Hindsight, 1983: Dr. Richard P. Kratz

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In 1983 the New Orleans Academy of Ophthalmology was honored to have world renowned phaco and IOL pioneer Dr. Richard P. Kratz speak at our cataract surgery symposium.

Born in 1920 in Los Angeles, Dr. Kratz knew from an early age that he wanted to be an ophthalmologist.  His mother was a physician – the only female student at Stanford Medical School when she graduated.  Her textbook, May’s Ophthalmology was the only book in their home with color prints, and at five years old when asked what he wanted to be when he grew up, he replied that he wanted to be able to heal the “sick eyes” that he’d seen in that book.

Dr. Kratz received his medical degree from the University of Southern California in 1946, but before completing his residency he was sent by the US Army to serve at their largest hospital in the Far East.  Though not yet a trained ophthalmologist, he became chief of the Eye, Ear, Nose, and Throat service at the US Army General Hospital in Tokyo.  After completing his service, he continued his training in basic sciences at Moorfields Eye Hospital in London and completed his residency in ophthalmology at Duke University in 1951.  While at Moorfields, Dr. Kratz was a student of Sir Harold Ridley shortly before Sir Harold implanted the first IOL in 1950, making him one of the early ophthalmologists to learn about IOL implantation.

In 1965, Dr. Kratz testified at a Senate hearing and helped defeat a bill sponsored by optometrists and opticians that would have made it illegal for an ophthalmologist to fit contact lenses or glasses, thereby forcing patients to go to an optometrist for that service.

According to Dr. Kratz, modern cataract surgery began when Dr. Charles Kelman taught his first classes in phacoemulsification in 1971.  But by the mid-1970s neither phaco nor IOL implantation were recognized by mainstream ophthalmology.

Phaco was especially controversial.  It was growing in popularity due to the outpatient nature of the procedure, and ophthalmologists who did not perform the procedure were starting to lose patients to those who did.  False reports began to surface claiming that vision would be lost in an ophthalmologist’s first 50 phaco patients, and in 1973 phaco was declared experimental, thus not payable through Medicare, which effectively shut down the procedure.

Subsequently the AAO formed a committee to examine the validity of phaco, which found that the procedure’s results were equal to those using intracapsular extraction, and phaco was eventually reinstated as a payable procedure by Medicare.  Full acceptance of phaco in the ophthalmic community didn’t take root until the late 1980’s, though, helped in part by the development of the foldable lense by Dr. Thomas Mozzocco, Dr. Kratz’ partner in practice.

Another controversial procedure was IOL implantation.  Many ophthalmologists believed that they were too risky, and complications with the early implants supported this belief – they often became dislocated and were removed.  However, after traveling to the Netherlands to attend IOL implantation courses taught by Drs. Cornelius D. Binkhorst and Jan Worst, Dr. Kratz became a leader in adopting and defending this technology.

What turned it around was that we began seeing US surgeons like Hirschman, Shepherd, and Jaffe get good results with IOLs.  Since it was something I had always wanted to do, my partner Tom Mazzocco and I started putting in IOLs in 1974. — Dr. Kratz

Just a year later, though, a national campaign to stop the use of IOLs emerged, leading to an FDA hearing investigating the safety and efficacy of IOLs.  Dr. Kratz was among the surgeons who brought forth witnesses to testify about the efficacy of the implants, among them the popular actor Robert Young, who was a patient of Kratz’.  He testified that he was nearly blind before Dr. Kratz performed bilateral cataract surgery and inserted IOLs, and that the implants saved his career and “should be available to all Americans.”

Believing that phaco and IOLs were the future of modern cataract surgery, Dr. Kratz made it his mission to increase the number of students who were taught these procedures.  He and Dr. Robert Sinskey co-founded a course that taught the phaco technique to over 4,000 ophthalmologists worldwide, modifying the tools and procedure to make it easier to learn.  Said his fellow, Dr. William Maloney,

A lot of impetus and encouragement came from men like [Dr. Kratz] who saw phaco’s potential and where cataract surgery could go and were persistent enough to make sure it happened.

Dr. Kratz is or has been a member of fifteen ophthalmological societies and is a founding member of the ASCRS, the Contact Lense Association of Ophthalmologists, the Joint Commission on Allied Personnel in Ophthalmology, and the National Ophthalmological Society.  Retired from practice since 1990, he has maintained a presence in ophthalmology and continues to support new technology.  At 94 years old, Dr. Robert Kratz is still active at the University of California, Irvine, in the Ophthalmology Department Steering Committee and on the Beckman Laser Institute’s Board of Directors, and continues to attend the ASCRS, AAO, and a few other meetings yearly.  He has also raised two sons who were ophthalmologists, and a daughter who did corneal research.

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