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Ophthalmic community grieves Jan Worst, leader in IOL innovation

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Jan Worst, MD, a leader in IOL innovation, died Friday, Sept. 25, in his hometown of Groningen, the Netherlands, surrounded by his family.

Worst was trained as an ophthalmologist during the years when Sir Harold Ridley was fighting a hard battle to persuade the scientific community that an artificial lens could be implanted in the eye. Cornelius Binkhorst, MD, a great advocate of Ridley and inventor of the iris clip lens, was his “teacher and inspirer,” as Worst himself used to say.

Based on the Binkhorst lens and through progressive refinements, Worst developed the iris Medallion, which could be fixated to the peripheral iris with a stitch, and then the iris claw lens, which clamps to the iris without the need for sutures. Presented as a method to correct aphakia in 1970 at a meeting in Paris, the lens was met with skepticism. Nevertheless, Worst continued to develop and refine his prototype and in 1978 finally put it into production.

“I first met him whilst I was Senior Registrar with Eric Arnott at Charing Cross Hospital in London during a live surgery demonstration,” Richard B. Packard, MD, FRCS, FRCOphth, said. “He used stainless steel sutures to secure his Medallion IOL and close the wound but amazed us all when he asked his nurse to place the sutures. I met him many times after this at meetings, and we always seemed to have a conversation which stimulated my thoughts.”

Shortly thereafter he founded with his wife the Jan Worst Research Group (JWRG), launching a program to fight cataract-induced visual impairment in rural India, Pakistan and Nepal with the implantation of his lens. From 1978 to 2001, JWRG provided iris claw IOL implants to tens of thousands of aphakic patients in those areas.

In 1980, Worst started modifying his lens so it could also be used in phakic patients. The first phakic IOL was born, and through several improvements, it became the Artisan, the Artisan toric and the Artiflex, commercialized through Worst’s own company, Ophtec.

“Jan Worst was an ophthalmic giant to whom I owe an enormous debt of gratitude. His enthusiasm for lens implantation was infectious, and we had the privilege of his visit to Manchester Royal Eye Hospital in 1973 to start me amongst others in the wonderful practice of lens implantation,” Emmanuel Rosen, MD, said.

“Jan never used an operating microscope, preferring magnifying loops, but his skill was undiminished at the end of the pre-operating microscope ophthalmic operating era,” he said.

Passion for research led Worst to explore the globe further. His studies on the vitreous converged in a comprehensive textbook entitled Cisternal Anatomy of the Vitreous and in a handbook on the vitreous with three-dimensional illustrations, published by the JWRG in 1995.

“His knowledge of the vitreous body was second to none, and his three-dimensional representations of that elusive body were compelling,” Rosen said.

Okihiro Nishi, MD, met Worst almost 40 years ago in Nagoya, Japan, at a scientific meeting where he visualized the anatomical structure of the vitreous by injecting milk into the vitreous cavity.

Jan Worst, MD, and Okihiro Nishi at the dinner of the annual meeting of the Spanish Society of Refractive Implant Surgery held in Murcia in 1996. Source: Image courtesy of Okihiro Nishi

“For me, his presentation was electrifying. It was striking to see how the white milk, pouring into the vitreous channels, delineated the otherwise transparent and intangible vitreous structure. In that moment, I knew for certain that I would participate in clinical research. Since then, Dr. Worst has been my tutor, mentor and good friend,” Nishi said.

As a person, Worst is remembered for his passion, endless energy, perseverance and determination in accomplishing his projects to make science progress and people see and live better.

Roger Zaldivar, MD, and Roberto Zaldivar, MD, remember him as a man deeply committed to his beliefs and to the advancement of ophthalmology.

“We have learned so much from his experiences. It’s impossible to put into words how he positively influenced our lives in so many ways,” they said.

“Prof. Worst had a never-flagging passion and enthusiasm, which added a remarkable new dimension to refractive surgery, a dimension solidly anchored in anatomy and physiology and with a great concern for clinical results. In my eyes, Prof. Worst is a man who achieved a perfect balance between patient-based and science-based medicine, a balance that has given tens of thousands of patients throughout the world a better perspective on life,” Camille Budo, MD, said.

Nishi remembers him as “warmhearted, honest and humorous.”

“Some may have found him confrontational because of his strongly held views. This was usually because he was right. He will be sorely missed,” Packard said. – by Michela Cimberle

For more information:

http://www.healio.com/ophthalmology/cataract-surgery/news/print/ocular-surgery-news/%7B2caec03f-816d-4867-bb0c-01f07f58f3f4%7D/jan-gf-worst-early-innovator-of-iol-design