Eric Arnott

Eric John Arnott, MA, FRCS, FRCOphth (12 June 1929 – 1 December 2011)^[1][2] was a British ophthalmologist and surgeon who specialized in cataracts, a condition which in many parts of the world still remains the principal cause of blindness. He is known for inventing new surgical techniques for treatment of various ophthalmological disorders, and received professional awards for his contributions.

Eric John Arnott
Born	(1929-06-12)12 June 1929
Died	1 December 2011(2011-12-01) (aged 82)
Nationality	British
Occupation	Ophthalmic surgeon
Known for	Advances in cataract surgery

Career

Arnott was educated at Harrow School (Elmfield) and Trinity College, Dublin where he was awarded the Surgical Prize in 1952; BA (Hons) 1953 and MB (Hons), BCh (Hons) and BAO (Hons) 1954. He gained his Diploma in Ophthalmology (DO) in 1956 and Fellowship to the Royal College of Surgeons (FRCS) in 1963.

Arnott's first ophthalmic appointment was as Houseman at the Royal Adelaide Hospital and Royal Victoria Eye and Ear Hospital, Dublin, following which he held early appointments at Moorfields Eye Hospital, London, and University College Hospital London, where he trained under Sir Stewart Duke-Elder and H. B. Stallard.

Whilst at Moorfields he worked with Sir Harold Ridley, the inventor of the intraocular lens; Arnott was inspired by Ridley's work on the intraocular lens and they later became lifelong friends.

After completing training at University College Hospital, Arnott was appointed as consultant initially to the Royal Eye Hospital and later, in 1965, to Charing Cross Hospital; then still in the Strand. In 1973 the hospital moved to its current site in Fulham, where Arnott was responsible for setting up the ophthalmic surgical services.

In 1974, Arnott and his wife Veronica organised the first Live International Ophthalmic Micro-Surgical Symposium in Charing Cross Hospital, where ten of the world's top eye surgeons performed live surgery, relayed to over 300 international delegates, courtesy of the BBC. This novel concept in advanced surgical teaching set a standard for future surgical conferences. He later organised two other live symposia with Professor Emanuel Rosen, with the objective of bringing new ideas in cataract surgery to a wider audience.

Arnott was known for his pioneering work in ophthalmology and many of today's top eye surgeons were trained by him whilst registrars at Charing Cross.

He retired from the NHS in 1994.

Phacoemulsification

In 1968, whilst Secretary of the Ophthalmic Society of the United Kingdom he invited Dr Charles Kelman MD, the inventor of phacoemulsification ("phaco"), to address the Society. Kelman had found a method of removing the cataract through an incision of 3.5mm compared to the 12mm required for most surgery at the time. This meant that patients no longer had to remain in bed for two weeks after surgery with all movement restricted.

In 1971, Arnott visited the United States to attend one of Kelman's first courses. On his return, he privately raised the finance to buy the expensive equipment required for the procedure. When he started performing this new type of cataract operation, history indicates that it was not well received by his colleagues. Six years later Arnott was virtually alone in performing and teaching this procedure outside America.

Today, almost all cataract surgery is carried out using a variation of the technique that Arnott pioneered in the UK in the early seventies.

Lens implantation

In 1974, influenced by Sir Harold Ridley's work on lens implantation, Arnott designed the Little-Arnott lens, which was manufactured by Rayners. This was one of the first intraocular lenses to be positioned behind the iris, the normal position of the natural lens. Previously, lenses were implanted in front of the iris, and many of them caused severe ocular problems.^[3] Arnott followed this up with several other designs before inventing "the totally encircling loop" lens^[3] which was manufactured under license by Alcon, Pharmacia and Smith & Nephew and others. Clinical data demonstrated that this lens maintained an excellent position within the eye and over 2 million were implanted worldwide during the 1980s and 1990s.^[4]

During the seventies, all of the lenses designed by Arnott were made of polymethyl methacrylate (PMMA). In 1981, Arnott and Richard Packard, his then senior registrar at Charing Cross Hospital, were the first to describe the use of a soft lens material, which could be folded to go through a small incision.^[5] In 1988 Arnott was the first surgeon to insert a bi-focal lens implant in Europe.

Following cataract removal, it used to be common for patients to require thick pebble glasses to be able to see. Nowadays, virtually all patients receive a lens implant following cataract surgery, avoiding the need for glasses.

Other contributions

Arnott was also responsible for introducing other surgical techniques.

In 1966 he was amongst the first surgeons in the world to follow Dermot Pearce's use of the surgical microscope.^[6]

In 1967 he and Paddy Condon, his then senior registrar, used the first silicone implant for retinal detachment surgery.

In 1968 he modified the final approach to glaucoma surgery by making the opening into the anterior chamber through the clear cornea, as opposed to the previous dialysis approach.

In 1976 he and Jared Emery of Houston, Texas, invented the diamond tipped "spear headed" surgical knife for making the phaco incision and in 1978 he was the first surgeon to perform a combined phaco cataract and glaucoma operation.

Arnott was very early in recognising the new trend of laser refractive surgery to correct myopia (shortsightedness). He acquired one of the first excimer lasers, which he located in Cromwell Hospital in 1991, where his private practice was based. In 1992 he was the first person in the UK to perform LASIK.^[7]

In 2000 Arnott received an award from the International Intra-Ocular Implant Club - the IIIC Medal, at the club's annual autumn meeting in Brussels, Belgium.

Charity work

In 1982 he reduced his work in the NHS (from maximum part-time) to four sessions a week and began concentrating on charitable work at the Royal Masonic Hospital, London, (where he remained an honouree consultant until 1994) and international teaching commitments.

Over the course of his career, Arnott lectured and performed live surgery throughout the world, paying particular attention to the Asian and African continents where cataracts are most prevalent.

In 1984 he was one of the first surgeons to demonstrate phaco surgery and lens implantation in India and in 1991 he received a special award from the Asian branch of the Royal National Institute for the Blind for "outstanding support" to blind Asians in London and India. The same award was presented a year later to his son Stephen,^[8] who managed Arnott's private practice. In 1996, Arnott was invited to officially open the first meeting of the Indian Academy of Ophthalmology, and in 1998 he was made an honorary visiting Professor at Indore University.

After Arnott's retirement in 1999, with the help of his wife Veronica^[8] and son Stephen, he raised funds to fund and equip a mobile operating theatre to perform modern eye surgery in remote Indian villages. This project was undertaken in conjunction with the Sathya Sai Institute.^[9]

Along with Dr G Chandra, he established the charity organisation 'Balrampur Hospital Foundation UK' in 2007 and served as a trustee and its president.

Medical societies

Arnott was a member of many international ophthalmic societies and was the founder President of the European Society for Phaco and Laser Surgery (1986–89), Secretary of the Ophthalmic Society of the United Kingdom (1967 – 1968), President of the Chelsea Clinical Society (1985) and President of the International Association of Ocular Surgeons (1983).

He was also one of the original founder members of the American Society of Cataract and Refractive Surgery.

In 2007 Arnott received the Honoured Guest award from the ASCRS for his services to ophthalmology.^[10]

Publications

He wrote over 40 published scientific articles for British and foreign ophthalmic journals on strabismus surgery, congenital abnormalities, cataract extraction, Phaco-emulsification and intra-ocular lenses.^[11]

Between 1992 and 1997 he wrote a regular chapter on the latest ophthalmic advances for the annual Royal College of General Practitioners Reference Book^[12]

Arnott was co-author of the 1983 textbook Extra-capsular Cataract Surgery and contributed specialist chapters to many other medical books including Emergency Surgery by H Dudley, Intra-ocular Lens Implantation by Rosen et al., Current Perspectives in Ophthalmic Surgery by Easty et al., and a Colour Atlas of Lens Implantation by Percival.^[13]

Arnott, with assistance from his son Stephen, wrote and published "A New Beginning in Sight" in September 2006, chronicling the development of modern cataract and refractive surgery.^[14]

Personal life

Arnott was born in Sunningdale, Berkshire, the second son of Sir Robert Arnott Bt.^[8] and Cynthia Amelia (née James). His family were notable Anglo-Irish philanthropists who owned, amongst other things, Arnotts department store, the Irish Times, and the Phoenix Park Racecourse.

He was married to Veronica (née Langué) from 1960 until her death in 2011 and had two sons, Stephen John 1962, Robert Laureston John 1971 and one daughter Tatiana Amelia 1963.^[8]

Until 2001 he remained fit by swimming a mile every morning and in 1974 he successfully completed a challenge to swim from the infamous Alcatraz Island to the shore of San Francisco.

When Arnott finally retired at the age of 70 years, he bought a retirement cottage in Cornwall in Mounts Bay overlooking the Atlantic Ocean from where he wrote his memoirs "A New Beginning in Sight" before his death 1 December 2011.^{[15][16][17][18][19]}

See also

• Harold Ridley
• IIIC
• David J. Apple

Notes

1. . EuroTimes. Archived from the original on 26 April 2012. Retrieved 12 January 2012.
2. "Ocular Surgery News U.S. Edition". Ocular Surgery News U.S. Edition. Retrieved 10 March 2012.
3. Apple D.J., Kincaid M.C., Mamalis N, Olson R.J. Intraocular Lenses: Evolution, Designs, Complications, and Pathology. Baltimore, Williams & Wilkins (1989)
4. Arnott E.J. Condon R. TELL - 3-year follow up of 1800 cases from Aug 1982 - Aug 1985. Cataract Journal Vol. 2 No. 8
5. Arnott E.J., Packard R.B.S., & Garner A. Poly-Hema as a material for intraocular lens implantation - a preliminary report. B.J.O. 65. (1981)
6. 1978 Nursing Mirror Nov. 30-34 E J Arnott & M C W Treplin; Surgical use of the microscope in ophthalmics
7. Scotland on Sunday, The Times, Guardian (13 December 1992)
8. "Professor Eric John Arnott". The Peerage. 8 December 2011.
9. Ocular Surgery News – 15 October 1999
10. American Society of Cataract and Refractive Surgery (ASCRS)
11. Publications • 1964 B.J.O. Vol. 48 E J Arnott; Ocular movement in homocystinuria • 1977 Trans.ophthal.Soc. U.K. (1977) 97,60. E J Arnott; Kelman phacoemulsification - Results & Complications • 1978 Nursing Mirror Nov. 30-34 E J Arnott & M C W Treplin; Surgical use of the microscope in ophthalmics • 1981 Trans. Ophthal. Soc. UK E J Arnott; Intraocular implants • 1981 B.J.O. 65 E J Arnott, R B S Packard, A Garner; Poly-Hema as a material for intraocular lens implantation - a preliminary report • 1982 B.J.O. Vol. 4 No. 2 E J Arnott; Consideration for lens implantation in patients with glaucoma • 1983 Cataract Journal Vol. 1 No. 3 E J Arnott; Refinement of ECCE and IOL design for posterior chamber lens implantation • 1983 Midwife Health Visit Community Nurse May: 20(5)184-93 E J Arnott; The development and treatment of cataracts • 1984 Trans. Medical Soc. London E J Arnott; Ophthalmology - Recent advances in cataract surgery • 1984 Cataract Journal Vol. 1 No. 3 E J Arnott; Refinement of ECCE and lens design of PC-IOL implantation • 1984 J. Oc. Ther. & Surg. Vol. 3 No 4. E J Arnott and A Garner; Concepts of posterior capsular fixation for posterior chamber lens implantation • 1985 Cataract Journal June E J Arnott, R W Condon & P Desai; Primary infantile glaucoma • 1985 AIOIS Journal Jun/Jul E J Arnott; Primary, secondary capsulotomy inversely related • 1985 Proceedings of the VII Congress European Soc. of Ophthal. E J Arnott & G Chandra; Posterior chamber lens implant in glaucoma • 1985 Cataract Journal Vol. 2 No. 8 E J Arnott & R Condon; TELL - 3-year follow up of 1800 cases from Aug 1982 - Aug 1985 • 1985 Hospital Doctor 12 December E J Arnott article; Future looks bright for cataract patients • 1985 Cataract Journal Vol. 2 No. 8 October; Editorial by E J Arnott • 1985 Glaucoma 7:188-189 E J Arnott; Insertion of posterior chamber implants and glaucoma • 1986 Ocular Surgery News Vol. 4 No 14 July pg 31 E J Arnott; Cataract/implant precedes ALT in glaucoma approach • 1986 Ophthalmology Times E J Arnott; article on cataract extraction & lens implantation on patients with glaucoma followed by laser trabeculoplasty • 1986 Ophthalmology Times E J Arnott; article on cataract extraction & lens implantation and relationship to retinal detachment • 1986 Proc. XXV Int. Cong. Ophthal. May; E J Arnott & G Chandra • 1988 Ocular Surgery News Vol. 6 No. 22 E J Arnott; contribution to "Phaco overview: what lies ahead" • 1988 Ophthalmology Times Vol. 13 No. 18 E J Arnott; article on cataract extraction and lens implantation on children • 1988 J. Cat. Refract. Surg. Vol. 14 Jul. E J Arnott, C J F Grindle & G M Krolman; Four and one-half-year study of the relationship between one-piece encircling loop PMMA lenses and retinal detachment • 1989 Eur. J. Implant Ref. Surg. Vol. 1 E J Arnott; Lens Decentration • 1989 January J. Cat. & Ref. Surgery; Response to Dr Blumenthal’s letter re one-piece TELL lens implant • 1989 Ocular Surgery news Vol. 7 No. 19 E J Arnott; Operative profile • 1989 November J. Cat. Ref. Surgery E J Arnott; Contribution to consultation section edited by Dr S Masket re nucleus handling for small pupil • 1990 Ocular Surgery News International Edition Vol. 1 No. 1 E J Arnott; Operative profile • 1990 Sept Ocular Surgery News Vol. 1 No. 9 E J Arnott & Mr R Cooling; Totally encircling haptics and the Hilding effect help to minimise retinal detachment • 1990 Oct Ocular Surgery News Vol. 8 No. 17 E J Arnott; Guest commentary "Innovations in the relentless development of phaco" • 1991 May Ocular Surgery News Vol. 9 No. 10 E J Arnott; Complicated case history for David Soll • 1991 Feb Mims Magazine E J Arnott; New lenses for cataract patients • 1991 June Mims Magazine E J Arnott; An ophthalmologist’s comments on sticky eyes in neonates
12. General Practitioners Reference Books • 1992 The Royal College of General Practitioners Members' Reference Book E J Arnott & D K Williams Pgs: 467-470 - Helping patients with eye problems • 1993 The Royal College of General Practitioners Members' Reference Book E J Arnott & Dr L Jenkins Pgs: 368-371 - Lasers in ophthalmology • 1994 The Royal College of General Practitioners Members' Reference Book E J Arnott & D K Williams Pgs: 333-341 - Helping patients with eye problems • 1995 The Royal College of General Practitioners Members' Reference Book E J Arnott Pgs: 295-300 - Update in ophthalmology: Cataract surgery and myopia • 1996 National Association of Fundholding Practices official yearbook E J Arnott Pgs: 308-309 - Day case cataract surgery
13. Contributions to Books. • 1977 Emergency Surgery - H A F Dudley; E J Arnott contributed chapter "The Eye and the Orbit". Published by John Wright & Sons • 1983 Extracapsular Cataract Surgery - J M Emery & D J McIntyre; E J Arnott contributed chapter on "Special Surgical Considerations" • 1987 Chirugia Extracapsulare della Cataratta - Lucio Buratto; E J Arnott contributed chapters on cataract extraction and lens implantation as follows: removal of nucleus and cortex (manual & automated), two-handed and single-handed surgical technique and dialling technique • 1987 Intraocular Len Implantation - A text book of cataract surgery; E J Arnott co-author with E S Rosen, S L Severin & W M Haining. Published by C V Mosby, St Louis • 1990 Current Perspectives in Ophthalmic Surgery - Prof Easty; E J Arnott & C F J Grindle contributed chapter on "Phacoemulsification". Published by Balliere Tindall Ltd • 1990 Colour Atlas of Lens Implantation - Piers Percival; E J Arnott contributed chapter on "Phacoemulsification". Published by Wolfe Publishers
14. Arnott, Eric J (2005). A New Beginning in Sight. Docwife Publications. ISBN 0-9548786-0-4.
15. International Intra-ocular Implant Club
16. "Professor Eric Arnott". The Daily Telegraph. from the original on 25 September 2015.
17. Euro Times, Volume 17, issue 2, P34
18. Telegraph, Letters to the Editor, Friday 17 February 2012
19. The Times, 17 February 2012

References

• The Honoured Guest award from the ASCRS
• Eric Arnott's obituary in the Irish Times
• The Little-Arnott lens