UPFRONT

Garage Days Revisited

Peter K. Kaiser, MD

“Out there in some garage is an entrepreneur who’s forging a bullet with your company’s name on it.”

—Gary Hamel

Some of the things we use on a daily basis in retina were developed in basements and garages. In 1972, Robert Machemer converted his garage in Miami into a workshop where, using straws, hand drills, and eggs, he and Jean-Marie Parel developed one of the first commercially successful vitrectors. The 16-gauge, single-port device started an entirely new field in ophthalmology (although to be historically correct, C. Haruta had described closed vitrectomy in 1959 in the Japanese literature).

We have certainly come a long way from those early days. In this issue, Carl Regillo discusses the latest miniaturization of this breakthrough technology with a article on 27-gauge vitrectors and instruments.

In a basement of a home in Newark, DE, a former DuPont chemist and his son worked with polytetrafluoroethylene (PTFE), a perfluorocarbon resin, to try and develop better insulation for electrical cables. At the time, PTFE was better known as DuPont’s Teflon.

The chemist’s son discovered that, when you rapidly stretched heated rods of PTFE, a porous sheet was produced that had some special properties. It was very strong, gas permeable, hydrophobic, chemically inert, and weather resistant. Studies have shown that it can last more than 100 years in outdoor environments, owing to the strength of the C-F chemical backbone. The homeowner’s name was Wilbert L. Gore, his son was Robert, and the compound they made is Gore-Tex.

Most of us thank this discovery as we trudge through the snow in our waterproof, windproof jackets. But more recently, Gore-Tex products have been used in numerous medical applications as our body integrates into the porous, super-strong material instead of encapsulating it. More importantly, no examples of rejection have been reported. It is an ideal substrate for suturing. In this issue, we explore the use of Gore-Tex sutures for dislocated lenses, and its advantages over Prolene and nylon sutures.

As you ski down the slopes in your nice Gore-tex jacket, you can ponder another perfluorocarbon that we use in retina: perfluorooctane or perfluoro-n-octane (PFCL). Discovered in 1966, when mice could survive for weeks after being dunked for one hour in containers of PFCL due to its oxygen carrying properties, PFCL was developed as a blood substitute. In 1982, the idea of using it as a vitreous substitute was reported. Soon thereafter, Stanley Chang described using it in retinal detachment surgery.

What other companies started in a garage? In 1939, engineering graduates Bill Hewlett and Dave Packard made their first computer in Packard’s garage. In 1976, Steve Jobs, Steve Wozniak, and Ronald Wayne made the Apple I in Jobs’ parents’ garage. In 1998, Stanford graduates Larry Page and Sergey Brin leased a garage to start Google.

So what will you discover in your basement? In mine, I only see the tomato and pepper plants we are preparing for our garden. Maybe I need to think bigger?