In tribute to Sir Nicholas Harold Lloyd Ridley

The greatest fear known to man is a new idea. If you have strong reasons to believe in your ideas, have confidence—face the brickbats and go ahead. Sir Harold Ridley Nicholas Harold Lloyd Ridley (July 10, 1906–May 25, 2001) was born in Kibworth, Leicestershire, UK. His father, Nicholas Charles Ridley, was a consultant ophthalmic surgeon at Leicester Royal Infirmary. He attended Charterhouse, a prominent boarding school in Godalming, Surrey, from 1920 to 1924. From 1924 to 1927, he attended Pembroke College, Cambridge, with emphasis on natural sciences. (This was the equivalent of undergraduate premedical training in the U.S.). After successfully completing the Tripos (honor's degree earned after a qualifying examination) at Cambridge in 1927, Ridley undertook medical training at St. Thomas' Hospital in London. He received his MD from Cambridge. In 1931, he completed a year of general surgery at St. Thomas' Hospital as a junior resident. In July 1932, at the youngest eligible age of 25, he received his fellowship (FRCS) from the Royal College of Surgeons in London. After this, he worked in the ophthalmology department for 6 months under the tutelage of Cyril Hudson. Although Ridley did not get any surgical opportunity as a junior resident, he learned from observation and considered Hudson his finest teacher. Said Ridley, “He certainly taught me how to do extracapsular extractions and he was far better than anyone at Moorfields Hospital.” The second surgeon who was highly influential to Ridley during his time at St. Thomas' Hospital ophthalmology department was Geoffrey Doyne, whose father Robert was the discoverer of Doyne's honeycomb retinal dystrophy. Doyne, with appointment at both St. Thomas' and Moorfields hospitals, helped to ensure that Ridley was fully trained and that Ridley underwent surgical residency training at Moorfields Eye Hospital. Ridley was thus, from the beginning, exposed to the best of the eye surgeons at the two most reputed eye departments in the country. After this training, Ridley was appointed as a full-time consultant ophthalmologist at Moorfields Eye Hospital in 1938. The first idea of an artificial intraocular lens (IOL) stemmed from a casual comment made by a medical student, Steve Parry, who in 1947 when watching Ridely operating on a cataract said, “It's a pity you can't replace the cataract with a clear lens.” This casual comment made Ridley realize that cataract operation without a replacement lens was an incomplete, only half-finished operation. Working closely with John Pike, the then optical scientist at Rayners London, they decided on the shape, location, and material of this first IOL. Poly(methyl methacrylate) (PMMA) was chosen as the material of choice as it was light and had the same specific gravity (1.09) as that of the aqueous. Ridley's first IOL operation was performed on a 45-year-old woman at St. Thomas' Hospital in London on November 29, 1949. The cataract was removed by extracapsular cataract extraction (ECCE), and a biconvex IOL made of PMMA was placed behind the iris onto the anterior surface of the posterior capsule. Ridley did this first implant in two stages—first the ECCE and then the implant 3 months later. His goal was to ensure that the eye was quiet after the ECCE so as to not to compound and confine any reaction caused by the implant itself. Because the calculations for the Ridley IOL were apparently based on measurements of the human crystalline lens, not properly accounting for the differences in refractive index between human lens protein and plastic, the initial lens was too thick. The first patient's refraction revealed a high myopic overcorrection of over 14 diopters. Ridley's first article relating to IOLs was published in 1951, in Transactions of the Ophthalmological Societies of the United Kingdom.1 Most of the years between 1949 and the 1980s were difficult. For over 3 decades, he was supported by a very few visionary individuals but defamed by many. His presentation at the 57th American Academy of Ophthalmology and Otolaryngology meeting in Chicago was met with great hostility by several skeptical ophthalmologists, including Derrik Vail, the then editor-in-chief of the American Journal of Ophthalmology.2 It is unfortunate that several prominent surgeons in the 1950s and 1960s, many representing the academic establishment in Europe and the U.S., treated Ridley and his lens with severe disdain, as Ridley discussed in his 1993 Gullstrand lecture.3 Not until the late 1970s and 1980s did Ridley begin to receive appropriate honor and credit for this original achievement. In 1986, he was elected as Fellow of the Royal Society of London. This society was chartered in 1662 by King Charles II, and Sir Isaac Newton was an illustrious early member. This society is reserved for individuals who have made scientific contributions of the highest order. In 1998, an annual Ridley Lecture was established by the European Intraocular Implant Lens Council (the current ESCRS). In February 2000, he was knighted by Queen Elizabeth II for his innovative efforts. To celebrate and acknowledge his contribution, the ESCRS during the 2024 Congress created a unique IOL museum showcasing the history of IOL invention from Ridley and others that had contributed to the development of modern IOLs. The UK and Ireland Society of Cataract and Refractive Surgeons at their annual meeting on November 28–29, 2024, will celebrate the 75th year of the Ridley invention with a large international gathering of ophthalmologists representing several ophthalmological societies across the globe. A special event during this meeting will raise funds to support the Ridley Foundation that Sir Harold established in 1949 at St. Thomas' Hospital to relieve blindness among the underprivileged. On a personal note, I had the unique opportunity to meet him and his wife and spend an entire day with them at their retirement cottage in Stapelford, Salisbury, in April 1996 (Figure 1). As a young first-year resident in ophthalmology from India, I traveled to London in the spring of 1996 for the British Ophthalmology Board examinations. Inspired by a lecture from David Apple, I decided to “take my chances” and knock at his door unannounced with a sliver of possibility of meeting him. I was astonished not only by his kindness and warmth in welcoming an unannounced total stranger to their house but also by the enthusiasm with which he shared his story of IOL invention and the tribulations he had to encounter.Figure 1.: Sathish Srinivasan with Sir Harold Ridley and his wife, Elisabeth Ridley, April 1996, at their residence in Stapelford, Salisbury, UKFortunately, he lived to see the vast benefits he has provided to humanity with his invention. Very few in history have lived long enough or been in a position to reap the benefits of their own invention. Ridley was one such. He underwent cataract surgery with Michael Falcon in London in 1989 and 1990 with in-the-bag implantation of IOLs and achieved a CDVA of 20/20.