The year was 1966. I had recently graduated from Berkeley Optometry and was attending the annual meeting of the American Academy of Optometry at the encouragement of Dr. Bob Mandell. Understanding my keen interest in contact lenses, Bob made it a priority to introduce me to many of the stars (young and old) of the then rapidly emerging field of contact lens care. I was fortunate to attend lectures given by the “who’s who” in the world of contact lenses.
I especially remember a lecture given by a young but seemingly experienced clinician who was lecturing on several contact lens topics, including keratoconus, 3 to 9 staining, and central circular clouding. As the lecture proceeded, I wondered how such a young person could possibly have accumulated so much clinical experience. At first, I thought that perhaps he might just be quoting from what he had read in a textbook or learned from conversations with other clinicians. However, in following the lecture, Dr. Mandell introduced me to this speaker, and after about 45 min of intense discussion, I knew that Dr. Donald Korb spoke from his own experience and knowledge. Indeed, I was soon to learn that Dr. Korb not only talked the talk but also walked the walk (Fig. 1)!
Donald, or Don as he is known to many of his friends and colleagues, is an astute observer, able to make critical observations, followed by experiments to test his understanding and develop clinical interpretations. Korb’s early investigations into contact-lens-associated ocular changes are seminal, particularly those involving central corneal edema (central circular clouding), lid attachment fitting, giant papillary conjunctivitis (GPC), meibomian gland dysfunction (MGD), 3 to 9 limbal superficial punctate keratitis (3 to 9 staining), and lid-wiper epitheliopathy. During a period of 50 years of clinical practice, research, and development, Dr. Korb has made enormous contributions to the science of contact lenses and ocular surface disease. Over the years, Don has taught me much about the science of contact lenses and the etiology and treatment of ocular surface disease. I have been fortunate to have known him, both as a colleague and friend.
In every way, Dr. Donald Korb represents the quintessential clinician scientist. The profile and interview that follows summarize his achievements and make it clear that, to this day, Don’s incredible career continues to be amazingly productive. I would encourage clinicians to read carefully the interview section, because it identifies various clinical perils in the science and clinical application of contact lenses.
Donald R. Korb was born in Boston in 1933. He completed elementary, high school, and university education in that same city, not quite knowing what path he should seek for a career. Donald was always interested in how things worked. Although he admits to being only an average student, he knew that he could be “at the top of the class whenever I wanted.” Once achieving that goal, he returned to average. The main reason for his average performance was his lack of a goal to inspire him and unleash his enormous energy and talents. Eventually, it was Donald’s refractive error and dependence on glasses that, in his words, “first alerted me to optometry.” He became curious about the eye and vision, setting his target on optometry. It was a good choice, because optometry offered Donald all the essentials he needed to become motivated—science, exploring one of the most interesting aspects of human physiology, and providing health care. In 1957, Donald graduated from the Massachusetts College of Optometry and completed his doctoral degree in 1962.
Early Professional Years
After graduation, Dr. Korb began practice with an optometrist who had a small general practice fitting a limited number of corneal lenses. The practice was located at 80 Boylston Street, in downtown Boston. When the associate retired a year later, Don continued the practice, but with the more ambitious goal of becoming a leader in the field of contact lens care. (Korb remained at the celebrated address until 1995, when the building became part of the Emerson College downtown campus.) In the early 1960s, the field of modern day contact lens care was just emerging; before that time, most optometrists had received little or no clinical training in contact lens science and fitting. However, this was just the type of challenge that Donald welcomed.
Dr. Korb had a special opportunity during his first year in practice to attend the annual meeting of the American Academy of Optometry, which was held in Boston. Don attended lectures given by many contact lens pioneers (Feinbloom, Finklestein, Policoff, and Jessen). In particular, he recalls the courses by George Jessen, which were informative and practical, covering territory unknown to him. Korb was eager to learn more; fortunately, both Jessen and Feinbloom invited him to spend time at their practices, which, according to Don, gave him invaluable “hands-on experience.” These brief but intense clinical internships provided Don with a new level of knowledge and expertise in contact lens fitting. Dr. Korb states that after spending time with Jessen and Feinbloom “it all began to jell.”
During the first years of practice, there were not enough contact lens patients to expand his knowledge. Donald, therefore, made it a priority to treat each contact lens patient as an opportunity to learn. “Each patient,” says Don “was a lesson from which I learned, and my experience quickly increased.” He understood that by listening and carefully observing, it was possible to acquire clinical knowledge from the patient. Korb states, “I decided that knowledge in those days was the key [to success], and I worked hard at developing the knowledge … to understand the science of contact lenses.” Korb quickly began to better understand “the physiology” of contact lenses,” which forced him to think about the basic mechanism underlying his clinical observations. Donald knew that without understanding the etiology of his clinical observations, he would not be successful in developing treatment strategies. Before long, Dr. Korb developed into not only an outstanding clinician but also a first-rate scientist. His expertise, common sense, and clinical wisdom soon became well known by both patients and colleagues. The practice grew rapidly, and it was not long before contact lens care constituted 80 to 90% of his professional activities.
Four years after graduation, Dr. Korb was invited to acquire the practice of Dr. Frederick E. Farnum, his former professor in contact lenses at the Massachusetts College of Optometry. This was fortuitous, because Dr. Farnum also practiced in the same building at 80 Boylston Street and had the largest contact lens practice in the Boston area, having fitted scleral lenses from the 1930s. The merger substantially increased the opportunities for clinical observation and research.
Dr. Korb realized how little the profession understood about contact lenses. In Don’s mindset, every day was a research day and an opportunity for discovery. He explains that, “If one thought about what was one was doing, it would lead to research questions.” In his drive to understand what he observed in practice, Dr. Korb read just about everything he could that was relevant to the anterior segment and contact lenses. Among the many textbooks, he felt he was particularly fortunate to have obtained the classic 1943 work on slitlamp biomicroscopy by M. L. Berliner, Biomicroscopy of the Eye. The text described basic and advanced slitlamp techniques for examining the cornea. During the early 1960s, only a very small group of optometrists or ophthalmologists used the slitlamp in contact lens practice, and those who did were considered advanced clinicians (Fig. 2).
Using both basic and advanced slitlamp technology, Dr. Korb made several landmark observations related to the interaction of the contact lens with the eye. In 1962, he first described, using what he called a “split limbal technique,” the corneal response of central corneal clouding (CCC). Dr. Korb recalled, “I made the observation about 2 years into practice on a patient who was truly suffering with his lenses. I had already learned the sclerotic scatter technique from Berliner and had then combined retroillumination and sclerotic scatter as my initial method for corneal evaluation. Then, on the day of discovery, for no apparent reason I can recall, after the lens had been removed, I illuminated the cornea from the temporal side with the slitlamp beam focused so as to split the limbus (half on the cornea and half on the sclera) and observe from the opposite nasal side, but with the unaided eye and not the microscope … and there was a circle of gray in the central cornea!” Korb first published the “CCC” observation in 1963 in the Encyclopedia of Contact Lens Practice, and later in collaboration with Joan Exford Korb, in which photographic documentation of the clouding was reported.1,2
It took nearly 10 years for the profession to recognize that the clouding was corneal edema; however, Korb was ahead of his time: “Since the classical concepts of edema at that time (1961) included bedewing with micro droplets, I refrained from directly terming the clouding as edema, although in other publications I did state that the clouding was edema …. I was mixed between knowing it was edema and taking exception with the classical descriptors, including bedewing …. I almost immediately recognized that since it [clouding] was the farthest areas from the lens edge, it was an effect on the cornea by the unexposed tear film.” Understanding that that clouding must be related to inadequate “venting” of the tears, Korb developed a simple experiment to test his hypothesis. He placed small fenestrations in the lens and fitted them on the patients who normally develop CCC. He discovered that the holes in the lens prevented the clouding from forming. Although the profession now recognizes that this clearly would have been the expected result, it was not the case in the early 1960s. It is important to recognize that this classic work provided some of first scientific evidence that clouding was related to corneal hypoxia. Korb’s findings were the initial catalyst for many of the important basic and applied experiments that defined the relationship between contact-lens-associated hypoxia and altered corneal physiology. This important discovery clearly set the stage for years of productive research in areas such as oxygen needs, hypoxic effects on the cornea, lens oxygen transmissibility, and corneal oxygen uptake.
As Dr. Korb’s career continued, he and his colleagues made other discoveries, including 3 to 9 staining,3 GPC,4 MGD,5 corneal scarring associated with keratoconus,6,7 and lid wiper epitheliopathy8 Donald states that my “best work was in the development of the CSI membrane lens and in understanding the obstruction of the meibomian glands and meibomian gland dysfunction.” He chose not to publish on the CSI because of his financial interest in the company. Donald’s classic article on lid attachment fit was published in 1970, and the concepts presented in that article still remain for current GP fittings.9
Over the years, Don has presented hundreds of scientific papers at scientific conferences and has over 75 published articles in refereed ophthalmic journals. In our interview, we will have an opportunity to cover some of these important discoveries and gain some “insider insight” into the thoughts behind the discovery.
Donald was not only an astute clinical observer and investigator but also an innovator, consultant, and director of many clinical projects for product development. He has been awarded 25 U.S. patents (and corresponding foreign patents) in ocular diagnostic equipment, visual sciences, contact lens polymers, contact lens designs, ocular tests for dry eye, and ocular drugs and formulations. Currently, an additional 10 patent applications are in process. Among his more important professional associations, he has been a Project Manager (Polaroid Corporation); Director, Contact Lens Development Program (Itek Corporation); Founder, President, and Director of Clinical Research (Corneal Sciences, Inc—Developer of the CSI hydrogel lens); Director, Corneal Sciences Contact Lens Program (Syntex, Corporation); Founder and Director of Research (Koper Sciences, Inc); Founder, President, and Director of Clinical Research (Ocular Research of Boston); and Co-Founder and Chief Scientific Officer (Corneal Sciences; Fig. 3).
Dedication to and Recognition from the Profession
One would think that with a full clinical practice, an active research program, and consultant to industry, that Donald Korb would be flat against the wall. Those who know Donald, however, understand that this man has an extraordinary capacity for work and achievement. Don never wavered in his allegiance to the profession. He served as a member and often chair of important and prestigious professional committees. Some of the most notable include: Member, Subcommittee on Impairment of Visual Functions, Federal Office of Vocational Rehabilitation, 1960 to 1964; Editor, Recent Developments, Encyclopedia of Contact Lens Practice, 1962 to 1964; Member, Contact Lens Section, American Academy of Optometry, 1966 to 1973; Chairperson, Papers Program, Contact Lens Section, American Academy of Optometry, 1966 to 1968; Chairperson, Papers and Program Committee, American Academy of Optometry, 1968 to 1969; Chairperson, Committee on Aid to the Partially Sighted, American Optometric Association, 1968 to 1971; Member, Board of Directors, Massachusetts Society for the Prevention of Blindness, 1971 to 1979; Special Editor and Editorial Consultant, Journal of the American Optometric Association, 1968 to 1984; Invited Founding Member, International Society for Contact Lens Research, London, England, 1980; Invited Founding Member and Distinguished Practitioner, National Academies of Practice, 1981; Working Group on Contact Lens use Under Adverse Conditions, National Research Council, Committee on Vision, 1988 to 1991; Member, Board of Trustees, Schepens Eye Research Institute, Boston, Massachusetts, 1993 to present; and Chairperson, Awards Committee, American Academy of Optometry, 2000 to 2006 (Fig. 4).
Dr. Korb has received many honors and awards. In the interest of space, I have included only a partial list of some of the more impressive: Person of Vision of Year Award, Massachusetts Society for Prevention of Blindness, March 1983; Contact Lens Person of the Year, Contact Lens Section, American Optometric Association, November 1985; Schapero Memorial Lecturer, Section on Contact Lenses, American Academy of Optometry, December 1985; Dr. William Feinbloom Award for Advancement of Visual Science and Clinical Excellence, American Academy of Optometry, December 1986; First Memorial Morton D. Sarver Lecturer, School of Optometry, University of California, Berkeley, California, January 1987; Founder’s Award, Contact Lens and Cornea Section, American Academy of Optometry, 1994; Professor Montague Ruben Research Medal, International Society for Contact Lens Research, 1995; Regents’ Lecturer, University of California, Berkeley, 1995 to 1996; Donald R. Korb Medal for Excellence, established by the Contact Lens Section, American Optometric Association, 2000; Dr. Josef Dallos Award, Contact Lens Manufacturers Association, 2001; Distinguished Service Award, Massachusetts Society of Optometry, 2001; Bronstein Memorial Award for Contact Lens Achievement, Arizona Optometric Association, 2005; Bausch & Lomb Visionary Award, 2005; Pioneers’ lecture, British Contact Lens Association, November, 2005; University of Houston College of Optometry Award for Distinguished Research on the Cornea and Contact Lenses, 2008, and National Optometry Hall of Fame, inducted as member 2007.
COMMENTS FROM COLLEAGUES AND FRIENDS
One of the best ways to learn about someone is to ask his colleagues and friends to share their thoughts and insights.
John Herman, OD, Clinical Practice, Boston:
“Don has been a mentor for some of the best known and most prolific researchers in our field, both clinicians and scientists. His list of residents includes people who have gone on to become ophthalmologists, retina specialists, corneal surgeons, and PhDs at the best universities in the country, as well as a wide array of some of the most outstanding clinicians in optometry. It is impossible to estimate the number of publications, posters, lectures, and inventions that have been the direct or indirect result of his efforts. Certainly, there is no other person in our field who has ever possessed the unique combination of capabilities as an intellectual, researcher, clinician, inventor, mentor, author, and lecturer as Don Korb. He has always been driven by the search for better diagnostic tests and treatment methods for the clinical problems encountered by the contact lens patient. His research and development efforts have enabled us all to be better clinicians. Not the least of his skills is his ability as an outstanding clinician. He has always been more than kind and generous with both his time and resources in helping many people throughout his life. Knowing him personally as I do, I can honestly say that despite being small in stature, he is one giant of a man” (Fig. 5).
Robert B. Mandell, OD, PhD, Emeritus Professor of Vision Science and Optometry, University of California, Berkeley:
“Don Korb has spent his very productive life in the practice of optometry while carrying out groundbreaking research and contact lens development. Over the last half century, he has often been the first to recognize a clinical problem and then conceive of and implement a research protocol to provide the answer to that problem. His work has elevated the contact lens field to new heights in both rigid and soft lens design. He has shown an ability to bring together a group of scientists from various disciplines in order to invent and develop new products. Most clinicians who try to do all of this find at some point that the demands of practice inhibit their efforts to make progress. Don is the rare exception with his many successes. The enthusiasm for his work spills over to those around him, and his energy is unsurpassed. With all of this, he still finds time to contribute unselfishly to the welfare of optometry with his service and teaching.”
Miguel Refojo, DSc, Emeritus Senior Scientist, Schepens Eye Research Institute, Harvard Medical School:
“In the late 1960s, an entrepreneurial optometrist friend of mine, Donald Korb, invited me to join in a new company to develop a new hydrogel contact lens. The lenses, named CSI, were the first available ultrathin hydrogel contact lenses, made so to optimize ocular comfort and to adjust the lenses oxygen transmissibility to the physiological requirements of the cornea during daily wear. Don Korb was the clinician who provided the background and testing that ultimately resulted in this breakthrough development. It was a great pleasure to work with Don and be one of his friends. Don continues working in his clinic, and has many grateful patients, but finds time to be very involved in research and development projects in his own laboratory at the clinic, and also finds time to be a contributor to nonprofit organizations. Among these is his valuable contribution as a trustee of the Schepens Eye Research Institute, an affiliate of Harvard Medical School. One last important thought comes to mind, and that is I must mention the contribution of Dr. Joan Exford Korb, his wife, colleague, and friend, whose support was central in the achievements the Donald made over the years.”
Dwight Cavanagh, MD, PhD, Dr. W. Maxwell Thomas Chair Professor and Vice-Chairperson of the Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas:
“I have known Donald for nearly forty years, and when I think of Don, the following phrases come to mind: Brilliant; does not suffer fools or incompetents gladly; paved the way for an RGP renaissance; demonstrated the role of meibomian lipids in interaction of dry eye, blepharitis, and contact lenses; discovered lid wiper syndrome; developed the CSI Korb-Refojo thin membrane lens; behind the great Korb is Joan; comparable contemporaries include Otto Wichterle, John de Carle; and finally, the most important, serves as a role model and friend to students via the AOF” (Fig. 6).
Anthony Adams, OD, PhD, Dean Emeritus and Professor of Optometry and Vision Science, University of California, Berkeley:
“I think of Donald Korb as the model of the inquiring entrepreneurial practice optometrist who is always the innovative clinician researcher within his practice. He arguably has been responsible for more contact lens related discovery and investigation of the basic mechanisms of dry eye and contact lenses over the years than any other OD in our profession. He has earned the reputation as one of a hand full of the very best contact lens practitioners in the world and has been active in presenting his discoveries and observations for decades. He holds about 20 fundamental patents and a number of clinical approaches are named after him because of his observations. Perhaps some of his most interesting observations and publications were in the field of keratoconus. An entire NEI clinical trial (CLEK) evolved from his early work. Most recently AOA recognized him by naming an annual Award after him; thoroughly deserved. He has used his high standing in the nonoptometric eye community to advance optometry, often quietly ‘behind the scenes’ and without awareness by his colleagues—beginning way back in the early therapeutic legislation times in the late 1960s (Rhode Island), and continuing to this day.
He has completely turned the Academy of Optometry Awards program around, and it is now among the finest found in any professional organization. Unknown to many is his impressive quiet generosity in sponsoring young talented OD’s in graduate work—something he regards as essential but prefers to down play in terms of his personal role. I believe Donald Korb will ultimately be seen in a similar context as Irv Borish; certainly in the contact lens arena. Quite simply, he will be acknowledged as one of the ‘giants’ among optometric practitioner entrepreneurs. I am proud to consider him both a very close personal friend and an extraordinary professional colleague and mentor. He is a colleague of great personal integrity and exceptional generosity of spirit. I am confident the profession will recognize him as one of its greatest clinician-researcher role models of the twentieth century.”
Tony Henriquez, MD, PhD, Professor, Department of Ophthalmology, University of Barcelona, and President, Boston Eye Institute, Barcelona, Spain:
“I met Donald Korb in Boston 35 years ago. I am still most impressed with him as a friend and as a professional. As a pathologist, I was impacted by his ability to first detect and then solve problems. More of a mover, he is most curious trying to understand the real nature of disease and then perseveres in searching the best solution. I think Donald Korb deserves universal recognition in many areas of research and, particularly, meibomian gland dysfunction, known to be the most common cause of consultation (eye dryness) in clinical optometric and ophthalmologic practice. Thanks to Donald Korb and his wonderful wife, Joan, I learned that the collaborative efforts of optometrist and ophthalmologists, working together, are the best way to help our common subject: the patient. The Lord in His Magnificence provided us with Donald Korb.”
Harold Davis, OD, Clinician and Contact Lens Pioneer; Chicago:
“Donald Korb is an astute clinician, a keen observer with an inquisitive mind. This characteristic has enabled him to focus tenaciously on a project until completion. He has made many contributions in contact lens designs and the understanding of dry eye. His observations also led him to uncover many complexities of the cornea and adnexa related to contact lens wear. On his personal side, he has mentored several professionals in getting them started in their chosen profession. Donald has many admirable characteristics— his concern for people, devotion to family and friends, as well as being charitable to less fortunate individuals.”
Kenneth P. Trevett, JD, President and CEO, Southwest Foundation for Biomedical Research:
“I first met Dr. Donald Korb when I was the Chief Operating Officer and General Counsel of the Schepens Eye Research Institute. I was immediately struck by Donald’s passion for his profession, his zeal for new approaches to enhancing “sightedness” (particularly with respect to contact lens technology), and his sense of social justice. The man’s energy is volcanic, his loyalty to issues and people about which and whom he cares is profound, and his curiosity to learn is inexhaustible. Donald’s contributions to optometry and his thoroughness and caring with patients are exemplary. When a patient gets to see Dr. Korb, be he or she a member of Congress or the humblest of shopkeepers, that person is his only focus. Similarly, at the research bench, or as a member of a not-for-profit board of trustees, the world has to wait while Donald tackles the problem at hand. One of the great gifts I have received in life is to have gotten to know Donald, laugh with him, work with him, and dream with him. He is a very special man.”
LET’S TALK WITH DONALD
Polse: For some of us, experiences early in life lead us into making important career decisions. What attracted you to the field of optometry?
Korb: To be direct, I was not certain as to what I would find interesting and satisfying. My father was a physician whose office in a professional building was adjacent to that of an OD. He became my optometrist, and when I knew that I did not want to be a physician, my mother thought optometry would be a great career—it was my mother who provided the impetus for my attending optometry school.
Polse: You have had an amazing career in clinical practice, research and innovative development. Could you identify some of the individuals who most influenced your career and describe how they helped mold your professional development?
Korb: Ken, this is a short question, but I am afraid requires a long answer. I think I can divide the contributions of what helped me in my growth and development into two components, working with industry in the research and development of innovative products, and working in a more academic environment, which fostered the science of contact lens care.
Early in my career, I was to have the experience of watching Dr. Edwin Land’s private research laboratory achieve miracles in so many areas and observing and knowing the individuals involved with Dr. Land, one of whom was John McCann, provided me with the clear understanding that one could achieve almost anything if one were to commit entirely to that end (Fig. 2).
Also, being in Boston allowed me to meet and work with an endless number of intellectuals; one such person was Father Tom Carroll, the founder of the Catholic Guild for the Blind, now the Carroll Center. Working with Father Carroll at his allied American Center for Research in Blindness, and particularly with two MD researchers, taught me how to be a better observer and to think more creatively.
I was also fortunate to have the opportunity to work on projects with many lummaniers doing work such as constructing lenses for corneal implants for Judah Folkman, MD, the father of angiogenesis; George Wald, PhD, the Nobel Laureate for his work on Vitamin A and rhodopsin (fitting special scleral lenses); John McCann in the lab of Edwin Land (fitting lenses for experiments) and many others.
Itek Corp (responsible for all the cameras and photography on the initial space flights) gave me the opportunity to develop a next-generation contact lens, and then provided significant funding for the company I founded, CSI, to develop the first membrane lens.
My participation in optometry and more specifically the American Academy of Optometry and its’ Contact Lens Section were critical components of my early development. I had the opportunity to interact with many of the Academy leadership including David Dzik of Chattanooga, Harold Simmerman of the Admittance Committee, and Otto Bebber and Meridith Morgan of the Contact Lens Section. My first fully dedicated mentor was Ted Bayshore who appointed me as Chair of Papers for the Section in 1966. I must also mention C. Edward Williams, the quintessential student, who was an inspiration to me because of his enthusiasm and clinical excellence (Fig. 7)! Finally, I must acknowledge Harold Davis, an early pioneer in contact lenses, who was most generous with his mentoring and particularly helpful in so many ways in the early days of CSI development (Fig. 3).
Polse: As with most successful clinical scientists, you have also had many collaborators. Could you briefly describe some of the more important collaborations and what discoveries, developments or innovative products stemmed from theses collaborations?
Korb: Ken, it did not take me long to understand the necessity for collaboration. Over the span of my career, I have worked with over 100 collaborators. Notable examples include:
John McCann who was a scientist and personal assistant to the founder and inventor of instant photography, Edward Land at Polaroid Corporation. John was of great assistance in many of my early efforts in topography, and for the past 20 years in interferometry. Mathea Allansmith, MD, (Schepens Eye Research Institute) and I worked on the entity that we named giant papillary conjunctivitis (GPC), which led to our understanding of this important disease. Antonio Henriquez, MD, PhD—an ophthalmologist, pathologist, and ocular pathologist—with whom I worked on MGD. I continue to meet with him and learn from him to this day. Miguel Refojo, DSc, a senior scientist at the Schepens Eye Research Institute, developed the polymer that met the criteria for my idealistic dream of a hydrogel membrane CSI lens. I worked extensively with two members of the Mathea Allansmith lab team, Jack V. Greiner, PhD, OD, DO, and subsequently his colleague, Thomas Glonek, PhD. Working with Drs. Glonek and Greiner resulted in the development of oil-in-water metastable emulsions for treatment of dry eye and for contact lenses. John P. Herman, OD, has worked with me in many areas including: sequential corneal staining, GPC, CSI lens development, and lid-wiper epitheliopathy. Through the years, I have collaborated on numerous projects with my two associates for over 35 years, Dr. Victor Finnemore and my wife, Dr. Joan Exford. Caroline Blackie, OD, MPhil, PhD, has made innumerable major contributions to our ongoing work with meibomian glands, including developing a metric for the diagnosis of individual meibomian gland functionality, and the treatment of MGD with new methodology. Egon Matijevic, PhD, Chair of Chemistry and LaMer Professor of Colloid and Surface Chemistry at Clarkson University collaborated on a dry eye formulation, now marketed as Soothe XP. Tim Willis, an engineer, and I worked on several projects including the development of the lipid eye drops for the treatment of MGD and dry eye.
Polse: Don, you represent the true model for the clinician scientist. From your professional experience could you share what you believe are the essentials necessary to become a successful clinician scientist?
Korb: A willingness to accept that one knows far less than what one thinks one knows, a passion to understand what one does not understand, a determination to solve problems or less than optimal situations, and the ability to realize satisfaction in using clinical science to achieve the end goal of improved clinical care. I still discipline myself to listen to every chief complaint and ask do I understand what the basis for the complaint is and why? There are very few full clinical days when I do not formulate more questions.
Polse: Don, in my mind, you are like the “Eveready Battery ads:” You never seem to lose energy and just keep going on and on. I know there is a “pony” here; can you share with us your formula for what seems to be continuous source of energy, enthusiasm, and success.
Korb: I honestly remain excited about what I am so fortunate to be able to do—I believe I am as enthusiastic about our work as I was in the 1970s when developing the CSI lens was my all-consuming passion every day to the point of physical collapse. I realize how fortunate I am to have the abilities, health, and desire to dedicate more than the usual amount of time to those areas I find satisfying. As many have said, being involved with areas one enjoys is the ultimate way to spend one’s time—that has been my fortunate situation since the first few years following graduation.
Let’s Talk Research
Polse: I understand that soon after you made your observation of central corneal clouding, you believed CCC was related to corneal hypoxia, and of course you were correct. At that time, this was a bold observation. What led you to this conclusion, and did you also believe that spectacle blur, which often accompanied CCC, was also caused by insufficient oxygen to the cornea?
Korb: Short answer, yes. As you know, I worked with Dr. Farnum for several years and then took over the practice. Dr. Farnum obtained follow-up keratometry readings on all of his polymethyl methacrylate (PMMA) patients, although he did not use slitlamp except to detect staining. His records and watching him with patients revealed that the Ks were almost always steeper compared with baseline measurements. Farnum’s treatment for spectacle blur was to reduce the lens diameter and/or flatten the peripheral curve until the K readings were normal after 6 h of wear. In this process, he frequently inadvertently achieved a lid attachment fit and thus improved tear circulation under the lens. So in an indirect way, he improved oxygen availability and consequently, reduced spectacle blur.
Also, the area of CCC was correlated to the central areas of the lens—it was obvious that the further the distance from the lens edge and the tear film, the more severe the CCC. At that time, it was known that Sattler’s veil would occur with scleral lenses if they were not ventilated with fenestrations. It was obvious that the location of the CCC and the localized disappearance of CCC under the corneal lens when the lens was singly or multiply fenestrated provided exposure to the atmosphere and that exposure was the key factor—and since the cornea was avascular, the culprit must have been oxygen.
Polse: You developed the lid-attachment fit as a strategy to improve comfort and help eliminate CCC. How did you conceptualize the lid-attachment fit?
Korb: I first conceived the concept of lid attachment when I observed that almost all of the patients who were successful in both the first practice, and then in Dr. Farnum’s practice, were wearing lenses that rode high, moved with the blink, and did not lag after the blink. I also noticed that the lenses which rode low had very severe CCC, and generally the patients were unable to maintain successful contact lens wearing. The accepted ideal positioning for PMMA lenses was central or low—superior positioning was not considered acceptable. All of the preferred fitting techniques made every effort to convert high riding lenses to centered or low riding lenses.
From these observations, I decided to learn the rules to position the lens high and then to make a science of fitting the lens so that it would attach to the upper lid. I learned that it was necessary to design the lens as light as possible (Dr. William’s influence). Although I was aware that the lens should ride high and had figured out how to do it as an art with each patient, it was not until 1967 when I read Kessing’s paper on the shape of the inner upper lid that I realized that the missing link was Kessing’s discovery that there was a very small attachment area for the lens on the upper lid, and that a special design was needed to achieve the goal of lid attachment. I then conducted many experiments in 1967 to 1968 and was able to determine that the lens required an anterior peripheral portion which would “attach to the upper lid,” and researched on a group of patients covering the power range from +15.00 to −10.00 the optimal outer lens and edge shape and the resultant lens parameters (e.g., diameter, optical zone size, thickness, secondary and edge curvatures). The next step was to construct a table and standardize the specifications for the lid attachment design in 8.6, 9.0, and 9.4 mm diameters. The goal, as reported in the publication, was to have a lens, which would allow and improve blinking, in order to move the lens with every lid movement and every blink, thus improving tear circulation under the lens.
Polse: Experiencing contact lens success as defined by patients being able to wear their PMMA lenses for longer hours created another series of corneal problems. One of these problems that you reported was nasal and limbal superficial keratitis (e.g., 3 to 9 corneal staining). After reporting this finding, there was much controversy in the professional community regarding the etiology; however, you were steadfast in your belief that this was caused by drying, often as a result of poor blinking. Limbal staining is still an issue today with GP lenses and I wonder if you could share with the readership some of your thoughts about the etiology and amelioration of this common problem.
Korb: My position on the etiology of 3 and 9 staining resulted not only from observation but also from several contralateral eye studies proving that blinking was a major factor in exacerbating dryness and staining. It is my current position that 3 and 9 staining will always be a problem with any lens design that is smaller than the cornea because two environments are created—the rigid lens covers the cornea acting as a shield and a barrier to prevent evaporation, and the exposed area of the cornea surrounding the lens where evaporation occurs. The desiccation on the exposed area is also enhanced by the effects of the meniscus forming at the edge of the lens, thinning the tear film about the lens, which is further compromised by the less than optimal wiping of the surface resulting from the bridging of the upper lid from the corneal surfaces by the mass of the lens. And, if the lens design impedes blinking, the consequences are even more severe and immediate. While great strides have been made in minimizing the problem of 3 and 9 staining with rigid lenses, 3 and 9 will prove impossible to totally eliminate, especially with marginal tear films, because of the inherent physical circumstances created by any lens whose diameter is less than that of the cornea.
Polse: Don, you were one of the most successful rigid lens fitters in the world… almost too many patients for any one doctor to care for. What made you decide to develop a soft membrane hydrogel contact lens (CSI)?
Korb: Ken, there are many reasons, some of which are:
* Because I knew from my studies that a RGP lens could never be totally comfortable, it was not possible to completely solve desiccation unless the lens covered the entire cornea.
* Having had the experience of fitting a few of the early soft lenses from Europe, although minimal, I was convinced that using a hydrogel material could solve the discomfort associated with RGP.
* The soft lenses in the late 1960s and into the 1970s were thick, and I knew that the thinner a rigid lens the better. I hypothesized that a membrane thin hydrogel lens would be desirable, and I came to believe with conviction that a membrane hydrogel lens would be a major and required next step development in soft lens science. My conviction was also supported by my work with rabbits, which led to the observation that any extension of the cornea with a contact lens should mimic the micron thickness of the nictating membrane of the rabbit.
Polse: What was the contribution of the CSI lens to the advancement of the soft lens industry?
Korb: CSI introduced the concept of design architecture to the soft lens field which had been without design architecture. A lens was a lens prior to CSI; however, the CSI made the lens a membrane by design, starting with a minimal center thickness for minus lenses of 0.03 to 0.05 mm, and specifically designing every aspect of the lens to best achieve membrane profile despite the power factor. Prior to CSI, lenses were lenses made according to the constraints of the material, where physical design was not a deliberate process. CSI was possible because the material allowed the implementation of the membrane concept, and the related design architecture for thickness, periphery, and edges. All modern disposables follow the CSI teachings and patents for thickness and form. The CSI project required almost 10 years from conception and initiation to its marketing after FDA approval. This was the most exciting project I have ever worked on—it was the first time I could place a lens on most eyes and there was literally “NO FEEL” from insertion to all day wearing. I can still remember the excitement!
Polse: Don, probably there is not a single observation that you have made that has done more to alert the practitioner to a syndrome that can seriously affect the comfort of contact lens wear. GPC was and continues to be a major clinical issue associated with contact lens wear. What led to the discovery of GPC associated with contact lens wear?
Korb: I should first note that this syndrome, unknown to us at the time of our discovery, had been previously described by Thomas Spring, a very astute Australian ophthalmologist who was directly involved in contact lens practice. We were not aware of his work since it was published in the Australian Journal of Medicine, and the search systems of the 1970s did not provide the reference. We discovered his work literally after manuscript submission when an Australian colleague who was in the audience when Dr Allansmith and I were presenting a lecture on GPC informed us of Dr. Spring’s paper. We were then able to credit Dr. Spring’s superb work in our initial 1977 GPC paper.
I was aware that soft lens wear for some patients created remarkable amounts of mucus and itching, much more than was customary with rigid lenses. There was one patient, who was particularly symptomatic, and for no apparent reason in the course of my examination, I everted the upper lids and it was then I observed the giant papillae and inflamed conjunctiva. Since this was not normal, I then everted the lids of all patients to obtain a baseline understanding. Mathea Allansmith’s interest in collaborating with us brought her expertise and knowledge in vernal and ocular anaphylaxis, which was second to none—her qualifications included board certification in pediatrics, dermatology, allergy, and ophthalmology and fellowship training in cornea. Dr. Allansmith provided me with the opportunity to understand the background science of GPC from those aspects. Mathea and I assembled a team of laboratory and clinician scientists (Jack Greiner, Tony Henriquez, Victor Finnemore, and Meridith Simon). They were involved with our several discovery studies involving correlating palpebral morphology with histological and pathological findings, which led to our understanding and improved treatment of this disease (Fig. 8).
And, as GPC was better understood, it became apparent that there was a correlation between dryness and GPC. I particularly noticed that many individuals experiencing discomfort with contact lens wear would only have dryness and discomfort in the winter heating months. As a result of CSI being able to be worn all day by the majority of patients, I was led to the meibomian glands as a source of intolerance when there were no other signs to account for the intolerance. This resulted in the Korb Henriquez publication which was the first to use the precise words “Meibonian Gland Dysfunction” and the first to report nonobvious, noninflamed obstruction. With this knowledge, we had contact lens patients with intolerance wear swim goggles with their lenses in place when they were uncomfortable for diagnostic purposes. Usually within 20 min total relief resulted. This observation of comfort in high humidity led to a planned study to learn if increased periocular humidity increased lipid layer thickness. Learning that the increased humidity did increase lipid layer thickness led to the realization of the critical importance of the meibomian glands to the tear film and contact lens comfort—and our initiating a concerted effort in meibomian gland research which is currently my major area of interest.
Polse: I am glad that you mentioned MGD. There is a lot to explore in this disease, but first, how did you and your colleagues discover that MGD was a major player affecting contact lens success?
Korb: The initial interest in the meibomian glands was the result of the CSI experience where patients after several hours of wear without sensation then developed intolerance. I recognized that dryness was the limiting factor, but was unable to identify any reason. Dwight Cavanagh, MD, PhD, who was at the Mass Eye and Ear and had just completed his PhD in biochemistry with George Wald, the Nobel Laureate, was a member of the CSI clinical team. Cavanagh asked the question; was there foam or bubbles on the eye? This proved to be the critical question, because on investigation there was foam at the external canthi with many intolerant subjects, and Dwight suggested that this was due to faulty meibomian gland secretion (Fig. 9).
However, the lids and meibomian glands appeared normal, and the concept of meibomian gland obstruction in an apparently normal lid had never been considered. I also understood from my passion for reading Berliner’s wonderful book that, “the orifices of the Meibomian glands are said to open and to release a small drop of clear fluid upon the application of slight pressure.” Once focused in this area, I soon realized that many meibomian glands orifices did not follow Berliner’s teaching and that despite normal appearances of the lid and meibomian gland orifices, the application of either slight pressure, as taught by Berliner, or experimental forceful pressure did not release any type of secretion from most of the meibomian glands of the lower lids. This finding was, of course, unexpected and led to my conducting several pilot studies.
I then conducted a number of pilot studies, and with this background was very fortunate to recruit Tony Henriquez, whom I met when he was a cornea fellow of Dr. Claes Dohlman at the Massachusetts Eye and Ear and Schepens Eye Research Institute, to collaborate. Tony was a MD and also a PhD in physiology, with board certification in both ophthalmology and pathology. He also completed fellowships in ocular pathology and cornea. Within months of us starting, he returned to Spain but remained active in the project and we met for a month every year to review the data and prepare the publication. He not only performed all of the pathological analyses, but he was able to obtain several lid sections demonstrating meibomian gland obstruction from his patients in Spain who were undergoing enucleation. These individuals agreed to allow forceful expression of the meibomian glands to be conducted prior to the surgery by Dr. Henriquez, to establish whether obstruction was present.
The two of us collaborated for 4 years, resulting in the publication in 1980 of “Meibomian Gland Dysfunction and Contact Lens Intolerance.” We remain close friends and he is a constant advisor and mentor to us in our ongoing meibomian gland studies. As I mentioned, this paper was the first to use the precise words Meibomian Gland Dysfunction, and the first to report that meibomian glands might be obstructed so that secretion could not be obtained even with forceful expression despite a normal lid appearance without signs of inflammation, blepharitis, or lid changes.
Polse: Last year at ARVO, I reviewed a poster on a test (instrument) to diagnose MGD. You were a coauthor, and I suspect you were instrumental in the development of the instrument. Are you able to share with us any details on this exciting development?
Korb: The diagnosis of MGD and the question of whether a specific meibomian gland is or is not functional have not been addressed, and there has never been a metric for this assessment. The state of the art attempts to express a gland using “gentle expression” or “forceful expression,” with the fingers of the examiner applying the force against the lower lid. I decided to develop a diagnostic meibomian gland expression instrument to deliver a constant force of approximately 1.25 g/mm2 to mimic the forces exerted on the meibomian glands during forced blinking. This allows for the diagnostic expression of a single or up to 8 meibomian glands simultaneously. The instrument has a flat rectangular contact surface area, approximately 8.5 mm × 4. 5 mm, which is designed to apply pressure to approximately one third of the lower eyelid.
Standardizing the amount of force and technique used to diagnostically express the glands provides consistency across examiners and also for the same examiner using the instrument on the same or different individuals at different times or on different days. Our studies with this instrument have established10,11:
* Asymptomatic patients have approximately 8 to 12 meibomian glands of the lower eyelid yielding secretion at any one time.
* Moderate to severely symptomatic patients have <5 meibomian glands of the lower eyelid yielding secretion at any one time.
* The secretory status of the lower eyelid meibomian glands is correlated to dry eye symptoms.
* The secretory status of all of the meibomian glands of the lower lid is not uniform across the lower lid; the nasal and central glands secrete more frequently compared to the temporal glands.
* If a functional meibomian gland is drained of all of its liquid contents, approximately 2.5 h are required for a 50% recovery.
* For normal healthy individuals without dry eye symptoms or conventional dry eye signs, the meibomian glands of the lower lid are able to secrete over a 9-h period from 8.00 a.m. to 5.00 p.m.; they do not run out of secretion. However, the meibomian glands of the nasal one third of the lower lid are the most productive.
We continue with ongoing studies that are providing the information necessary to understand the multifactorial roles of the meibomian glands in the maintenance of the anterior tear film, the ocular adnexa, and in the wearing of contact lenses.
Polse: Your work on MGD perhaps was the beginning of a long and very successful career into many studies on ocular surface disease. I wonder if you could briefly tell us of some of your more important discoveries and how these findings may impact the way we diagnose and treat ocular surface disease?
Korb: Contact lenses provided both the impetus and the knowledge for me to understand and become involved in ocular surface disease. Since staining was a problem with contact lenses, I became interested in staining. Since dryness was a major impediment, I became interested in meibomian glands. Since blinking is essential to contact lens wearing, I recognized the importance of blinking in ocular surface disease. Discomfort and symptoms associated with contact lens wear led to our work with GPC and allergic conjunctivitis and the discovery of lid wiper epitheliopathy. Thus, contact lenses were essential to my interest and work in ocular surface disease.
I would hope that the introduction of sequential staining by John Herman and me some 20 years ago has helped and will further help our understanding of the ocular surface. I consider that one of the many roles of the tear film is to defend the ocular surface. The tear film’s ability to protect the epithelium from staining when there is a prolonged residency of fluorescein dyes over a period of time remains, in my opinion, a valuable evaluation and one that requires further consideration and development.
I would hope that our development and the commercial availability of the DET test for break-up time will facilitate the diagnosis of dry eye states.
Our early work leading to our initial recommendations for the diagnosis of MGD and obstruction and treatment to relieve obstruction by three home therapy procedures (wet heat, orifice scrubs and self-expression), and if required, by forceful office expression with topical anesthesia remain the accepted methods to this time. Hopefully, the professions will understand that meibomian gland obstruction is the leading cause of dry eye. The Tear Film and Ocular Surface Society is currently addressing this issue with their Meibomian Gland Workshop, with recommendations scheduled for publication in 2010.
Our current work in meibomian gland dysfunction and obstruction has provided a metric that I believe will become the standard for both office and research diagnosis of obstructive dysfunction. This work also has an arm to provide a method of treatment for meibomian gland dysfunction and obstruction. I would predict that in the next 5 years, meibomian gland dysfunction and obstruction will be recognized as the primary cause of dry eye states with both aggressive professional and industry research efforts to develop effective treatments.
I am pleased with achieving a commercial product after a 15-year effort dedicated to the philosophy of adding lipid to the tear film as the optimal tear film adjuvant methodology for the treatment of dry eye states. Soothe XP contains lipid and interfacial molecules to enhance the lipid layer and is achieving significant recognition. Another pharmaceutical company has scheduled commercial marketing of another aspect of our technology containing both lipids and phospholipids. I would like to emphasize that although this was my original concept, the implementation required the collaboration of many.
And, of course my understanding of the palpebral conjunctiva, ocular allergies, and the discovery of lid wiper epitheliopathy all resulted from my continuing to practice and my personal involvement in contact lens research and development. I remain grateful and dedicated to this wonderful field.
Polse: In the past 5 years, you have spoken and published on lid-wiper epitheliopathy. Why do you feel this observation is important, and if the epitheliopathy is present, what should be done?
Korb: Lid wiper epitheliopathy represents a new frontier for ocular surface disease. I believe that it is now obvious that lid wiper epitheliopathy is a missing link in the diagnosis and treatment of dry eye. It is also obvious that it is the result of inadequate lubrication between the lid wiper surface and the ocular surfaces. I have performed recent studies which prove that in most instances of lid wiper epitheliopathy, resolution can be accomplished by the application of liquid lubricants every 15 min while awake and by the application of petroleum based ointments when sleeping.
Lid wiper epitheliopathy occurs with contact lens wearing, and is one of the primary reasons for discomfort experienced when wearing contact lenses. Lid wiper epitheliopathy will remain a problem until the anterior surface of the contact lens provides a tear film which is comparable of meeting the lubrication requirements of the epithelia of the lid wiper.
Lid wiper epitheliopathy occurs with approximately 75% of noncontact lens wearers who experience dry eye symptoms, regardless of whether other conventional signs of dry eye area are present. In a recent study, the prevalence of all grades of LWE was 6 times greater for the symptomatic than for the asymptomatic population, and 18 times greater for the symptomatic population for grade 2 and 3 LWE than for the asymptomatic. I believe that lid wiper epitheliopathy is on a fast track route for acceptance as a diagnostic sign of dry eye conditions and disease.
The etiology of lid wiper epitheliopathy, as I mentioned, is most probably a combination of inadequate lubrication of the lid wiper and between the lid wiper and the ocular surfaces with resulting physical trauma and resultant damage to the lid wiper and to a lesser degree of the ocular surfaces. Since the lid wiper is in constant contact with the ocular surfaces and travels across the ocular surfaces with every lid movement, it is constantly susceptible to mechanical trauma in the presence of inadequate lubrication in contrast to the ocular surfaces, where any particular area is only minimally exposed to potential trauma from the lid wiper for a fraction of second during blinking.
Treatment of lid wiper epitheliopathy requires restoring adequate lubrication, achieved by restoring a normal tear film. The role of the meibomian glands is paramount, and treatment of MGD and obstruction is mandatory for long-term success, as established buy our recent work. Palliative treatment requires the use of a bland ointment at night and an effective liquid lubricating eye drop, preferably with lipids (Fig. 10).
Polse: Don, I know from many conversations with you that much work may not have happened without the support and collaboration with your partner and “significant other,” Dr. Joan Exford Korb. Can you provide us with a little detail of how Joan was strategically involved in your career?
Korb: Joan was vital, and continues to be vital, in all of my work. In our early career, she worked with me as a significant collaborator and contributor, including edema, central corneal clouding and its photographic documentation, lid attachment, and the design of the first Polycon lens. Joan spent countless hours helping to write my early publications. Despite a 3-year-old and pregnancy, Joan not only practiced but was instrumental in the founding of Corneal Sciences and my collaboration with Miguel Refojo for the development of polymer and the first membrane hydrogel contact lens. Joan sacrificed many aspects of her career and interests to always be there to help me. She has been a source of both ideas and encouragement over our 40 years together. She has made many observations that inspired me to investigate further. One of her observations led to sequential staining. Many of my collaborations were the result of introductions by Joan, who had been active at the Cornea Service of the Massachusetts Eye and Ear for several decades. I am confident Joan has not only been instrumental in my career, but that my career would have been very different without her remarkable dedication and synergy. And, as we all know, her own career is distinguished, including the distinctions of being the first woman Diplomate of the Contact Lens Section, the first woman President of the Academy, the first woman Chair of Awards of the Academy, and the second woman member of the National Optometry Hall of Fame.
Polse: Don, from the beginning of your professional career, you were always thinking ahead of the curve. Can you tell us of some your accomplishments related to professional development?
Korb: From the time I was an optometry student, I was thinking about the direction of the profession with regard to both research and scope of professional practice. By the time I completed Optometry, I was convinced that the profession needed to use pharmaceuticals in order to provide a more comprehensive eye service. Unfortunately, in the early 1960s, optometrists were very resistant to using ophthalmic drugs. In the mid 1960s, I was an advocate for the use of drugs here in Massachusetts. I was rewarded by essentially being expelled from the Massachusetts Society of Optometrists, removed from committees, and considered a radical (which I was).
Polse: Donald, I think another excellent example of your vision was demonstrated when you accepted the position of program chair for the 1969 meeting of the Academy. What do you recall that was so special about the assignment?
Korb: I was very involved in attempting to introduce pharmaceutical agents in to optometric practice, and I envisioned the Academy as the optimal platform to attract those learned in pharmacology to educate and support optometry. My attempts were rebuffed. Thus, when in 1968 when I was offered the chairmanship of the Papers and Program Committee of the Academy for 1969, I requested that the Executive Council and Dr. Carel Koch, the founder and individual who controlled the Academy, allow me to change many of the operating procedures. In tribute to Dr. Koch, he was gracious in granting my rather unreasonable requests to invite up to 10 speakers and pay them. There was a tradition at the Academy that it was a privilege to talk, and one could not be paid. Of course, as you know, it is impossible to recruit speakers with these constraints, particularly when those speakers are not in our profession. I requested three distinct symposiums. There had never been a symposium at the Academy and it was not considered appropriate. However, that was one of my conditions, and in tribute to Dr. Koch’s wisdom, he did approve the symposia after he understood my rationale. The first was for the rehabilitation of the partially sighted, which was conducted by Frank Brazelton. The second was on corneal physiology, which was conducted by the great corneal researcher and surgeon, Dr. Claes Dohlman. The third, conducted on Sunday afternoon, was “Pharmaceuticals in Optometry,” an invited colloquium with Harold I. Silverman, DSc, the Chairman of Research at the Massachusetts College of Pharmacy organizing the colloquium and presiding. Kenneth Melville, MD, PhD, participated. He was formerly Chairman of both the Departments of Pharmacology and Toxicology at McGill University and a world-renowned individual. He was also distinguished by the fact that he was black and as a child the son of a sharecropper on a British Caribbean Island. Following the American Academy of Optometry Meeting, he became a staunch advocate of optometry, and then testified for the use of diagnostic drugs at the first and other Rhode Island hearings. He proved to be an eloquent, credible, and convincing authoritative key witness for optometry, and perhaps tipped the table. Several of the other speakers on this 1969 Program also testified in Rhode Island.
In summary, the new meeting format that I was allowed to initiate not only set a precedent for future Academy programs but also was a contributing factor that made diagnostic drugs a key issue in the profession. Notable leaders in Optometry, including Glenn Fry, Merideth Morgan, and Gordon Heath, expressed their written support for pharmaceuticals in optometry. The 1969 Academy Program also gained several key advocates for optometry who testified at the Rhode Island hearing in 1970 to 1971when the Rhode Island society sought diagnostic drug privileges.
Polse: You are as dedicated to the profession and the science of vision as anyone I know; however, I also am aware that you have other interests/activities. Could you share with our readers some of these interests and what they have meant to you over your lifetime?
Korb: My activities in optometry and research leave very little time for other activities. I long ago decided that I enjoyed spending my time in my professional activities, and especially research, more than I do in other areas. I also enjoy supporting research and have been active in raising funds for Schepens Eye Research Institute and others.
I have also enjoyed supporting the education of individual high school and college minority students.
I do have interests in collecting glass from the nineteenth century, and although it is hard to imagine, the past 20 years I have become very interested in China from the nineteenth century. I am interested in philosophy and I am tempted to write a serious manuscript on how ego has impacted society. However, I recognize that I would have to leave optometry and research, and so far I am not willing to do so. Through the years, perhaps my prime recreational enjoyment has been being with Joan and our two children at our summer cottage on the water on Cape Cod, and also having the opportunity to host many optometrists and colleagues in this relaxed setting (Figs. 4, 6, and 11).
I should stress that I recognize how fortunate I have been to be in Optometry and in related areas where I find great pleasure, since they have provided me with my intellectual challenges, the opportunity to be with others of similar philosophies in health care for the improvement of what we do, almost all of my personal friends, and even resulted in Joan and my marriage. If all that is not enough, Optometry has allowed me to contribute to society and in turn to receive both great personal satisfaction and adequate compensation to meet obligations and to support a number of areas of both personal and philanthropic interest.
Polse: You have been witness to almost unbelievable changes in the prevention, diagnosis, and treatment of eye disease and disorders. Could you share with our readership what you consider to be the 2 or 3 most significant developments in the vision field during the last 50 years, and why they were so important?
Korb: In my opinion, the two most remarkable changes are in the management of cataracts and in retinal disease.
The present phako-iol procedures are truly remarkable. The ability to not only restore vision without refractive correction but also to frequently achieve an actual improvement in vision compared with the baseline several decades prior to the development of the cataracts must be considered astounding. Further improvements to resolve both astigmatism and presbyopia are imminent, fortifying the conclusion that this area, of broad spectrum relevance, should be a prime candidate for recognition as the most remarkable change in eye care of the past 100 years.
The improvements in retinal diagnosis and surgery, so vital to the fragile retina of the compromised myopic eye, are similarly astounding, although confined to a smaller population.
And, contact lenses, refractive surgery, and the rapidly accelerating improvements in all areas of ocular diagnosis and treatment are similarly remarkable for the quality of life they make possible.
Polse: Donald, this has been truly a fantastic opportunity to learn about your career and accomplishments, and the contributions you continue to make to the profession and vision research. In particular, although I know you well and am familiar with most of your work, this profile has allowed me (and other readers) to appreciate in greater detail much of what you have achieved. We thank you for your time and we especially thank you for your monumental contributions you have made to in a real way improve vision care.
Kenneth A. Polse
School of Optometry
University of California
Berkeley, California 94720-2020