Scientific Method and Glaucoma

Friedrich Wilhelm Ernst Albrecht von Grafe, or Graefe, was born on May 22, 1828 and died July 20, 1870. Graefe He was considered by many, a Prussian pioneer and founding father of 19th century ophthalmology. (Daroff and Aminoff) Father to Albrecht von Graefe and son to Karl Ferdinand von Graefe, he was born in Finkenheerd, Brandenburg. In Berlin, he studied anatomy, natural sciences, logic, and philosophy, going abroad to study in London, Prague, Vienna, and Paris. (Daroff and Aminoff) It was while abroad that Graefe decided to devote special focus to the field of ophthalmology.

He traveled back to Berlin to become an oculist where he established a private institute for eye treatment. His thesis, Uber die Wirkung der Augenmuskeln, led to his habiltation and eight years later, a position as an associate professor of ophthalmology. (Daroff and Aminoff) Eight years after that in 1866, he gained the position of full professor. His career continued to progress just four years later as he was elected to be part of the Royal Swedish Academy of Sciences as a foreign member. (Daroff and Aminoff)

He married in 1862 with only one child out of three surviving into adulthood. Eight years after his marriage he died of pulmonary tuberculosis at the age of 42 in 1870. Although he lived a short life, he managed to accomplish many things and contribute greatly to ophthalmological science. (Daroff and Aminoff) Considered as a notable figure of that era, in that field, two of his achievements were a new surgery for patients with cataract and a method for the treatment of glaucoma. "He introduced the operation of iridectomy for glaucoma, refined several surgical procedures, and had many contributions in the evolving field of neuro-ophthalmology." (Mach, et al. 152)

To understand and refine the treatments he formulated for glaucoma and cataract, Graefe had to dive into the scientific method. The scientific method involves different steps to observe, question, hypothesize, and then develop an experimental design, which would lead to data collection, analysis, interpretation, and finally conclusion. He used the process of the scientific method to not only focus on operating as a treatment for glaucoma, but also to refine lens extraction along with other key areas of ophthalmology. "He introduced the operation of iridectomy for glaucoma and refined the procedure of lens extraction. He is also remembered for having described sympathetic ophthalmia, retinal embolism, progressive external ophthalmoplegia, and some of the ocular signs in dysthyroid ophthalmomopathy." (Pryse-Phillips 425)

Graefe had to observe the eye, study it in order to develop the analysis that would lead to effective treatment protocols. Sjorgen in his article, "A Study in Pseudoglaucoma" notes the ability of Graefe to effectively describe the disease of glaucoma noting the symptomology via extensive observations. He discovered the primary element to glaucoma was 'enhanced intraocular pressure' stating all other symptoms came from this. (Sjogren) How Graefe achieved such insight was through examining patients with glaucoma and seeing the state of the eye under the effects of the disease.

He collected the information and analyzed it, understanding the main element, enhanced intraocular pressure, as a key determiner for glaucoma. However, in his continued observations, he saw the same elements of glaucoma without the prevalence of enhanced intraocular pressure.

Consequently, it called forth great attention when von Graefe in 1857 described a disease which he called amauros with excavation, a disease which exactly coincided with chronic glaucoma except that the most important symptom, the enhanced intraocular pressure, was missing. It was thus a glaucoma without hypertension. (Sjogren 239)

He reassessed the data and determined the disease to be glaucoma without hypertension. This led to the discovery of a new form of glaucoma.

Although his work was met with strong opposition, he decided to take the route of the scientific method and came up with this conclusion. This newly identified form of glaucoma which is not used today, is one of Graefe's most interesting discoveries because it goes against what is standard information concerning glaucoma. Had he not continued with his observations, performing experiments, and analyzing the information he collected, he would have never reached such a novel and new perspective.

Although glaucoma is characterized by enhanced intraocular pressure, secondary glaucomas can have no presence of hypertension as the source of the disease. For example, pigmentary glaucoma refers to deposits from the iris' posterior surface that block the drainage system. This type of glaucoma can occur in young, Caucasian males. (Tombran-Tink, et al.) Another form of secondary glaucoma can develop from exposure to corticosteroids. (Tombran-Tink, et al.) These secondary glaucomas exist separately from primary glaucoma and could be what Graefe was discussing.