Article

As I See It

Thank you, Dr. Troutman

Richard C. Troutman, MD

A disproportionate number of innovations that have helped direct our world have come to us through the genius of Richard C. Troutman, MD, who passed away in April. Dr. Troutman helped shape modern ophthalmology by inventing ocular microsurgery, pioneering keratorefractive surgery and organizing clinics by specialty, among many other contributions.

HIS MANY FIRSTS

Ophthalmology residencies were once based on general clinics. In 1955 Dr. Troutman established one of the first specialty-based training programs at SUNY Downstate Medical Center. Residents began rotating through retina, glaucoma, anterior segment — and our training changed forever.

But most of his advancements affected the OR. While today we all routinely perform microsurgery, until 1953 loupes were the order of the day. It was then that Dr. Troutman worked with Zeiss to develop an ophthalmic microscope. Innovations such as remote motorized zoom followed. In 1967, he added X-Y and tilt. His innovations had the breadth to affect other specialties such as vascular, hand and neurosurgery.

When intracapsular surgery was standard, Dr. Troutman took the cataract out through a clear-corneal incision, leaving the eye white He dissolved the zonules by irrigating under the iris with alpha chymotrypsin and closed the incision with 10-0 nylon sutures, both products he introduced to the U.S.

When he began doing a lot of corneal transplants for bullous keratopathy caused by early and primitive intraocular lenses, he called them intraocular time bombs. He was right. They were. They got better.

The tray table also caught Dr. Troutman’s creative attention. Bulky surgical instruments would not do, so he developed what we use today: delicate tools whose curves are visible under the microscope while our hands remain outside of the field. To teach surgeons how to use them, he established hands-on courses in microsurgery at Downstate and at the annual Academy meetings. These helped usher in the Skills Transfer Courses.

Outside the OR, he was an early advocate for modern eye banking, helping to draft policies for harvesting, processing and distribution. As astigmatism postcorneal transplant ruined the visual result of many a fine graft, he developed corneal wedge resections and corneal relaxing incisions, which are now performed in the periphery and called limbal relaxing incisions.

He traveled to Colombia to learn cryolathe keratophakia and keratomileusis from Jose Barraquer, MD, and organized the first American course to teach those techniques. He helped establish the International Society of Refractive Keratoplasty whose members helped usher in the smooth transition to LASIK.

A LIFE- AND CAREER-CHANGING FRIENDSHIP

When I was a second-year resident at the Manhattan Eye Ear & Throat Hospital, my wife worked as a receptionist — in Dr. Troutman’s office. He and I hit it off and he invited me to attend that first keratorefractive surgery course. Immediately after it was over, he told me I could use his microkeratomes and cryolathe for any clinic patients who could benefit. Through his generosity I was performing keratomileusis months before I had permission to do cataract surgery.

By letting me perform cryolathe surgery so early in my residency, he also taught me to think outside the world of refractions and cataracts. It was perhaps the most influential event to shape my entire career. I’m glad I had the chance to tell him that before he died. OM