John Lee: Pioneering ophthalmologist and teacher
Wednesday 22 December 2010
John Lee was the pre-eminent surgeon for eye-movement disorder (strabismus) of his generation. A consultant ophthalmologist at Moorfields Eye Hospital, he pioneered the use of botulinum toxin therapy in the UK, and went on to develop the leading toxin clinic in the world.
He had first come across this use of the paralysing poison when, while on a fellowship to the US in 1981, he had visited Alan Scott, the inventor of botulinum toxin therapy, in San Francisco. On his return, he had in his hand-luggage the first vials of botulinum toxin to be used in the UK. Its use to treat strabismus meant that many patients could be treated by injection, without surgery.
In 2009 Lee was elected president of the Royal College of Ophthalmologists – the first time that the president had been elected by the members of the college rather than by the council of the college. His appointment was a measure of Lee's reputation and popularity in the UK. Lee had already proved himself an effective, pragmatic and well-liked president in the short time that he was in office, before his sudden death while attending a conference in the US.
John Lee was born in Kingston upon Thames, one of 11 children in a family of Irish origin. The family was not well-off and Lee worked in a garage to pay for his school uniform. He was spectacularly successful at school, gaining five A-levels – one of which he undertook by himself, as the school would not let boys studying science take English – and went up to Oxford at the age of 17. By his own admission he was not a model medical student and only just scraped through his final exams. While there, he met Arabella Rose, whom he married in 1971.
After qualification, he trained at Moorfields Eye Hospital, becoming a consultant there in 1984. He also ran a clinic for complex strabismus cases, seeing patients from all over the UK. I once sent him a complex case on whom I had carried out surgery with great reluctance and who had subsequently made a complaint against me. Lee was pleased to tell me that the patient had a good outcome after a further operation, but he did not hesitate to tell me a few months later that the patient had also made a complaint against him.
Lee was an outstanding teacher. He taught at the American Academy of Ophthalmology for over 20 years and organised the Moorfields squint grand rounds (during which the patient and problem were presented to an audience of doctors and medical students) for 15 years. His fellowship programme has produced a steady stream of strabismologists who now practise worldwide.
I was his first registrar when he took up his appointment at Moorfields. On one occasion we were in theatre and I was exposing a previously operated muscle. I had been working with him for a short time and was a novice strabismus surgeon. As I dissected the muscle from the eyeball, a dark patch appeared in the sclera – I had accidentally perforated the eye. When a jelly-like substance, the eye's vitreous humour began to emerge, I was horrified, but Lee mildly observed how lucky we were that I had just finished working with the vitreo-retinal team and was thus ideally placed to deal with this interesting and unusual complication.
Lee was very active in promoting his specialty. He was the author of more than 200 scientific papers and many book chapters. He championed the use of botulinum toxin in strabismus and published 45 papers on this subject alone. He was president of the International Strabismus Association, vice-president of the European Strabismus Association, a major contributor to the Informa healthcare journal Strabismus, and founder of the British Isles Strabismus Association. He was president of the Ophthalmology Section of the Royal Society of Medicine and Master of the Oxford Ophthalmological Congress.
Lee was an excellent speaker, erudite and entertaining with a good-natured, irreverent sense of humour. He was on his usual sparkling form at the ISA meeting in Istanbul the week before he died.
He relished his Irishness and loved his trips to the family home in Connemara, where fly-fishing served as an important escape and relaxation. He could complete the Times crossword with astonishing speed and had an encyclopaedic knowledge of film and music, which served him well when he appeared on University Challenge while a student at Oxford. He was a devoted fan of the Orchestra of the Age of Enlightenment.
The following story, sent to me by Tim Freeguard, illustrates Lee's characteristic generosity of spirit. "I was coming up to a training assessment and I was sat before two people whom I perceived to be terrifying potentates of the ophthalmic world – John Lee and Peter Leaver – to assess me and I was not at all confident of a positive outcome. They quickly came on to talk about my MD thesis, for which I had already taken time out, but was still in that no-man's land of not having quite written up. Peter Leaver said very sternly that I must write it up (shaking his head with a rictus of disapproval) and said that to not do so did not look very good at all and it would hold me back – 'a bit like qualifying from Oxford with a third-class degree'.
"There was a pregnant silence and a pause at the end of which Peter Leaver turned to John Lee with an incredulous look of consternation (had he been a monocle wearer it would have theatrically fallen out at this point). 'Good god, John – you didn't get a third did you?' – and at John Lee's shrugging, hands-held-aloft response in apology/acquiescence (that we all have seen so many times) we all fell about laughing and I went on to have a very constructive assessment. Needless to add, this was pure theatre set up by John Lee and Peter Leaver for the desired purpose of putting me at my ease... very much appreciated at the time!"
John Lee, ophthalmologist: born Kingston upon Thames, Surrey 25 October 1946; consultant ophthalmologist Moorfields Eye Hospital 1984-2010; married 1971 Arabella Rose (two sons); president Royal College of Ophthalmologists 2009-10; died Traverse City, Michigan 8 October 2010.
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