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Charles L. Schepens: Eye Spy

2023; Medknow; Volume: 71; Issue: 7 Linguagem: Inglês

10.4103/ijo.ijo_1541_23

1998-3689

Mrittika Sen, Santosh G Honavar,

Ophthalmology and Visual Health Research

"It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of light, it was the season of darkness, it was the spring of hope, it was the winter of despair." Charles Dickens Physician. Scientist. Academic leader. Captain. Surgeon. Author. Resistance leader. War hero. Humanitarian. In the last issue of Tales of Yore, it is our proud privilege to cover the remarkable life of Dr. Charles Schepens, a man who played all roles with dogged conviction. Charles Louis Schepens was born in Mouscron, Belgium, on March 13, 1912, the youngest of six children. In college, it was mathematics that fascinated him, but like his father and three of his elder brothers, he eventually went on to study medicine and received his degree from the University of Ghent in 1935.[1,2] He received his ophthalmic postgraduate training at Moorfields Eye Hospital (1936–1937). His inclinations toward quantitative science and instrumentations were evident as a student.[1] Schepens returned to Brussels in 1937 and began work at the Clinique St Jean and Elizabeth. In 1939, Schepens went into active service, as a Captain in the Medical Corps of the Belgian Air Force.[1] In German occupied Belgium, 28-year-old Schepens was erroneously arrested in 1940 with charges of transporting allied pilots in a bus that he owned but had to be released on account of lack of evidence.[3] But this episode made him become a part of the Belgian Resistance. He allowed his clinic to be used as post-office to exchange maps and information.[3] "Every few weeks a Flemish-speaking 'patient' would make an appointment and bring along a brown satchel filled with secret documents that the ophthalmologist hid in the thick ivy on the wall at the rear of the property until [resistance network member Anselme] Vernieuwe could retrieve it."[4] In 1942, he had a narrow escape from the Gestapo when he was alerted of his impending arrest for his role in aiding Belgian resistance. He was forced to give up his ophthalmology practice and managed to reach Paris where he adopted the identity of Jacques Perot-Spengler (later shortened to Jacques Perot), a lumber-mill manager, in Mendive in Basque country.[1] He acquired an abandoned sawmill with his childhood friend Cyrille Pomerantzeff and rebuilt it.[1] He also repaired a cable car system, for the laborers, that ran up the mountains to the border of Spain, making it a brilliant escape route.[5] With the functional lumber mill as the façade, he aided hundreds of people, military and political personnel, prisoners of war, allied pilots, documents, propaganda, and currency cross the border to Spain.[2,5] In his efforts, he was helped by a shepherd, Jean Sarochar.[3] Despite his own and his family's life being in danger, he continued his efforts toward supporting the resistance. One day a mill worker was injured with a foreign body embedded in his cornea. Perot could have easily sent him to a distant hospital, but he was not sure if there were ophthalmologists with adequate skill and training.[6] Instead, he decided to perform the surgery himself, fully aware that he would be giving up his alias.[6] The Gestapo soon arrived at the mill to arrest him.[1] "Look I will cooperate with you. However, you know, it is now 10 o'clock. I have 150 workers idle, because they have not been given their orders this morning. Give me 10 min with them. I'll give the orders and come back." With that, Perot made a daring escape into the mountains and hiked his way into Spain and then England. His family was kept under house arrest but with the help of his friends managed to escape but could only join him after 9 months.[5] It was not only the mid-1980s that people actually came to know that Charles Schepens, the father of Modern Retina Surgery and Jacques Perot, the lumber-mill manager were one and the same. An American Museum curator, Meg Ostrum, happened to visit Basque where a priest gave her a letter to deliver to an eye doctor practicing in Boston. Ostrum got in touch with Schepens, "Are you Jacques Perot?" Schepens was initially reluctant to admit his former identity, but Ostrum was persistent and they, finally, met and the letter was delivered. Ostrum spent the next 15 years researching about Perot's role in the resistance, culminating in the critically acclaimed book, "The Surgeon and the Shepherd: Two Resistance Heroes in Vichy France," in 2004 [Fig. 1].[7] In an interview to Boston Globe the same year, Schepens admitted, "It was a wonderful life, you know."[2]"At the time I even had the idea that I could spend the balance of my life there, give up medicine, and get a diploma from some forestry department," Schepens recalled his life in the French Pyrénées.[4]Figure 1: The book by Meg Ostrum[ 7 ]Schepens returned to Moorfields, London, where he worked with Ambrose King in general ophthalmology. He was certain that a binocular viewing system would improve the outcomes of retinal surgeries, and although he had ideas, he had no way of giving them shapes for it was almost impossible to buy any metal, even screw, because of the war.[8] The evening before he was to start his residency, a German buzz bomb struck Moorfields. With the hospital shut for a few days, he ended up collecting metal scraps from the rubble and started designing a head-mounted, binocular indirect ophthalmoscope in the basement of Moorfields.[1,8] One of the prototypes is in the Smithsonian Institution in Washington, DC, and the other in Retina Associates, Boston, which he founded [Fig. 2].[1,9] The indirect ophthalmoscope, called the "Le Schepens" in France, revolutionized the way retina was examined and opened the doors to modern retinal surgery, with a self-contained light source and stereoscopic view.[2] It allowed the physician's hands to be free to depress the sclera and view the periphery easily. Schepens modified the instrument several times, but it had most features of the present-day indirect ophthalmoscope, including interpupillary distance adjustment, light adjustment for small pupil, lens wheel with +1 to +5 allowing the observer to change the distance from the patient, and rotational feature of the optics allowing the doctor to draw without taking-off the instrument.[5]Figure 2: Prototype of the Indirect Ophthalmoscope invented by Dr Schepens housed in the Smithsonian (https://americanhistory.si.edu/collections/search/object/nmah_1062822)[ 9 ]Schepens brought retina in the forefront as an ophthalmic subspeciality. He went on to establish the retina service in Moorfields.[5] Schepens moved to Massachusetts Eye and Ear Infirmary and Howe Laboratory at Harvard Medical School as a Fellow in Howe Laboratory in 1947 with the goals of developing a training program to teach his ideas and techniques, treating patients with retinal detachment, and forming an organization for research on causes and diagnosis of vitreoretinal diseases.[1,6] In 1949, he established the retina service in MEEI, the first of its kind in the USA. He popularized fundus examination with scleral indentation using a thimble depressor and invented the vitreous microscissors.[3,5] He performed the first scleral buckling surgery in 1951 in the USA.[5] He also popularized the use of polyethylene tubes, and later pioneered silicone implants, as encircling bands.[5] He once had a colleague build him a table that could keep patients upside down during procedures, considering that gravity could be used to keep the retina attached.[4] Other inventions to his credit are the first monochromatic green laser, the first wide angle (140°) camera, the scanning laser ophthalmoscope, and the laser Doppler flow meter.[6] Schepens pioneered the "open-sky approach" for retinal surgeries in patients with retinopathy of prematurity.[4] In 1950, he founded the Retina Foundation, a research laboratory, with six researchers, personal funds, and some modest charitable donations.[1] The Foundation received donation from the Rockefeller Foundation at a key time and continued its work of developing ophthalmic instruments and surgical techniques and became the largest eye research institute in the United States, now known as the Schepens Eye Research Institute. Today, it has two dozen laboratories, 200 staff, 600 post-doctoral fellows involved in basic and clinical research and is the largest independent institute for eye research in the world.[1,2] The Schepens Retina Associates Foundation provides training to retina surgeons and patient care.[6] The Retina Society began as an outgrowth of alumni meetings of Retina Associates, with first formal meeting held in Chicago on October 29, 1967. Drs Charles Schepens, Robert Brockhurst, Charles Regan, and David Roby were the founding organizers, and Dr Schepens was the first President and Dr P. Robb McDonald was the Vice-President.[10] Dr Schepens has authored four books, published nearly 400 scientific papers and trained hundreds of ophthalmologists. People remember him for his energy, warmth, and humility. He was fiercely faithful to his work. "It gives me tremendous satisfaction. It gives me the impression that I am not a parasite in this society, that I play a role. I am important to that person and it gives me more self-respect because I am not just after a good meal or a good car. Society has given me a tremendous amount and I feel it is my duty to pay back, and when I give sight to someone, this is my way to pay back." In 2001, the American Society of Cataract and Refractive Surgery recognized him as one of the 10 most influential ophthalmologists of the 20th century.[6] The Harvard Medical School established the Charles L. Schepens Professorship in Ophthalmology in 2001.[6] When Dr Schepens had presented the indirect ophthalmoscope at the Academy meeting in 1947, it was not very well received.[8] In 2003, Dr Schepens was bestowed the inaugural Laureate Award by the American Academy of Ophthalmology, their highest honor.[2] In his own whimsical way, Dr Schepens had remarked to Dr Sebag, "You know, it just goes to show you that if you live long enough, anything is possible."[2] The Schepens International Society was established by alumni trained by him and in 2003, the meeting was held in Bruges, Belgium, attended by Dr Schepens himself. (8) On March 21, 2006, he was honored with Chevalier de la Légion d'Honneur, Knight of the French Legion of Honour for his contributions as an ophthalmologist and a Nazi resistance leader.[1] A week later, Charles L Schepens died of a massive stroke on March 28, 2006. The Boston Globe penned a beautiful obituary, "Two callings led Charles L. Schepens to greatness, and one nearly kept him from the other. He risked his life, and those of his wife and young children, to work with the resistance in Belgium and France during the World War 2, but he sought no honor or recognition. Instead, Dr. Schepens resumed his medical career after the war and became one of the most important ophthalmologists in history."[5] "I don't want to have lived in vain like most people. I want to be useful or bring enjoyment to all people, even those I've never met. I want to go on living even after my death!" Anne Frank Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.