Happy 50th Birthday
2009; Elsevier BV; Volume: 116; Issue: 11 Linguagem: Inglês
10.1016/j.ophtha.2009.09.038
ISSN1549-4713
Autores Tópico(s)Retinal Diseases and Treatments
ResumoIn mid-November, 1959 the first human fluorescein angiogram was performed on me, and photographs of my right eye were taken. An original 8×10 inch glossy print of that event with a copy of the paper Harold Novotny and I wrote for the journal Circulation is in the Museum of Vision of the American Academy of Ophthalmology.In this day and age of instant information due to the digital explosion in photography and communication, I think it is important to reflect upon the origin of this procedure, which laid the groundwork for improved photographic equipment, lasers, imaging, and better understanding of the pathology and treatment of retinal diseases. Fluorescein angiography (FA) was an unexpected result of different clinical research.Harold Novotny and I were junior and senior medical students, respectively, on our “quarter off” from clinics. We each wanted a job to learn about medical research. We were fortunate to be employed by Dr. John B. Hickam, chairman of the department of medicine, Indiana University School of Medicine. We were assigned to work on a grant from the United States Air Force to determine the oxygen saturation of circulating blood through retinal vessels by photographic means. Neither of us was well informed about ocular anatomy nor the use of Dr. Hickam's new Zeiss fundus camera, the first camera with an electronic flash on the medical center campus.We learned our skills by practicing on our fellow students who were pleased to receive $15 per session. It was during one of these sessions that Harold noted a particular coloring of the crystalline lens that was new to him. He asked me what it was, and I responded that perhaps it was fluorescence. I have no idea to this day why I said that. Harold then wondered if we could photograph fluorescence in blood as it circulated through the retinal vessels. Dr. Hickam allowed us to try it on each other after we had determined from a library search that it was possible. As the saying goes, “The rest is history.” We next tried the procedure on patients with either hypertensive or diabetic retinopathy before writing our paper.Our work was conducted before the 1964 Declaration of Helsinki on which much of so called “Good Clinical Practice” is based, and the 1966 Memorandum issued by the Research Grants Division of United States Public Health Service concerning investigational review boards. Our use of patients and fellow students was before the days of stringent rules governing medical experimentation. There were no review boards, advisory committees, informed consent forms, or signed papers of any kind.Getting the medical community interested in FA was not easy. We submitted our work to The American Journal of Ophthalmology, and we were denied publication. Dr. Derrick Vail, then the editor, told me years later that he had made a mistake in refusing to publish our findings. Dr. Hickam was able to convince the editor of Circulation that we had a worthy contribution to the medical literature for publication.I next presented the paper to the mid-western meeting of The Association for Research in Ophthalmology, which was meeting in Indianapolis. I was the last presenter on Sunday before the meeting adjourned, and no interest was expressed at all.I had similar results in applying for residency positions. Dr. Irving Leopold, then in Philadelphia, showed no interest in our work. Neither did A. D. Ruedemann at Wayne State University in Detroit when I interviewed. Not until the physicians and angiographers at Bascom Palmer Eye Institute began using FA and writing about it did the procedure become more widely used in this country then internationally. The rest is history. I am flattered to be a part of it.1Novotny H.R. Alvis D.L. A method of photographing fluorescence in circulating blood in the human retina.Circulation. 1961; 24: 82-86Crossref PubMed Scopus (433) Google Scholar In mid-November, 1959 the first human fluorescein angiogram was performed on me, and photographs of my right eye were taken. An original 8×10 inch glossy print of that event with a copy of the paper Harold Novotny and I wrote for the journal Circulation is in the Museum of Vision of the American Academy of Ophthalmology. In this day and age of instant information due to the digital explosion in photography and communication, I think it is important to reflect upon the origin of this procedure, which laid the groundwork for improved photographic equipment, lasers, imaging, and better understanding of the pathology and treatment of retinal diseases. Fluorescein angiography (FA) was an unexpected result of different clinical research. Harold Novotny and I were junior and senior medical students, respectively, on our “quarter off” from clinics. We each wanted a job to learn about medical research. We were fortunate to be employed by Dr. John B. Hickam, chairman of the department of medicine, Indiana University School of Medicine. We were assigned to work on a grant from the United States Air Force to determine the oxygen saturation of circulating blood through retinal vessels by photographic means. Neither of us was well informed about ocular anatomy nor the use of Dr. Hickam's new Zeiss fundus camera, the first camera with an electronic flash on the medical center campus. We learned our skills by practicing on our fellow students who were pleased to receive $15 per session. It was during one of these sessions that Harold noted a particular coloring of the crystalline lens that was new to him. He asked me what it was, and I responded that perhaps it was fluorescence. I have no idea to this day why I said that. Harold then wondered if we could photograph fluorescence in blood as it circulated through the retinal vessels. Dr. Hickam allowed us to try it on each other after we had determined from a library search that it was possible. As the saying goes, “The rest is history.” We next tried the procedure on patients with either hypertensive or diabetic retinopathy before writing our paper. Our work was conducted before the 1964 Declaration of Helsinki on which much of so called “Good Clinical Practice” is based, and the 1966 Memorandum issued by the Research Grants Division of United States Public Health Service concerning investigational review boards. Our use of patients and fellow students was before the days of stringent rules governing medical experimentation. There were no review boards, advisory committees, informed consent forms, or signed papers of any kind. Getting the medical community interested in FA was not easy. We submitted our work to The American Journal of Ophthalmology, and we were denied publication. Dr. Derrick Vail, then the editor, told me years later that he had made a mistake in refusing to publish our findings. Dr. Hickam was able to convince the editor of Circulation that we had a worthy contribution to the medical literature for publication. I next presented the paper to the mid-western meeting of The Association for Research in Ophthalmology, which was meeting in Indianapolis. I was the last presenter on Sunday before the meeting adjourned, and no interest was expressed at all. I had similar results in applying for residency positions. Dr. Irving Leopold, then in Philadelphia, showed no interest in our work. Neither did A. D. Ruedemann at Wayne State University in Detroit when I interviewed. Not until the physicians and angiographers at Bascom Palmer Eye Institute began using FA and writing about it did the procedure become more widely used in this country then internationally. The rest is history. I am flattered to be a part of it.1Novotny H.R. Alvis D.L. A method of photographing fluorescence in circulating blood in the human retina.Circulation. 1961; 24: 82-86Crossref PubMed Scopus (433) Google Scholar
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