Hurrah for Jules Gonin!

At approximately 3am on Tuesday 15 April 2014, shortly after being diagnosed with a macula-off retinal detachment in the eye hospital in Berlin, the nice German doctor (who was reassuringly wide awake for such an unearthly hour) told me that not so very long ago there would have been no treatment available for cases of retinal detachment.  The patient would have been advised to lie down on the same side as the retinal tear for weeks, if not months, and hope to eventually regain some sight.  I stared at her in horror.  Already struggling to deal with the quite literally blindingly obvious loss of vision in my right eye and the prospect of emergency surgery in a foreign country, my shocked brain simply couldn’t cope with this incomprehensibly horrifying piece of information.  (Read https://rdramblings.wordpress.com/2015/06/15/how-it-all-began/ if you’d like a full run-down of my night of trauma.)  It was only months later that my curiosity compelled me to have a hunt around for further information on the history of RD surgery, and this is what I discovered…

Before the early twentieth century, there was pretty much no hope of successful treatment for retinal detachment, with success rates following the early surgical techniques being less than 5%. [1]  Retinal tears were first spotted in 1853, around the time that the ophthalmoscope (the instrument which allows the doctor to see inside the eye) came into common use. [2, 3, 4]  However, at first it was thought that the tears were a side-effect of the detachment rather than its cause.  It was believed that the retina detached as a result of force from behind it, resulting in holes and tears as the detachment progressed.  This belief led to surgeons concluding that the progress of the detachment could be halted by making cuts in the retina to drain the fluid. [2]  Upon reading this, I actually gasped aloud in horror, because of course the exact opposite is true.  Detachment occurs as a result of a tear or hole in the retina through which vitreous fluid escapes and then pulls the retina away from its place at the back of the eye.  I won’t go into further detail about the treatment which was attempted at this point in history,  but suffice it to say that reading about it made me shudder and I wasn’t surprised to learn that the results of treatment up until the turn of the twentieth century were so bad that it was generally considered insane to even attempt surgery. [2]

Cue our hero, Jules Gonin, who rode into battle on his white charger, with his cape billowing in the wind and an expression of grim determination on his face as he lifted his chin defiantly in response to cruel jeers from the other side of the battlefield.  Okay, that’s not actually historically accurate, but you get the general picture.  Born in Lausanne, Switzerland, in 1870, Jules Gonin studied medicine at the university there and eventually settled down to working in ophthalmology at Lausanne Eye Hospital in 1896.  He became particularly interested in the cause and development of retinal detachment, and its subsequent treatment.  He published a number of papers, on the subject, co-founded the Swiss Ophthalmological Society in 1908, became director of the Eye Hospital in Lausanne in 1918, and was appointed Professor of Ophthalmology at the University of Lausanne in 1920. [1,2]  So basically, he knew his onions.  Or rather, his eyes.  Or, to be strictly accurate: other people’s RD eyes. 

As a result of his extensive research, he became convinced that the hole or tear in the retina was the cause of the detachment, rather than the other way around.  He logically concluded that treatment would only be successful if the hole or tear was mended, although at first he couldn’t work out how this could be done.  Despite this, and the fact that many of his fellow ophthalmologists continued to oppose his views, sticking rigidly to their original dangerous beliefs, Jules Gonin continued his efforts to figure out a cure. [1,2,4]

He went on to develop the ignipuncture, a surgical procedure by which the retinal break was sealed by cauterisation.  He gave details of this technique at the German Opthalmological Society meeting in 1925 and emphasised that the process of finding the retinal tears was just as important as the actual surgery.  His ability to find retinal tears increased dramatically over the years, in contrast to the surgeons who still refused to believe that the tear was the cause of the detachment. [2]  This emphasis on the importance of locating the tear is vital, and an issue which I’m very aware of, particularly after speaking to a fellow patient once, who told me that one surgeon found a tear in her retina and assumed that was the only one until she was examined by another surgeon who discovered two additional tears in a different location.  Obviously, all tears must be found and treated for the re-attachment surgery to stand a chance of succeeding. 

Eventually, as more surgeons learnt the technique developed by Jules Gonin and observed successful results for themselves, his findings were accepted.  In 1931, he reported a success rate of 53% based on 221 detachments on which he operated using the same technique; and a success rate of 67% for detachments which were less than three weeks old. [2]  In the last few years of his life, he was swamped with difficult cases and visitors from all over the world.  He died in 1935, leaving a large portion of his assets to people who had lost their sight late in life. [1]  I think this gesture underlines what a remarkable man he must have been, not only in his relentless pursuit of a solution to the apparently hopeless conundrum of retinal detachment, but also in demonstrating compassion for those who had lost their sight.  If I ever get a cat, I shall name it Jules.  In the meantime, who will join me in a great big resounding cheer, as I lift my mug of tea and cry, “Hurrah for Jules Gonin!”?

References
1. Wolfensberger TJ. Jules Gonin. Pioneer of retinal detachment surgery. Indian J Ophthalmol [serial online] 2003 [cited 2016 Apr 15];51:303-8. Available from: http://www.ijo.in/text.asp?2003/51/4/303/14656

2. Gloor, BP and Marmor, MF. Controversy over the etiology and therapy of retinal detachment: the struggles of Jules Gonin. Survey of Ophthalmology [serial online] 2013 [cited 2016 Apr 16];58;2;184-195. Available from: http://www.surveyophthalmol.com/article/S0039-6257(12)00193-2/fulltext

3. Keeler, CR. A brief history of the Ophthalmoscope. Optometry in Practice [serial online] 2003 [cited 2016 May 8];4;137-145. Available from: http://www.optometryinpractice.org/en/utilities/document-summary.cfm/docid/401E0411-F197-4ED1-99936804BFEADC23

4. Albert, DM, Gloor, BP, McPherson, AR. Why Jules Gonin achieved his “audacious goal initiative” – and why he is a model for the present day. Ophthalmology [serial online] 2015 [cited 2016 May 13];122;10;1955-1957. Available from: http://www.aaojournal.org/article/S0161-6420(15)00536-9/fulltext

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2 thoughts on “Hurrah for Jules Gonin!

  1. Stephen Rockey

    I will join you in three cheers for Jules Gonin. It’s only pioneers like him that advance medical science. Hope you’re ok x

    Liked by 1 person

    Reply
  2. Pingback: The curse of PVR | RD Ramblings

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