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Tales of Yore

Marshall M. Parks

Straightening the Skew

Sen, Mrittika; Honavar, Santosh G

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Indian Journal of Ophthalmology: August 2021 - Volume 69 - Issue 8 - p 1991-1992
doi: 10.4103/ijo.IJO_1829_21
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Somewhere inside all of us is the power to change the world.” – Matilda, Roald Dahl

Dr. Marshall Parks was born in Old Mission, Michigan, in 1918. His twin brother passed away from diphtheria at the age of eight, and this was when Parks decided to become a doctor and also lead his life as if living for two, explaining his immense productivity, which the younger generation often found difficult to keep up with.[1] He graduated from St. Louis University School of Medicine. The Father of Pediatric Ophthalmology, ironically, confessed that although he was a good student, he erred shamefully during his ophthalmology examination when asked to differentiate between nystagmus, strabismus, and astigmatism.[2] He entered the U.S. Navy and served as the medical officer on destroyers in the South Pacific during World War II. Having lived through the Depression and a World War, his endurance and tenacity were enviable, as was his sense of humor despite adversities.[3]

In 1947, Dr. Parks was released from his wartime Navy Service and was assigned to the Eye, Ear, Nose, Throat (EENT) Service at the Great Lakes Naval Hospital. While there, he realized that ophthalmology essentially addressed adults. The Chief of EENT Service would strike out all cylindrical powers to correct astigmatism, permitting only the spherical glasses to be prescribed. None of the staff were willing to devote time to the large volume of pediatric patients – for developing a rapport with them, their examination, or enhancing knowledge related to their specific visual problems. This troubled Dr. Parks, and when he voiced his concern, he was made the “Chairman of the Improvement Committee,” and his entire schedule was filled with only children. Much to the annoyance and amazement of the staff, he loved it. Although his contemporaries found him strange, it only strengthened his resolve to fill the void that was pediatric ophthalmology.[2] A civilian ophthalmologist, Dr. Perry Ross, though not encouraging about his ideas, told him about Dr. Frank D. Costenbader at Washington, D.C. Dr. Costenbader was credited as the world’s first pediatric ophthalmologist. From 1943, he completely limited his practice to children. He was bothered that ophthalmologists treated strabismus in adults and older children to improve cosmesis rather than for establishing binocular vision in children. With his thesis on “Infantile esotropia,” he had secured his position as a “strabismologist” and was also the co-founder of the Association for Research in Strabismus and the Squint Club.[4] Without even meeting him, Dr. Costenbader had already become Dr. Parks’ idol. He wrote to him about his hopes and views, and after an interview, he became Dr. Costenbader’s first trainee. A year later, he joined him as his associate. The friendship, professional ideology, and mutual respect helped the two develop pediatric ophthalmology as the first subspecialty in ophthalmology.[4] This was a period when pediatric ophthalmology was viewed as a threat by general ophthalmologists, who believed they could do all that a pediatric ophthalmologist could, similar to the disdain pediatrics received when it evolved as a separate branch of medicine.[2] Dr. Parks described the evolution of pediatric ophthalmology, “Initially, during the formation of any association, there are the timid, the doubters, the jealous, or for whatever reason, those reluctant to join. This attitude poses the greatest risk for failure of the new association. Often, at this point, a second association appears in competition with the first, with the result that each association is weaker than had only one prevailed. However, if the first association is strong enough to ride out the storm, and all those who initially chose not to join convert to support the association, a single strong association usually emerges.”[5]

Dr. Costenbader and Dr. Parks started the first Ophthalmology Fellowship Training Program at the Children’s Hospital in Washington, D.C., now called the Children’s National Medical Centre. This was, in fact, the first-ever program in a subspecialty of ophthalmology.[6] They were known for their excellent skills, care, enthusiasm for teaching, lucid lectures, and passion for early diagnosis and treatment of pediatric eye disorders. Dr. Parks was deeply influenced by the warm approach of Dr. Costenbader to his little patients and his ability to hold their attention. Dr. Parks made the examination room more comfortable for the pediatric patients, allowed parents to be beside the child during anesthesia, and stopped patching eyes after strabismus surgery. While Dr. Costenbader was a purist, not seeing patients older than 16 years of age, Dr. Parks included both adult strabismus and pediatric ophthalmology in his practice. These differences did not affect their association or collaboration, both being gentlemen.

During his prolific career, Dr. Parks performed more than 40,000 strabismus surgeries, trained about 175 fellows, presented more than 50 named lectures, authored a dozen books including Ocular Motility and Strabismus in 1975 and Atlas of Strabismus Surgery in 1982, contributed chapters to 26 books, and published more than 75 papers.[7] He was the editor or assistant editor of the American Association’s Archives of Ophthalmology, Survey of Ophthalmology, and the American Orthoptic Journal.[7]

Dr. Parks described and refined multiple strabismus surgeries, standardized the early correction of squint before 12 months, and developed surgical techniques for pediatric cataract and glaucoma. He elaborated the monofixation syndrome and described the diagnosis and treatment of amblyopia, sensory adaptation to strabismus, the modern version of the “Head Tilt Test” to identify the paretic muscle in acquired vertical diplopia, gradable oblique muscle surgery, fornix approach to strabismus surgery, and mechanisms of orbital and post-traumatic restrictive syndromes.[78] Talking about his mentor’s surgery, Dr. M. Edward Wilson said, “It was like a dance. There were no wasted motions – each step doesn’t have to be done fast, but there was no awkwardness, the steps were in perfect cadence. I’ve never seen anybody who could operate like that where it looked literally like a dance.”[79]

During the 1967 annual American Academy of Ophthalmology and Otolaryngologist meet, at a breakfast meeting held by Dr. Parks, a discussion was held to set up an organization where the alumni of the pediatric ophthalmology fellowship program at Children’s Hospital could come together and have an annual scientific as well as social meeting. The alumni decided on the name Costenbader Society, in honor of the individual responsible for training most of the graduates at that time. The logo created for the Costenbader Society by the University of California Medical Centre Art Division had four stacked figures of children, one with swimming gear, one with baseball paraphernalia, a girl with a doll, and one with a lollipop, each of them with an article occluding one eye, was later given to the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) [Fig. 1]. With the increasing popularity of the meetings of the Costenbader Society, there was a demand to include pediatric ophthalmologists trained elsewhere. Respecting these sentiments, the American Association of Pediatric Ophthalmology was born in 1973. Dr. Jampolsky later added “Strabismus” to the name.[10]

Figure 1
Figure 1:
The logo of Costenbader Society and the American Association for Pediatric Ophthalmology and Strabismus[5]

Dr. Parks was the first President of AAPOS. He founded the National Children’s Eye Care Foundation. He was the President of the Costenbader Society, the American Academy of Ophthalmology (AAO), Chairman of the American Board of Ophthalmology, and member of the prestigious Squint Club. He was awarded the Lucien Howe Medal in 1989 by the American Ophthalmological Society, inducted into the Knights of Malta, and voted as one of the 10 most influential ophthalmologists of the millennium. He was awarded the Superior Public Service Award by the Department of Navy, and the Conference Room at the Naval Medical Centre bears his name.[11] The AAO bestowed him with a Laureate in 2004 and created a Lecture in his name.[7] The Marshall M. Parks Medal is awarded by the Children’s Eye Foundation and AAPOS to recognize individuals who have made outstanding contribution to pediatric ophthalmology and strabismus.[1] The Marshall M. Parks Education Fund by the Costenbader Society supports fellows during their ophthalmology training.[11]

Dr. Parks was loved by his small patients, his fellows, colleagues, and his family for his kindness, warmth, and humility. He had 11 children, 25 grandchildren, and 24 great-grandchildren. He had a “sacred place” in Belgrade Lakes, Maine, where he would like to retreat, but would also host his friends and trainees.[1] He kept a large map on the wall of his examining room with the name and location of each of his fellows indicated with a pin.[12] He passed away on July 27, 2005.

Dr. George R. Beauchamp voiced the feelings of many with his words, “This man extended his hand in friendship to many. A truer and more trusted friend one could not have found. The future of pediatric ophthalmology is filled with promise, substantially because Marshall Parks metaphorically hoisted us up to his broad shoulders. From there, it is easier both to see and to free oneself – as he did – from the gravitational pull of ignorance, myth, and convention. Thank you, Marshall, for bringing all of us along with you. We, and the children we care for, receive the sustaining benefits of your influences and contributions every day. You created good.”[8]

Having power is not nearly as important as what you choose to do with it.” – Roald Dahl

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

1. Available from: https://aapos.org/meetings/lectures/hall-of-fame/gold-medalistLast accessed on 2021 Jul 06
2. Parks MM. Pediatric ophthalmology and I Surv Ophthalmol. 1991;36:70–6
3. Mitchell GP, Mitchell PR. Marshall M. Parks, MD (1918-2005) J AAPOS. 2005;9:506–7
4. Available from: https://aapos.org/meetings/lectures/hall-of-fame/frank-costenbaderLast accessed on 2021 Jul 06
5. Parks MM. Founding and early history of the American Association for Pediatric Ophthalmology and Strabismus J AAPOS. 2001;5:199–202
6. Natarajan S. Pediatric ophthalmology:The oldest ophthalmology subspeciality Indian J Ophthalmol. 2011;59:419–20
7. Available from: https://www.noao.org/hindsight-1977-dr-marshall-parks/Last accessed on 2021 Jul 06
8. Beauchamp GR. Father to children's vision:Marshall M. Parks, MD J AAPOS. 2005;9:508–9
9. Available from: https://costenbadersociety.org/marshall-m-parks-lecture/Last accessed on 2021 Jul 06
10. Available from: https://higherlogicdownload.s3.amazonaws.com/AAPOS/159c8d7c-f577-4c85-bf77-ac8e4f0865bd/UploadedImages/Documents/_363_aaposhistoryjackrevised4307.pdfLast accessed on 2021 Jul 06
11. Available from: https://costenbadersociety.org/wp-content/uploads/2014/04/obit.pdfLast accessed on 2021 Jul 06
12. Isenberg SJ. There are some debts in life that you can never repay:We remember Marshall M. Parks, MD J AAPOS. 2005;9:505
13. https://costenbadersociety.org/marshall-m-parks-m-d/Last accessed on 2021 Jul 06
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