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Retinal Drawing: A Lost Art of Medicine
Article in The Permanente journal · July 2011
DOI: 10.7812/TPP/11-101 · Source: PubMed
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NARRATIVE MEDICINE
Retinal Drawing: A Lost Art of Medicine
LuAnn Dvorak, PhD, LPN
Stephen R Russell, MD
For the retina specialist half of our team (Stephen Rus- The drawings had been removed from the ophthalmol-
sell), finding the “lost” retinal drawings at the University ogy clinic years before when the practice of formal retinal
of Iowa was personal. I (SR) was one of the last retina drawing ended—due, in part, to Medicare’s restrictions on
fellows in a line of Iowa-trained ophthalmologists who lengths of stay and reimbursement, to advancements in
had, from 1958 to 1988, created formal retinal (ocular technology, including the increasing use of electronic and
fundus) drawings, a form of preoperative documentation. digital diagnostic tools, and to changes in retinal detach-
For those 30 years, drawings that took from 30 minutes to ment management. Nine years and a great deal of detec-
3 hours each were routinely created both to map retinal tive work later, I (SR) had 19 large boxes of drawings and
tears, detachments, and landmarks prior to surgical retinal a plan for the images that were most interesting or most
detachment repair and to rigorously educate the examiners varied in artistic style and historical merit.
in ocular anatomy and the use of the binocular indirect We are currently developing a collection: The Lost Art of
ophthalmoscope, which Belgian-born Charles Schepens Retinal Drawing (in progress), which will feature over 120
had developed in the 1940s and 1950s.1,2 drawings and a history of the practice and process. Chapters
With lens in hand, examiners could visualize the pe- will highlight differences among various artists’ represen-
ripheral retina, a surgically important region that remains tations of similar diagnoses, and how drawing style and
difficult to view and document. Achieving visualization of technique evolved over time, how shading—sometimes
its pathology through both indirect ophthalmoscopy, and basic; sometimes sophisticated—was used, and how trans-
the discipline required to record its findings, allowed that parencies and opacities were represented. Although the
previously elusive area to be documented in the clinic and volume will include drawings and remembrances of artists
operating room far better than during the era of the direct at only one institution, fundus drawing in its entirety, as an
ophthalmoscope, the tool often used by nonophthalmolo- art and a practice, is being celebrated since the technique
gists who do not routinely receive specialized training with has become a lost art of medicine. Unlike at the University
the indirect ophthalmoscope.3 Edward Ferguson and Robert of Iowa, drawings at other institutions remain embedded
Watzke, who had learned Schepens’ methods in Boston, within individual medical records or charts, making access
brought with them to Iowa the “new” viewing technol- to them difficult, which renders the replication of the Iowa
ogy and expertise in surgical methods, specifically scleral collection unlikely.
buckling, that allowed indirect ophthalmoscopy to be fully Just as artifacts from past cultures and faraway lands find
exploited.4 The drawings immediately became a significant their way into museums and galleries around the world, these
part of the culture in the retina clinic and obtaining them colored-pencil (and watercolor) drawings emerge as art. v
a legendary challenge for “artists” in training.
When I (SR) left my position as the head retina-vitreous References
1. Schepens CL. A new ophthalmoscope demonstration. Trans Am
surgeon at Saint Louis University and joined the University
Acad Ophthalmol Otolaryngol 1947 Mar-Apr;51:298-301.
of Iowa faculty in 1997, I set out to find the roughly 12,000 2. McMeel JW. Obituary: Charles L Schepens, MD (1912-2006). Arch
retinal drawings from files then stored at an off-site facil- Ophthalmol 2006 Oct;124(10):1512-3.
ity. Inspired by the artwork and accompanying essays in 3. Havener, WH. Schepens’ binocular indirect ophthalmoscope. Am J
the Journal of the American Medical Association, and by Ophthalmol 1958 Jun;45(6):915-8.
the spectacular iris and iridocorneal angle drawings done 4. Hilton GF, McLean EB, Brinton DA. Retinal detachment: principles
and practice, 2nd ed. (Ophthalmology monograph; 1). San Fran-
by prior Iowa faculty Lee Allen (in W Lee Alward’s Color
cisco, CA: American Academy of Ophthalmology; 1995. p 178.
Atlas of Gonioscopy),5 I sought to somehow commemo-
5. Alward WLM. Color atlas of gonioscopy. San Francisco, CA: Foun-
rate this lost art; however, I soon learned the art was lost, dation of the American Academy of Ophthalmology; 2001. With
literally lost. illustrations by Lee Allen.
LuAnn Dvorak, PhD, LPN, is an Editor in the Department of Ophthalmology and Visual
Sciences at the University of Iowa, and a former Visiting Assistant Professor in the Department
of Rhetoric at the University of Iowa, in Iowa City. E-mail: luann-dvorak@uiowa.edu.
Stephen R Russell, MD, is the Co-Director of the Retina Service, Clinical Director of the
Center for Macular Degeneration, and the Dina J Schrage Professor of Macular Degeneration
Research at the University of Iowa in Iowa City. E-mail: steve-russell@uiowa.edu.
74 The Permanente Journal/ Summer 2011/ Volume 15 No. 3
NARRATIVE MEDICINE
Retinal Drawing: A Lost Art of Medicine
C Neal Jepson, MD — 9/5/63 Stanley G Shortt, MD — 4/7/82
Recurrent retinal detachment after silicone injection, right eye. Extrusion of implant.
Blind left eye from recurrent retinal detachment despite s/p scleral buckling of right eye with polyethelene implant,
operations. 1957, and bilateral cataract extraction, 1974.
Surgery: Replacement of vitreous by silicone injection, right eye. Surgery: none.
Patrick J Caskey, MD — 2/11/87 Steven J Vermillion, MD — 1/5/80 (apparently Dr V wrote
Tractional retinal detachment of left eye, with possible the previous year’s date, as people often do in January).
rhegmatogenous component. Retinal detachment of right eye, macula off.
s/p panretinal photocoagulation for proliferative diabetic s/p cataract extraction 1968.
retinopathy. Surgery: Scleral buckling, right eye.
Surgery: Retinal reattachment with vitrectomy,
membranectomy, and scleral buckling.
The Permanente Journal/ Summer 2011/ Volume 15 No. 3 75
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