|Year : 2020 | Volume
| Issue : 2 | Page : 203-205
Dr. Charles Schepens and the first head-mounted binocular indirect ophthalmoscope
C Biju John
Department of Ophthalmology, Regional Institute of Ophthalmology, Government Medical College, Thiruvananthapuram, Kerala, India
|Date of Submission||16-May-2020|
|Date of Acceptance||17-May-2020|
|Date of Web Publication||25-Aug-2020|
Dr. C Biju John
Regional Institute of Ophthalmology, Government Medical College, Thiruvananthapuram, Kerala
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
John C B. Dr. Charles Schepens and the first head-mounted binocular indirect ophthalmoscope. Kerala J Ophthalmol 2020;32:203-5
What happens when an astute imaginative mind aspiring to be an engineer ends up finally in medicine and then in ophthalmology. Those skills are likely to be applied there for benefitting that particular science, ultimately resulting in its advancement.
Thomas Alva Edison had famously said, “To invent, you need a good imagination and a pile of junk.” And so, when the excellent imagination and the innate engineering skills of Dr. Charles Schepens met a pile of junk in Moorfield's Hospital and adjacent London Streets created by the heavy German bombing of 1940, the result was an invention that changed the landscape of Ophthalmology forever – The head-mounted binocular indirect ophthalmoscope.
However, in the words of his daughter Claire Delori, he might have ended up as an undercover spy turned lumber businessman had the German Gestapo police not caught up with his operations. And then, it was nothing sort of a miracle that he escaped from them and possible detention in a concentration camp. The story of the first Head-worn Binocular Indirect Ophthalmoscope [Figure 1] and its inventor makes fascinating reading.
Charles Louis Schepens (March 13, 1912,–March 28, 2006) was born in Belgium in 1912 to a doctor father. Even though he wanted to study Engineering, he joined medical school due to family compulsions. However, he did not let his passion for engineering and mathematics die and decided to take Ophthalmology for postgraduation as “It seemed closest to Engineering.” He had developed a keen interest in Instrumentation even during his Postgraduate training in 1936 and 1937, at Moorfields Eye Hospital in London. After returning to Brussels, Belgium, he worked in a clinic for some time and then went into active service with the Medical Corps of the Belgian Air Force in 1939. As fate would have it that was when the World War 2 began, and by 1940, Belgium was under siege by Germany. Before long, Dr. Schepens's unit was left with nothing to fight as all the planes where completely destroyed by the Germans. Unable to accept his superior officer's command to “Prepare for surrender and to keep everything in order for the Germans,” the young Schepens along with three other officers just ran away. Schepens then joined the secret Belgium resistance and began to lead a double life. His Ophthalmic clinic served as a sort of secret postoffice for smuggling clandestine documents and packages to London. He was arrested by the German Police in 1940 but was released after 2 weeks in prison for want of evidence. This only increased his resolve (made him very angry in his own words) and he carried on his underground operations with renewed vigor putting himself along with his young wife and two toddlers in grave danger. However, by the spring of 1942, Schepens and his family had to flee to Paris as they came to know in the nick of time that the resistance has been found out and the Gestapo was about to arrest him.
In Paris, with the help of some friends, Dr. Schepens managed to forge a new identity, Jacques Perot-Spengler [Figure 2] and continued his Anti Nazi activities. This time, he was more daring. With considerable research and effort and with the help of other members of the Belgian resistance in exile, he managed to purchase a defunct lumber mill in Southern France in the Pyrenees Mountains on the Spanish border. One of the key features there was a 12-mile cable car system extending up the mountain and terminating near the border. He managed to repair the entire cable car system and had the lumber mill fully operational. His family also joined him. The site became a functioning lumber enterprise, taking orders, delivering wood, and meeting a payroll. Dr. Schepens himself was a rugged outdoor man and would say later that he really loved the lumber business and would have happily continued there had fate not intervened in the form of German Police.
The men performing manual labor around the mill could surreptitiously ride the cable car system to the top of the mountain and slip into Spain. Dr. Schepens used this effectively to help more than 100 people escape to Spain. These included allied pilots, prisoners of wars, Belgian government officials, and many others. The system was also used to move documents, currency, propaganda, and other materials into and out of France.
Dr. Schepens himself recounts in an interview how he made friends with the local Gestapo letting them believe that he was their collaborator. To take them into confidence, he used to give them lists of people who had “presumably escaped from his mill,”. Needless to say, the lists were given only after making sure that the escapees were safely over the border and in friendly territory.
However, in July 1943, the Nazis captured a member of the resistance who told them about Schepens' activities. When the Gestapo showed up, to arrest him, he realized from their conversation that they were not fully prepared and were not sufficiently armed. He could sense that they were a little uneasy due to the number of laborers there.
As he would later recount in an interview Dr. Schepens told the Gestapo officers. “Look I will cooperate with you. However, you know, it is now 10 o'clock. I have 150 workers idle, because they have not been given their orders this morning. Give me 10 min with them. I'll give the orders and come back.”
That was the last the Gestapo saw of him as he made his escape into the mountains. He spent 16 days in the forest trekking with some shepherd friends before reaching Spain and eventually England. His spouse and children were placed under house arrest by the Nazis, who hoped to use them to lure Schepens back. However, they made their own daring escape guided by Schepens and his friends, hiking through the mountains to reach Spain, and were reunited with Schepens in England 9 months after he fled.
Once in England, Dr. Schepens had no difficulty in joining the Moorfield Eye Hospital as he had trained there before. However, he was not allowed to do a residency as he wanted initially, as the management thought that he would be called back into the army at any time. However, it was another resident who was called away and Dr. Schepens was given the opportunity to replace him. The day when he presented himself in the hospital for taking up the appointment was quite an eventful day. There was chaos and confusion everywhere as the hospital had been bombed the previous night. It was a V1 bomb and there was a lot of damage. All the damaged equipments, furniture, and debris were swept into a giant rubble as part of the restoration. For Dr. Schepens, it was an opportunity. He had been dreaming of making a binocular indirect ophthalmoscope for some time. He was familiar with the handheld Uniocular Indirect Ophthalmoscope of Giraud Teulon but did not find it very useful. To quote his words “I thought it was ridiculous to look with one eye at a retinal detachment which had too many features where stereopsis would be important.” What had held his keen engineering mind back from finding a solution was the inability to get even scrap metal as it was wartime. There was no means to get even a screw anywhere as you needed a permit to buy anything of that kind. The bomb had solved that problem for him. Now, he had a large pile of junk before him with metal scraps, screws, instrument parts, and even some instruments with only minor damages swept into the rubble. Dr. Schepens made use of it fully. Every day, he would search in the rubble picking up screws, metal pieces, lenses, and whatever he thought could be useful to him. Every night, he would work with these in the basement of the hospital.
After much painstaking work, he could achieve his dream and the first ever Head-mounted Binocular Indirect Ophthalmoscope was ready for action. Dr. Schepens used this for his clinical practice at Moorfield's and was instrumental in establishing the retinal service there. The instrument was modified several times by Schepens each time perfecting it. His instrument had almost all of the present adjustments including the interpupillary distance adjustment, adjustments for the small pupil, a strong electric light, and even some which are not there in the present ones. It had a Lens wheel in front with lenses from +1 to +5 which allowed the observer to actually go closer to the patient or go further back by adjusting the convergence of the rays using the lens wheel [Figure 1]. It was possible to rotate the whole of the optics away so as to allow the examiner to write or draw the fundus without removing the instrument. In his own words when the American Optics took up mass production of the instrument, they removed some of these which they thought were not very practical and will only increase the price.
Along with the Binocular Indirect Ophthalmoscope, Schepens also popularized the art of scleral indentation with the thimble depressor.
Because little research money was available in war-ravaged Europe, Dr. Schepens immigrated to the United States in 1947 and started the retina service, the first of its kind in the United States at the Massachusetts Eye and Ear Infirmary, part of Harvard Medical School in Boston. Three years later, he established what is now the Schepens Eye Research Institute, the largest independent institute for ophthalmology research in the world. The center would serve as a leading force in developing innovative surgical techniques and ophthalmic instrumentation and training a huge number of leading Retinal Surgeons. The management of Retinal Detachment was one area which fascinated him and it was his invention, namely, the binocular indirect ophthalmoscope which helped him to study it in detail. He also gets the credit for doing the first scleral buckling surgery in the USA in 1951. He popularized segmental and encircling bands made of polyethylene tubes and used the same after making lamellar scleral flaps. Complications secondary to polyethylene tubes led Schepens to introduce the silicone rubber implants in 1960. Dr. Schepens is credited with establishing retina surgery as a subspecialty. He subsequently became known internationally as the “Father of Modern Retinal Surgery.”
Dr. Schepen's wife Marie Germaine Schepens, called by most as Cete - who worked as tirelessly as her husband in a background role in their 69 years of married life was asked to describe how she managed to make sure that her workaholic spouse had a successful professional as well as family life. Her answer was sweet and simple. “When you have a man who has a passion, let him do what he wants and that is the only thing.” Dr. Schepens was passionate about whatever he did and probably would have been a passionate lumber businessman in a remote mountain village had it not been for the German Gestapo. Following his death on March 28, 2006, the Boston Globe in an obituary wrote.
“Two callings led Charles L. Schepens to greatness, and one nearly kept him from the other. He risked his life, and those of his wife and young children, to work with the resistance in Belgium and France during the World War 2, but he sought no honor or recognition. Instead, Dr. Schepens resumed his medical career after the war and became one of the most important ophthalmologists in history.” That, in essence, is the Schepens story.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Ono SJ. Schepens CL. Dr. Charles Schepens and theFirst Head mounted Binocular Indirect Ophthalmoscope. Br J Ophthalmol 2006;90:942.
Marquard B. Charles Schepens, 94, Leader in Nazi Resistance, Pioneer in Retina Surgery. The Boston Globe; 05 April, 2006.
Maugh TH. Charles Schepens, 94; Doctor Who Helped People Flee Nazis Became an Innovator in Retinal Surgery; The Los Angeles Times 2006.
Pal BP, Saurabh K. Evolution of retinal detachment surgery down the ages, Sci J Med and Vis Res Foun 2017;XXXV:3-6.
[Figure 1], [Figure 2]