The next ports of call for our journey through the capitals of the eye are in Switzerland: Bern and Zurich. Dedicated eye clinics appeared in these cities in 1834 and 1862, respectively. A number of clinical signs, including Horner’s syndrome and Haab’s lines, were described in these early days by ophthalmologists working there. As in the headline, the dispute between Alfred Vogt and Hans Goldmann occupied minds in the middle of the last century, as they tussled over the etiology of “glassblowers’ cataract.” However, many more important developments came from these two centers, including Amsler’s grid, the Goldmann tonometer and the YAG laser. All of these are still in use today by ophthalmologists all over the world.
Richard B. Packard, MD, FRCS, FRCOphth
OSN Eye Capitals Section Editor
Chairperson of OSN Europe Edition Editorial Board
In the 18th and 19th centuries, Germany, Austria, France and Great Britain were the main centers of ophthalmology in Europe. Many ophthalmologists, mainly cataract surgeons, traveled from city to city to operate and teach. Few eye hospitals existed, and many of them were privately organized.
In Zurich, Switzerland, the first mention of a location used for ophthalmic patients was in 1786: a so-called “Schnydstübli” for patients after a cataract operation.
During Napoleon’s Egyptian campaign at the end of the 18th century, the high number of soldiers with so-called Egyptian ophthalmia engendered considerable interest in ophthalmology. This led to it becoming a separate medical specialty. The first eye hospitals were opened in London and Vienna. In Switzerland, Bern and Zurich were the first two cities where dedicated eye clinics were funded, in 1834 and 1862, respectively.
In Zurich, the permit for the first eye clinic was signed by a famous poet, Gottfried Keller, who was at this time state secretary in the city. Johan Friedrich Horner was the first director. The clinic consisted of two big rooms with 10 beds each, and at the beginning, 350 patients were treated per year. The results of ophthalmological operations improved, mainly because of an increasing knowledge of antisepsis. Theodor Billroth, a famous surgeon and director of the University Hospital, promoted the disinfection of surgeons’ hands to stop patients being contaminated. During his work at the eye clinic, Horner described Horner’s syndrome: miosis, ptosis and enophthalmos. The following director was Otto Haab, known for the description of the Haab’s lines in congenital glaucoma. With the growing industrialization of Zurich, the amount of eye trauma increased exponentially. Haab developed a magnet to extract foreign metallic bodies out of patients’ eyes. He could perform this operation using either hand because he was ambidextrous.
Bern gained an international reputation through Hans Goldmann, head of the department from 1935 to 1968. Goldmann was born in Bohemia in 1899 and studied medicine in Prague. He actually wanted to become an astronomer, but his father told him to learn a “practical profession” and therefore he settled with medicine. Goldmann came to Bern in 1924 as a resident under August Siegrist. Eleven years later, he was head of the department and was granted Swiss citizenship. His interest in ophthalmology focused on fundamental research in perimetry and glaucoma. In 1933, he produced the first slit lamp together with Haag and Papitz; in 1945, the Goldmann cupola perimeter; and in 1954, the Goldmann tonometer, which is still the gold standard worldwide for measuring IOP.
In 1923, Alfred Vogt, then director of the University Eye Clinic in Basel, accepted the invitation to move to the same position in Zurich. Why was he in dispute with Goldmann?
The biographers of Vogt describe defining aspects of his life and character. On one hand, there is his outstanding work as a researcher and clinician. He published 235 papers and, in 1921, an extensive work on slit lamp microscopy. In 1906, he first described the symptoms of what was later named Vogt-Koyanagi-Harada syndrome. On the other hand, his personality is described as difficult, sometimes even aggressive, restless, persistent and strict. He worked from very early in the morning until late at night and did not allow himself any time off. His team had to cooperate fully with his requirements, and many were afraid of him. Residents had the utmost reverence and respect for him. One of them, one day, opened the door of the elevator. Vogt rode the elevator to another floor, and the same resident ran up the stairs to reopen the door and respectfully let Vogt out.
His intense dispute with Goldmann is well known. It concerned the etiology of the so-called glassblowers’ cataract. Goldmann claimed that it was caused by the extreme heat to which these patients were exposed during their work. Vogt asserted that the damage was caused by infrared radiation. Both Goldmann and Vogt published articles about the etiology of different cataracts, for example the “Feuerstar” or “fire cataract” and the “Röntgenstar” or “X-ray-cataract.”
It is said that Vogt disliked the personality of Goldmann and therefore tried to oppose him as much as possible, often by criticizing in public the articles Goldmann published.
The following generations brought further innovation in ophthalmology in both cities.
In Zurich, Marc Amsler became professor of ophthalmology in 1943. He designed the Amsler grid to assess distortion of central vision, and this tool is still used for macular degeneration.
In Bern, Franz Fankhauser, born in 1924, pioneered the use of lasers in ophthalmology. He did extensive research on the ocular effects of laser therapy and in 1982 developed with Lasag the first commercially available ophthalmic Nd:YAG laser.
More recently, Theo Seiler, director between 2000 and 2001, involved the eye clinic in Zurich in excimer laser refractive surgery. He also developed corneal cross-linking to treat keratoconus. This treatment has become the standard of care in many centers worldwide and continues to develop.
- Bregeat P, et al. Doc Ophthalmol. 1992;doi:10.1007/BF00155019.
- Enoch JM. Doc Ophthalmol. 1983;doi:10.1007/BF00161287.
- Fankhauser F, et al. Graefes Arch Clin Exp Ophthalmol. 1996;doi:10.1007/BF00184855.
- Goldmann H. Graefes Arch Clin Exp Ophthalmol. 1933;doi:10.1007/BF01853589.
- Goldmann H, et al. Graefes Arch Clin Exp Ophthalmol. 1938;doi:10.1007/BF01853159.
- Herbort CP, et al. Int Ophthalmol. 2007;doi:10.1007/s10792-007-9083-4.
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Frances Meier-Gibbons, MD, is a member of the OSN Europe Edition Editorial Board. She can be reached at Tiefenaustrasse 2, CH-8640 Rapperswil, Switzerland; email: firstname.lastname@example.org.
Disclosure: No products or companies that would require financial disclosure are mentioned in this article.