A profile of one of St. Paul’s true pioneers of innovative care
Few things are more precious to us than our eye sight. Vancouver is truly fortunate to have one of the world’s leading ophthalmology clinics right here as part of Providence Health Care. While it takes an entire team, and many years, to build a world-class facility, one of the milestones on the path to excellence for St. Paul’s eye clinic can be traced back to the University of Manitoba circa 1948. A pre-med student named Herbert Fitterman decided to become an eye surgeon instead of a brain surgeon. The reason? As an eye doctor, he would lose fewer patients and experience the joy of giving people the precious gift of sight. Over the course of his distinguished, 40-year tenure at St. Paul’s, Dr. Fitterman accomplished just that – and much more.
“Dr. Herb Fitterman was a true pioneer in lens implant surgery. And he was the driving force in creating this outstanding facility for the diagnosis and treatment of eye diseases,” says Dr. William Ross. He ought to know: Dr. Ross is himself a trailblazing vitreo-retinal surgeon at the clinic, and was recruited by Dr. Fitterman 45 years ago.
The gift of sight
It wasn’t too long ago that people with cataracts faced one of two grim choices. Remove the cataracts and spend the rest of your life wearing thick, ineffective “coke bottle” glasses. Or don’t remove them, and go blind. That all changed with the advent of intraocular lens implants, the technical term for cataract surgery. It stemmed from the idea that the eye’s cloudy natural lens could be replaced by an artificial lens sewn directly to the eye. Fifty years ago, this was a radical idea that faced strong resistance from all but the most innovative, forward-thinking physicians. Enter Dr. Fitterman.
Dr. Ross remembers that Dr. Fitterman had been travelling in Europe, and saw cataract patients receiving a revolutionary new treatment. Basically, the cataract was removed, an incision was made in the cornea, and a glass lens was stitched in place. Surgeons were giving patients a significant improvement in their vision. And patients were freed from those cumbersome glasses. But despite its success overseas, it was a new – and controversial – technique. Dr. Ross explains, “There was widespread uncertainty about whether the eye could tolerate an artificial lens. Most experts didn’t think it was worth the risk.”
Dr. Fitterman came back to Vancouver eager to try the procedure, but was confronted by stiff opposition. Dr. Ross says, “Herb was an excellent surgeon and he wasn’t afraid to take risks. He felt confident that he could do it. So he did.” That first implant took place in 1968. Today, it’s the gold standard for cataract treatment. Dr. Ross adds, “Once Dr. Fitterman and the other pioneers proved it could be done safely and effectively, eye doctors across North America started doing it, too.”
Those first operations took upwards of two hours and required 6-7 stitches to hold the heavy glass lenses in place. Even a surgeon of Dr. Fitterman’s calibre and experience could only do about four procedures per day. Over time, the instruments got better and the lenses got lighter. Today, they’re made of silicone and come as a small, folded package. The surgeon makes a tiny incision; the lens is inserted and unfolded within the eye, almost like opening an umbrella. It doesn’t require any stitches and takes just 15 minutes. A skilled surgeon can help upwards of 18 people in a single day.
All in a day’s work
Dr. Fitterman’s reputation as an exceptional cataract surgeon spread quickly. Before long, his practice became one of the busiest in Canada, treating patients from all over the world. In 1977, just nine years after that first operation, the Hospital opened the doors to its new ophthalmology department, with Dr. Fitterman at the helm.
From the start, the department was driven by Dr. Fitterman’s spirit of innovation, and his ability to engage and inspire other innovators. For example, at a time when most eye doctors were focussed exclusively on cataract surgery, Dr. Fitterman actively recruited specialists to treat other structures and diseases of the eye. Today, the department has specialized clinics in each of the eye disciplines: cornea, neuro-ophthalmology, uveitis, retina, ocular immunology, HIV, and general.
In addition to treating patients, these clinics also provide specialty training for residents at the University of British Columbia. Believe it or not, even this was revolutionary back in the day. (Dr. Ross recalls that the partnership between the ophthalmology department and UBC faced many political and organizational barriers.) Fortunately, common sense prevailed and today, the department plays an important role in training the next generation of eye surgeons. There’s even a prestigious annual fellowship for two aspiring vitreo-retinal specialists. Dr. Ross states proudly, “We have trained 57 vitreo-retinal surgeons from around the world. In fact, Dr. David Albiani, who is currently the Head of Ophthalmology, started his surgical career as one of our fellows.”
A vision of hope during the AIDS crisis
Dr. Ross then recounts a poignant story about how the department’s culture of innovation, outreach, and compassion – all nurtured by Dr. Fitterman – made a difference as the AIDS crisis took hold in the 80s. “People may not remember, but blindness was one of the terrible side-effects of the virus. As soon as we became aware of the epidemic, we knew we had to act quickly.” With the encouragement of Dr. Fitterman, the department fast-tracked the first HIV screening clinic in Canada lead by Dr. Ross, Dr. Peter Nash (an ophthalmologist), and Dr. Julio Montaner (at that time with St. Paul’s infectious disease clinic, now Director of the British Columbia Centre for Excellence in HIV/AIDS).
Even though HIV/AIDS patients were dealing with a variety of horrible ailments, Dr. Ross confides that they were often most terrified about losing their sight. His voice is filled with empathy as he says, “We were able to help most of our patients keep their vision right up until the end.”
Dr. Herbert Fitterman was a gifted surgeon, a passionate teacher, and an inspiring leader who loved his patients and his work. He was at his clinic until just a week before his death from complications related to a fall. He died at St. Paul’s on April 22, 2011. He was 78.
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