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    Confessions of an innovator

    How ophthalmic breakthroughs evolved from the bizarre to medical, surgical realities

    Many technologies that clinicians take for granted had extremely humble, unnoticed, and in some instances, underhanded beginnings. The development of a range of products for a number of ophthalmic subspecialties has involved a deal of looking outside the box to take existing primal technologies to their next level.


    Herpes keratitis treatment

    In his first foray into what now he described as a possible crime, Herbert E. Kaufman, MD, began his career as an upstart first-year resident at Massachusetts Eye and Ear, Boston, by presenting his superiors with an unnecessary truckload of toxoplasmosis-infected animals that ultimately served to guarantee him laboratory space.

    Dr. Kaufman explained how he addressed the concept of viral chemotherapy; that is, by doing the opposite of every other viral investigator in the country.

    “Most tried to interfere with the synthesis of nucleotide-building blocks of viral DNA by reducing the viral load in culture,” said Dr. Kaufman, who is the Boyd Professor of Ophthalmology, Pharmacology, and Microbiology, Louisiana State University Medical School, New Orleans. “However, that starves both the cell and the virus.

    “I thought that the virus coded its own special assembly enzyme, which would be the opportune place to work,” he explained, regarding his unsupported hypothesis and found a drug (IDU) that would meet this end. This proved to be a Herculean feat that required sleeping in an animal room and treating rabbits every 2 hours around the clock.

    Dr. Kaufman was correct in his hypothesis. This discovery reactivated an antiviral program run by GlaxoSmithKline that had been closed because of the considered impossibility of treating viral infections without killing the cells.

    His discovery was met with great fanfare, but not in the ophthalmic community, because the drug was not treating keratitis or iritis. This lead to the recognition by Dr. Kaufman that he could treat keratitis and iritis with a combination of a topical steroid and the antiviral drug (Viroptic/IDU). The reluctance on the part of clinicians to treat herpes with a steroid was overcome by his guess that the steroid overcame the hypersensitivity to viral antigen and antiviral prevented making infection worse.

    “To my astonishment, this turned out to be correct,” he said.

    Lynda Charters
    Lynda Charters is a freelance medical writer.

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