Tuesday, March 16, 2010

Arnall Patz, a Doctor Who Prevented Blindness, Is Dead at 89


Dr. Arnall Patz, an ophthalmologist whose research upset medical convention but ended up saving countless babies from blindness, died on Wednesday at his home in Pikesville, Md. He was 89.

The cause was heart disease, said his daughter, Susan.

Dr. Patz, a former director of the Wilmer Eye Institute at Johns Hopkins University, also did pioneering research, using lasers, that has been credited with preserving the sight of adults with common conditions that cause blindness.

In 2004 President George W. Bush awarded him the Presidential Medal of Freedom, the nation’s highest civilian award. Dr. Patz, Mr. Bush said, was “the man who has given to uncounted men, women and children the gift of sight.”

Dr. Patz began his pathbreaking work in the 1950s, when he discovered that the high doses of oxygen widely administered to help premature infants breathe could cause a form of blindness. Known then as retrolental fibroplasia, it is now called retinopathy of prematurity, or R.O.P. The oxygen, he found, led to overgrowth of blood vessels in the eye, damaging the retina irreparably.

At the time, doctors were puzzled about why R.O.P. had quickly become the most common cause of childhood blindness in the United States and other countries, counting among its victims Stevie Wonder.

To prove his theory that oxygen was the cause, Dr. Patz had to overcome the hostility of many doctors and nurses who believed he was harming, not helping, the infants. The National Institutes of Health rejected as unscientific his initial application for a grant to study oxygen’s role.

In the late 1960s, Dr. Patz helped develop one of the first argon lasers. They are now a standard treatment for macular degeneration and for certain eye disorders that occur among people with diabetes and other ailments.

Using an argon laser, eye doctors could focus intense beams of light to spot-weld leaking blood vessels in the retina. The procedure preserves nearly normal vision for many diabetics, said Dr. Morton F. Goldberg, Dr. Patz’s successor as director of the eye institute. It was “a technological revolution,” he said.

Arnall Patz was born on June 14, 1920, in rural Elberton, Ga., the youngest of seven children. His father, an immigrant from Lithuania, was a peddler who insisted on maintaining Jewish customs in Elberton, where his was the only Jewish family.

After earning undergraduate and medical degrees from Emory University in Atlanta, Dr. Patz served in the ambulance corps during World War II, often transporting patients from Camp Lee, Va., to Walter Reed General Hospital in Washington.

During stopovers there he learned of a vacancy in the eye clinic. After obtaining that position, Dr. Patz trained as an eye doctor at Gallinger Municipal Hospital, later known as the District of Columbia General Hospital, which closed in 2001.

While in training, Dr. Patz observed 21 infants who had developed severe R.O.P. after receiving continuous oxygen therapy delivered through a cone made from folded X-ray film. Four of the children showed a narrowing of the blood vessels in the retina that seemed to lead to R.O.P.

Dr. Patz and the pediatrician in charge of the nursery, Dr. Leroy Hoeck, who died last year, suspected that oxygen was toxic in the amounts administered, Dr. Patz wrote in an account in The American Journal of Ophthalmology in 2006. Despite a lack of training in research and grant support, Dr. Patz carried out a clinical trial to test his theory with a loan from his brother, Louis.

The theory was considered radical at the time, and Dr. Patz met strong opposition from colleagues. During the test, two well-intentioned nurses surreptitiously increased the amounts of oxygen the babies were being given, believing they were protecting their welfare. (After being lectured on the matter, the nurses became committed members of the research team, Dr. Goldberg said.)

In the first report on the test, in 1952, the research team found that 7 of 28 infants receiving high doses of oxygen experienced severe R.O.P., compared with none in the group receiving low doses. Although the findings strongly suggested a causal relationship, Dr. Patz sought more proof. So he and Dr. V. Everett Kinsey helped design a trial involving 18 hospitals. It was the first controlled clinical trial in ophthalmology, and it produced convincing data.

Their findings led to widespread restrictions on high-dose oxygen therapy, resulting in an immediate 60 percent reduction in the number of blind children in the United States.

In 1968, Dr. Patz began working with colleagues from the Johns Hopkins Applied Physics Laboratory to develop one of the early argon laser photocoagulators to treat diabetic retinopathy and other eye conditions. Overgrowth of blood vessels and leakage in the retina can occur in many eye diseases. Dr. Patz recognized the potential of lasers to seal leaks and stop the blood vessels’ growth.

Dr. Patz became a full-time faculty member of the Wilmer Eye Institute in 1970 and its director in 1979. At the age of 78 he went back to John Hopkins to earn a master of liberal arts degree, his wartime service having curtailed his education. In one term paper he explored how Beethoven’s progressive deafness affected his music.

In addition to his daughter, Susan, of Baltimore, Dr. Patz is survived by his wife, the former Ellen Levy; three sons, William, of Seattle, David, of Grand Junction, Colo., and Jonathan, of Madison, Wis.; and eight grandchildren. After his brother, Louis, and his wife died in a plane crash, Dr. Patz raised their children: Samuel, of Boston; Harry, of Acme, Wash.; and Sarah Anne, of St. Louis.

Dr. Patz was a ham radio operator, and before coordinating centers were developed, he made calls late at night to facilitate the transport of corneas as they were flown around the country for transplants.

In 1956, Helen Keller, who became deaf and blind as a toddler and who became an advocate for handicapped people, presented the Albert Lasker Clinical Medical Research Award to Dr. Patz and Dr. Kinsey.

She told Dr. Patz: “Never tell a patient there is nothing more to be done. Rehabilitation is always an option.” He repeated the advice many times in lectures.

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