the scene of what ophthalmology was like in the late 1940s. Thus, we created two spaces, one to reflect a consulting room and the other an operating theatre. We were fortunate that David Spalton had rescued the St Thomas’ operating theatre logbook and Ridley’s magnifying loupes, which were exhibited as well.

Alongside this we wanted to create the background that led Harold Ridley to go forward with what he called “the cure for aphakia.” After this, the museum set out to tell of the troubles that Ridley had from the ophthalmic establishment, who saw no merit in what Ridley was doing. However, others were trying out IOLs in different designs, mostly in the anterior chamber, which after initial success ended in failure due to endothelial decompensation. The long history over more than 30 years before IOLs moved into the mainstream of ophthalmic practice were highlighted too. Finally, it was shown that Ridley had been honoured by the profession and ultimately with a knighthood. There was a section devoted to the Ridley Foundation, as well as a segment for the way forward in IOL design.

AM: The museum was designed to take delegates on a journey through the entire story behind the first IOL implant, starting with how the idea originated from Ridley’s experiences as a military surgeon during World War II. Ridley observed that fragments from shattered airplane cockpit canopies, made of polymethyl methacrylate (PMMA), would sometimes lodge in the eyes of pilots, causing minimal tissue reaction unless the fragments had sharp edges. This observation inspired Ridley to explore the intraocular use of lenses made of PMMA.

Delegates at this year’s ESCRS had the opportunity to view a wide range of historic equipment, including spaces recreating Ridley’s clinic office at St. Thomas’s Hospital, as well as the operating room where he performed the first IOL surgery. These immersive environments allowed visitors to experience the setting in which this groundbreaking procedure took place. Original iconic artefacts, like equipment and tools used by Ridley, the first IOL and his slit lamp, helped bring his story to life.

Sir Harold Ridley. Image credit: The Ridley Eye Foundation

RP: Although Ridley moved away from a posterior chamber lens, not everyone did. Ridley performed the first IOL implantation in the USA in 1951 and presented his data at the American Academy of Ophthalmology. He was roundly condemned by his host, Derrick Vail, who said “The operation should never have been done.”

In the audience was Warren Reese, who worked at the Wills Eye Hospital in Philadelphia. He was very impressed with what Ridley was doing and asked Ridley if he could have some lenses to try. He flew back to Philadelphia and carried out the second implant in the USA. He and his colleague Turgut Hamdi modified what they called the Ridley operation and reported their results on 115 eyes in the Archives of Ophthalmology [now JAMA Ophthalmology]in 1957. They really were not too bad. None of their lenses dislocated, and 37% could see 6/21 or better unaided.

The other thing that came as a surprise was a statement by an employee of Rayner, the company who made the IOLs, Peter Caudell, who was the instrument department manager. He had assisted John Pike from the earliest days of the Ridley lens, and recorded that by 1960, Rayner had made 42 different IOL designs that had been used in human eyes. Lens designs with toric optics and Choyce's coloured haptic designs were produced during this period. Over 300 ophthalmic surgeons internationally had been supplied with implants.

AM: Perhaps what surprised me the most was the sheer intensity of the opposition he encountered from prominent figures in the field, who not only dismissed the concept of IOL implantation but actively discouraged other surgeons from supporting Ridley. His efforts were met with scepticism, fear of malpractice and legal threats, which delayed the widespread adoption of his innovations by over a decade. His journey from initial rejection to eventual vindication is inspiring, especially when you consider how his invention has evolved.

Today, we don’t just restore vision—we customise it. We offer patients a level of precision and personalisation that Ridley could never have imagined, transforming cataract surgery from a simple restorative procedure into a sophisticated refractive solution.

RP: When I left Moorfields at the beginning of December 1978, no one at that time was using IOLs and phaco[emulsification] was a complete anathema. I was advised strongly not to go to Charing Cross Hospital and work with Eric Arnott, as it would ruin my career. I arrived at Charing Cross Hospital on 4 December, 1978, to find that there was a phaco and IOL course going on. It was like St Paul’s conversion on the road to Damascus. I knew that was what I wanted to do.

A number of consultant jobs came up in 1981, and by this stage, I had been implanting for over 2 years, including full posterior chamber Kratz IOLs. At one interview, my first and only question from John Winstanley, the senior surgeon, was “Mr Packard, I understand you are interested in intraocular lenses?” with great emphasis on the last two words. I agreed that I was, and the interview ended. Winstanley had seen many of Ridley’s disasters and hated the idea of IOLs. He was not prepared to recognise that things had moved on. I went to two other consultant interviews in London that year with similar reactions to what I was doing. It was not until the following year that I abandoned London, and Jack Kanski asked me to apply for the job [at the Prince Charles Eye Unit] in Windsor. This was the best thing that could happen. There was no one telling me what to do with my cataract surgery, and Jack was a wonderful colleague.

Ridley’s contribution to ophthalmology was to have the vision to want a cure for aphakia, and to perceive a means of achieving this. I have always felt that you cannot advance without knowing what came before. This is why I am so keen that the upcoming generation of ophthalmologists are aware of the history of IOLs and phaco. Without understanding what people like Ridley and [Charles] Kelman went through to get their ideas accepted, believing in a new idea is not enough. You need to have the courage to fight for what you believe in. Just remember what Derrick Vail, he who had pilloried Ridley, said in 1962: “Cataract surgery has developed to its ultimate state, and any improvements from this date will be insignificant.”

The Ridley Museum included a recreation of Sir Harold Ridley's operating theatre. Image credit: Artemis Matsou, MD, MRCP(UK), FEBOS-CR, FEBO, PgDip CRS

AM: For today’s refractive surgeons, understanding Ridley’s journey is more than an academic exercise. It’s a reminder of the power of persistence in the face of adversity and of the fact that our practice today stands on the shoulders of those who dared to push boundaries in the past. The feedback from delegates was overwhelmingly positive. It was rewarding to see how the exhibit resonated with so many attendees.

Intraocular lens implants, the cornerstone of cataract surgery, are so pervasive that we tend to forget how revolutionary the concept of implanting a foreign body in the eye once was. In addition, Ridley’s invention not only improved the visual outcomes for patients [with cataracts] but also created an entire industry around intraocular lens implants, paving the way for what we now refer to as refractive cataract surgery. His legacy teaches us that true innovation doesn’t come from seeking immediate success but from having the patience and courage to see an idea through to its full potential.

The Ridley Museum didn’t just showcase the history of intraocular lenses—it also offered a glimpse into the future of cataract surgery and IOL technology. One of the most exciting sections focused on upcoming IOLs that are currently in development. These next-generation lenses promise improved visual and refractive outcomes by using innovative technologies. Some of these lenses hold the potential to be fine-tuned postoperatively, which could offer even more personalised vision correction. It will be exciting to see how these technologies perform once they reach the market and are put into practice.

RP: There are two things which I think we will see within the next decade. Firstly, a lens that mimics the accommodation of the young adult human lens. This may be mechanical, by shape changing the IOL optic or by some electronic means.

And [secondly], although we have become extremely skilled with our phaco surgery, there is scope for robotising parts of the operation to minimise even the low rate of complications and improve the accuracy of parts of the operation.

AM: In addition to IOL innovations, the museum featured a section on robotic cataract surgery, which I had the opportunity to design. Currently, there are robotic systems in development, some of which are being tested to perform the entire cataract procedure autonomously, while others are more like robotic-assist systems that can carry out specific tasks under the guidance of a surgeon. These technologies are not intended to replace surgeons but to enhance precision and efficiency, especially in complex cases. There is also significant potential for robotic surgery to increase access to cataract treatment inareas with limited healthcare infrastructure.

Artificial intelligence (AI) is already making its way into aspects of cataract management, from optimising IOL calculations to intraoperative decision-making and postoperative prediction of conditions like posterior capsular opacification. Continual advancements on the AI front hold the promise of more widespread clinical use in the near future.

I’m proud to highlight the importance of creating spaces like the ESCRS Ridley Museum to reflect on and celebrate the innovations that have shaped our field. Exhibitions like this help us appreciate the historical journey and inspire future generations of ophthalmologists. The ESCRS's commitment to honour our heritage while looking to the future was evident throughout this project. It was a privilege to be part of a project that not only reminds us how far we’ve come but also encourages us to keep the spirit of innovation alive.

Artemis Matsou, MD, MRCP(UK), FEBOS-CR, FEBO, PgDip CRS |E: art.matsou@gmail.com

Matsou is a consultant ophthalmic surgeon in the Corneoplastic Unit at Queen Victoria Hospital, East Grinstead, UK. She is an Editorial Advisory Board member for Ophthalmology Times Europe.

Richard Packard, MD, FRCS, FRCOphth

Packard is the Consultant Emeritus of Prince Charles Eye Unit Windsor, England. Previously, he was a surgeon at the Prince Charles Eye Unit. He was a board member of ESCRS from 1999 to 2007, and serves on the society's education committee. He delivered the 2024 ESCRS Heritage Lecture, “High Wire Act to the Standard of Care – Charlie Kelman and the History of Phacoemulsification.”