Figure 1: Helen Keller presents the prestigious Albert Lasker Medical Research Award to Drs Arnall Patz (right) and Everett Kinsey in 1956. Kinsey is the biochemist who organized a larger study that confirmed Patz's RLF oxygen findings. (Photo courtesy of Wilmer Eye Institute, Johns Hopkins University)

Dr Arnall Patz, might not have had instant name recognition among most Americans, but among ophthalmologists, he was a legend.

Dr Patz, who discovered the key to preventing blindness in infants in the early 1950s and who later developed one of the first argon lasers to prevent blindness in young adults with diabetic retinopathy, died in his sleep 11 March at his home in Pikesville, Maryland. He was 89.

The director emeritus of Johns Hopkins University's Wilmer Eye Institute and a longtime faculty member, Dr Patz is being hailed as one of the specialty's greatest ophthalmologists, not only for his scientific advances but for the manner in which he trained younger ophthalmologists to become leaders in the field.

"He was widely respected in ophthalmology, and, at Johns Hopkins, he was revered," said Morton F. Goldberg, MD, who succeeded Dr Patz as Wilmer's chairman in 1989 and served until 2003.

"I kept hoping we'd find out that he got the Nobel Prize," added Dr Peter McDonnell, Wilmer's current chairman. "I thought it would have been nice for someone whose work resulted in the closure of two-thirds of the schools for the blind. If that doesn't deserve a Nobel Prize, I can't think of too many things that do."

Born in Elberton, Georgia, Dr Patz received his undergraduate and medical degrees from Emory University in Atlanta. After serving in World War II, he joined the eye clinic at Walter Reed Army Hospital, then began his residency in ophthalmology at the District of Columbia General Hospital.

Infant blindness

As a resident, he noticed an unusual number of premature infants had an abnormal overgrowth of blood vessels in the eye that caused irreparable damage to the retina and often led to blindness. Many of them had received near-total oxygen in their incubators, which was believed beneficial to preventing cyanosis. Along with the late Dr Leroy Hoeck, a paediatrician, he conducted what is believed to be one of the first controlled clinical trials in American ophthalmology and discovered that excessive exposure to oxygen caused retrolental fibroplasia (now referred to as retinopathy of prematurity, or ROP), which then was the major cause of blindness in children.

His idea was met with a high level of suspicion and disapproval from the medical community, which found it hard to believe that something as beneficial as oxygen could cause such harm. Despite initially denying his request, Dr Patz eventually gained approval for his research funding, and his studies supported his theory. After a large-scale clinical trial led by Everett Kinsey, MD, confirmed his findings, oxygen was discontinued as the standard of care, saving the eyesight of countless infants.

His work earned him the Albert Lasker Clinical Medical Research Award, known as the 'American Nobel,' which was presented by Helen Keller in 1956. In 2004, President George W. Bush presented him with the Presidential Medal of Freedom, America's highest civilian honour.

He also received the Friedenwald Research Award in 1980, the inaugural Isaac C. Michaelson Medal in 1986, the first Helen Keller Prize for Vision Research in 1994, and the 2001 Pisart International Vision Award from The Lighthouse International. He served as a president of the American Academy of Ophthalmology (AAO) and in 2005 he received the Lions Humanitarian Award, the Lester S. Levy Humanitarian Award, and the AAO's Laureate Recognition Award.

When Dr Patz joined the Johns Hopkins medical faculty in 1955, he began a long association with the Wilmer Eye Institute that was his pride and joy as he continued his research in such areas as diabetic retinopathy and age-related macular degeneration. Working in conjunction with the Johns Hopkins Applied Physics Laboratory during the late 1960s, Dr Patz developed the argon laser that helped save the eyesight for young adults with diabetic retinopathy. The Seeing Eye Foundation awarded him a research professorship at Wilmer in 1970, when he founded the Retinal Vascular Centre.

He was passionate about his work, leading him to study diabetic dogs in his home so he could monitor them day and night, Dr McDonnell said. He occasionally was overwhelmed with requests from people with diabetic dogs, asking him to take them in.

"It's a different era now; you can't do animal research at home," Dr McDonnell said. "But he was able to make important research observations. It's also a testament to his lovely wife Ellen, because in their home would be these barking, diabetic dogs. Where his work day ended and his home day began each day was not clear."

He also devoted a portion of their home to his ham radio, which he would use to coordinate the donation of corneal tissue in the 1950s and 1960s in cooperation with the eye banks, Dr Goldberg said.

In his private time, Dr Patz and his wife enjoyed dancing and even gave lessons on dancing the Charleston at a Wilmer meeting, Dr McDonnell recalled. He also enjoyed fly fishing, and he and his five children would spend the month of August in a log cabin they built in the woods of Maine.

While it might be tempting to point to the scientific advances as his greatest achievement, those who knew him say he was equally proud of the people he mentored.

"His biggest legacy was not only as a brilliant clinician-scientist, but he also trained the leaders of American and international ophthalmology and showed by every virtue of his own life that one could be highly productive in clinical science but at the same time be an ethical, kindly, collegial friend and a humble man," said Dr Goldberg. "He downplayed his own accomplishments. He was kind and generous with everyone he came in contact with."

"I suspect he would have thought his greatest contribution were the people he trained," Dr McDonnell said. "He was very proud of his people. He trained generations of people who are today the household names in retina around the country and around the world."

Dr Goldberg said Dr Patz was one of the greatest ophthalmologists in history, pointing to his work on ROP, the argon laser and the excellence of the Wilmer Eye Institute under his tenure.

"Any one of these things would have been sufficient," he said, "but he did all of those while being a very kind and generous person."