Remembering Emanuel Rosen

With the passing of Emanuel Rosen, we have lost a unifying force who represented the best values of the international ophthalmic surgery community. We must thank him for the three elements he introduced, the ESCRS, JCRS, and EuroTimes, which together continue to support and encourage the development of cataract and refractive surgery on a global scale. With incredible drive and determination, he lit the spark that became the ESCRS. He was President of the ESCRS from its founding in 1987 until 1993. Continuing to serve in many capacities until 2017, he was instrumental in transforming the ESCRS into the fully fledged, highly successful, and important European ophthalmological organisation we have today. In 1996 he launched, with Steve Trokel at the ASCRS, the Journal of Cataract and Refractive Surgery (JCRS). This coincided with the publication of the first issue of the Society’s news magazine, EuroTimes. Working with Carol Fitzpatrick and John Henahan, he saw EuroTimes grow from a first issue of only eight pages to the fully fledged multimedia news magazine it is now. Dr Rosen was a direct link to surgical pioneers who introduced what are now standard ideas, including intraocular lenses, phakic lenses, phacoemulsification, and corneal refractive laser surgery. This included implant pioneers Harold Ridley, Peter Choyce, Cornelius Binkhorst, and early proponents of phacoemulsification Eric Arnott and Charles Kelman. It is worth remembering that intraocular implants, phacoemulsification, and corneal refractive surgery were all met with hostility and reluctance by the medical/surgical establishment of the time. Dr Rosen looked beyond this resistance, helping assemble a group of young, passionate surgeons from around the world who were eager to develop new methods of helping improve the vision of their patients. Dr Rosen also maintained a busy surgical practice—first working with the National Health Service and then as head of the Rosen Eye Clinic. The first surgeon to perform LASIK in the United Kingdom, he used his business acumen to develop a national chain of LASIK clinics. He also was an expert on medical-legal disputes, assisting many colleagues in need of advice. Emanuel Rosen was present and active during a period in history that saw remarkable progress in cataract and refractive surgery. Since the 1980s, refractive surgery has quickly evolved. Radial keratotomy gave way to photorefractive keratectomy, which led to the development of LASIK, and most recently to presbyopic IOLs, SMILE, and other refractive technologies. It is probably also worth remembering that the ESCRS began before the European Union came about. One of Dr Rosen’s core beliefs was ophthalmology should be global and inclusive. It was a somewhat radical idea in the first days of the ESCRS to include members from across Europe, welcoming to all. Indeed, it went beyond the borders of Europe to include Turkey, Israel, and Egypt. This was part of his philosophy of breaking down barriers to include the exchange of information towards the betterment of all involved. Looking Back on Emanuel Rosen’s Contribution to Ophthalmology By Phillipe Sourdille MD, past president of the ESCRS The ESCRS is Emanuel’s lifetime achievement. From the very beginning up to current times, he created, managed, and increased the influence of our society. I first met him in 1969 at a congress in Jerusalem organised by Professor Michaelson. We both had just completed our residency, and his special interest at that time was to illustrate clinical situations of the eye through an innovative photographic approach. To be in Jerusalem months after the Six-Day War was a very emotional time for all participants. We were staying in the King David Hotel, where colleagues from 15 nations presented their work on the anterior and posterior segments of the eye. Emmanuel’s work, despite his young age, was one of the meeting’s highlights. The late 1960s and early 1970s were a hard time for intraocular implants. Some painful first-generation results had created a most difficult situation for our field. Two great Dutch colleagues, Cornelius Binkhorst and Jan Worst, were the forefront in defence of iris fixation as a safe approach for implants. Their innovative creativity and dedication paved the way to the gradual acceptance of implants. Emanuel was one of the few surgeons to follow the new trail. At that time, microsurgery was not routine, phacoemulsification was far from general acceptance, and some famous names in ophthalmology were campaigning against all types of intraocular implants. Emanuel displayed a vision for the long term and a strong character to get us through these times. In 1981, Cornelius Binkhorst created the European Implant Club, and international meetings were organised every year in different countries. Emanuel was named president in 1989. In 1991, the meeting was held in Paris, Dan Lebuisson and myself in charge. English was the official language at the Paris meeting, with simultaneous translation in French. This was the first time when an ophthalmological meeting in France was not held in French. Some of my French colleagues considered that as a relighting of Joan of Arc’s bûcher, and we had to face some harsh criticisms! Despite these difficulties, the Congress in La Defense was a great success, with more than 400 participants from all over Europe and America. This was a very large audience in a still pioneering and struggling field. Manual extracapsular cataract extraction competed with phacoemulsification. Implants were made of PMMA and needed a large incision. Intracapsular fixation had just been described. Refractive surgery was mostly radial keratotomy, with mentions of the first LASIK and laser surgery procedures. After the meeting, we had a debriefing session with Emanuel, Ulf Stenevi, and Paddy Condon. The results were positive by all means: scientific value, audience participation and interest, industry support, financial success. But the general feeling was that we had to improve and stabilise the organisation. The historical words of Emmanuel then were: «Should we reinvent the wheel every year, should we not have a permanent office and a board?». A unanimous yes was the answer and Paddy proposed working with Agenda Communications, a company based in Dublin. This started a decades-long effective and fruitful collaboration with Mary d’Ardis, Carol Fitzpatrick, Susan Little, and their staff. The official language for the next meeting was then expected to be controversial, especially in France. Emmanuel raised the point and turned to me, asking for my advice. The answer was: «Whether you like it or not, English is not a foreign language, it’s a survival language!». Emmanuel added: «Coming from a French man, we can take that» and this was the end of the discussion. Emmanuel was acclaimed first president of the newly named European Society of Cataract and Refractive Surgery, ESCRS. In 1996, merging the European and the American journals of cataract and refractive surgery was another strategic change, initiated and realised by Emanuel and Steve Obstbaum. To date, this is still one of the few successful mergings of American and European journals. Confidence and friendship were the leading forces in this amazing adventure, where the two initiators’ charisma played a major role in bringing together colleagues of different cultures. In 1996, during an ASCRS meeting in Seattle, Emanuel, Michael Blumenthal, and myself decided to hold an ESCRS winter session dedicated to refractive surgery. At that time, no official European society held a scientific and educational comprehensive program in the winter months. Our first meeting took place in Spain. Despite great presentations, it was close to disaster, with only 87 pioneers participating. We survived this failure, and the winter meeting has become very successful from thereon. Creating the ESCRS, merging the journals, and creating a cataract and refractive educational programme are three milestones of our society where Emmanuel Rosen played a leading role. Up until the end of his life as journal editor, officer of the society, and active participant in all our meetings, he was our companion. Our debt to him is huge. Thoughts on the Passing of Emanuel Rosen By Prof Noel Alpins AM Emanuel (Manny) Rosen was my friend and colleague for more than two decades. As saddened as I was by his passing, I hold many fond memories of my experiences with him in numerous countries and on several continents. I often saw him as only a few degrees of separation between me and his countryman, Harold Ridley, who implanted the first intraocular lens in 1949. Ridley went on to co-found (with Peter Choyce) the Intra-Ocular Implant Club in 1966, which became the International Intraocular Implant Club (IIIC) in 1975. Manny served as president of the IIIC from 2000 to 2002. Manny’s twin passions for photography and ophthalmology were evident in his Jan Worst Medal Lecture given in 2007 to the IIIC, with spectacular photography of both scenery and fluorescein angiography, the latter published in a book in 1969. Manny and I travelled together on several occasions to IIIC meetings—memorably through South Africa and Botswana, where we went on safari, and other times to Aruba, Cambodia, Japan, and New Zealand. We also served together on several editorial boards on which he presided, such as the Journal of Cataract and Refractive Surgery (JCRS) and EuroTimes. We enjoyed one another’s company at international meetings as far distant as Australia and USA and made a point to meet regularly at the annual meeting of the European Society of Cataract and Refractive Surgery, wherever it happened to be. He was President of the ESCRS from 1987 to 1993. The legacy Manny left for future generations of ophthalmologists is immense. His dedicated work as a skilful editor provided an exemplary standard to guide members of the editorial boards he led, to elevate the quality of manuscripts and the publications they comprised. Manny’s dry wit and sense of humour together with his tireless efforts were instrumental in EuroTimes’ increasing success as an effective medium to communicate the diverse subjects it encompassed in clinical ophthalmic practice. It has granted this publication the widest of readership looking for concise information on topics encountered in modern-day practice. Manny wrote many splendid editorials for the JCRS in his time as European Editor. Many of these have had practical relevance and been useful for reviewers to reference, to help guide authors in their revisions of their submissions, to clarify detail and achieve consistent terminology while following established conventions. Accuracy in scientific presentation was a high priority for him. Manny was always ready to offer sage advice when asked. He had a broad knowledge of many relevant subjects and shared his wisdom in a genuine manner. Manny had profound influence on ophthalmology through his work, his publications, and the organisations he was instrumental in establishing with his enthusiasm and energy such as ESCRS, JCRS, and EuroTimes. He had a generous spirit and will be dearly missed by all who knew him—in countless countries and on most continents. My sincerest sympathies go to Barbara and all his family. Tributes to Emanuel Rosen from around the world Emanuel Rosen was a true friend. Emanuel had many good sides. One was he was an excellent teacher. We worked together in the late 1970s, running courses in cataract surgery. We were both at the first meeting of the European Intraocular Implant Club (the predecessor to the ESCRS) in 1982, which had 160 participants in one room. He had the vision, that without a Society as a backbone, things would go nowhere in our field. He had the ability to communicate to colleagues that were, like himself, not only interested in the surgery itself, but what it meant for society. He was the leader in the early days and the person that knew where we should go. Carefully and calmly, he made sure we got there. He is the founding father of the ESCRS. Without him, there would be no ESCRS. — Ulf Stenevi I remember Emanuel very vividly as a passionate refractive surgeon, one of the founding fathers of ESCRS, and a long-time editor of the JCRS and EuroTimes. Dealing with publications—whether peer-reviewed or not—appeared to be of greatest interest to him and for me was his most significant and valuable contribution to our field. — Oliver Findl I think he was the end of an era, as one of the few surviving surgeons of the 1980s, which saw the transformation of cataract surgery from ECCE to phaco, and IOLS from anterior chamber to iris clip, and on to sulcus and bag fixation. It was a very dynamic time. I think, however, his greatest contribution was as a superb committee person. Getting surgeons from different continents and countries to agree on anything is like herding cats, but with his affable non-confrontational Lancastrian personality, he could achieve the impossible—as seen in the founding of the ESCRS and JCRS. — David Spalton Emanuel will be remembered for his enthusiasm and energy, which led to an innovative and visionary career. He was one of the giants in ESCRS and modern ophthalmology history. — Rudy Nuijts So sorry to hear that Emmanuel Rosen, one of the greatest ophthalmologists in the world, founder of the ESCRS, and one of my mentors, has passed away. It is a great loss to eye surgeons the world over. His heart and vision will remain unparalleled. I will always be thankful for his help! But above all, I will miss his kind presence, his encouraging words, and the goodness of his heart which he gave freely. “If we have seen further,” to paraphrase Isaac Newton, “it is by standing on the shoulders of giants.” Giants like Emmanuel. — Cyrus Mehta Emanuel has been a leading light in the life of the ESCRS. Through the years, there are few ESCRS initiatives that have not been enlightened by his insight or touched by his skilful management. Indeed, he was a steady and constant influence in the ongoing success of ESCRS. — Stephen Obstbaum