DR. MANUS KRAFF
Focus Through the Generations (FTTG) offers insight from four different generations of the nation's top ophthalmologists. Hear from the experts themselves on their varying life experiences in the industry.
Dr. Manus Kraff, twice named to “Best Doctors of America,” is the only cataract surgeon in Chicago to be distinguished for his outstanding contributions as one of the “Best 111 Ophthalmologists in America.” He is also named one of America’s Best Physicians in 2017 by the National Consumer Advisory Board.
hear from dr. Manus Kraff
Our host, Polly Neely had the pleasure of sitting down with Dr. Manus Kraff for an exclusive discussion regarding his life and industry experiences. Get to know Dr. Kraff a little deeper in this episode of “Focus Through the Generations”.
Polly Neely: Good afternoon. Thank you all for joining us for Focus Through the Generations. We're in a very unique time right now in our industry where we have four generations of actively practicing ophthalmologists. So wonderful to have this. And today with us, we have Dr. Manus Kraff. And some of the words that Dr. Manus Kraff has said to me that have stuck with me are, "Kid, if you find a job you love, you'll never work a day in your life." And I found the job I love. So I'm happy that I followed his advice. Dr. Kraff, thank you for joining us this evening. I want to give you a time to introduce yourself. You have a lot to tell us, Dr. Manus Kraff about your life in ophthalmology. You just shared with me that you had 60 years in ophthalmology. So fill us in on where you started and how you got to where you are today.
Dr. Manus Kraff: I started in a small town on the Indian reservation in the state of Washington. A little town called Toppenish, which is an Indian name, that means onion. Strangely enough, the word Chicago also means onion. So I've never really left the onions. At any rate, I went to the University of Washington in Seattle for medical school. I graduated, I came back to Cook County hospital in Chicago, and did an internship there. I did my residency in ophthalmology and finished in 1961. In those days, there was a doctor draft, which you could get deferred for your residency if you agreed to go into the service for two years afterwards, which I did. So in 1961, when I finished my residency, I went into the United States Navy and I was stationed at the United States Naval hospital in Great Lakes, Illinois. I spent two years there. And when I came out in 1963, I engaged in a practice with my future partner who was Howard Lieberman. That lasted for more than 30 years and many, many fond memories. And basically, from '61 on, I was just an ophthalmologist in a busy private practice. And I did that until 1972. So I have to tell you, I had my greatest professional honor, one of my two, was when Dr. Venkataswamy came to Chicago for me to operate on his cataracts. Which I did.
Polly Neely: Wow.
Dr. Manus Kraff: And he could have had any of those fabulous ophthalmologists there. So that was maybe the finest personal honor I had in my career.
Polly Neely: I did not know that.
Dr. Manus Kraff: When I was in New York, I had ordered the second generation phacoemulsification machine. And when it came in April, it was delivered to the hospital that I worked at. I scheduled my first case in the afternoon. I think it was a Tuesday afternoon. So we set everything up by the book and it wouldn't work. The water wouldn't flow. I could not get the water flowing there. After two hours, somebody figured it out that inside the bottle there's a regular rubber stopper that covers up the air that bleeds into it when we pull down after the water. So it took two hours to start the first case. The case took me another hour too. And I was like four hours doing one case, my first phaco on my own. So we all have great memories.
Polly Neely: What brand of phaco was that?
Dr. Manus Kraff: There was only one at the time. And that was Cavitron. There was a little tiny one that we took to India with us but it wasn't the big Cavitron, like Charlie used with irrigation and aspiration. So this was what we called the Blue Monster because they had a blue face to it. And that was one of the very first ones of those second generations that they delivered. When the first generation was run you needed one or two technicians just to run the machine. So that changed a lot.
So I took my first case in lens implantation in November in Long Beach, California with Henry Hirschman. And Henry, was one of the wild early pioneers of phaco and lens implantation. This was the first course that they gave. And at that course, who did I meet teaching in it? I met Ken Hoffer, who was just a young kid talking about lens implantation formulas. And Bob Sinskey was there. And that whole crew of California ophthalmologists that started ophthalmology, because they were the group that really pioneered it in '73 and '74 in Long Beach, California. And so I took the course. Then I still wasn't sure when I was going to start putting in lenses, but I knew I had to do it.
So I made an arrangement to go to Holland. Because in those days, the two leaders were Cornelius Binkhorst and Jan Worst. I went with Dr. Lieberman and myself, and we took our accountant, Howard Feinstein. We first went to Holland and Amsterdam. And we toured and we looked at Holland. And before Amsterdam, we went up to Groningen. Groningen, which is in Northern Eastern Holland where Jan Worst lived and worked. I remember watching him operate and then practicing on his dining room table putting in these iris supportive lenses.
They were Binkhorst lenses, there were Worst lenses. They were all iris supported. And Binkhorst had just come out with this, with this two-loop capsular supported lens. So I can tell you all sorts of stories about those lenses in those days. Then we went to where Binkhorst was from in Holland and in his kitchen, we also worked. And we came back from Holland. And started doing implants, and they were all iris supported with these loops at first.
I met all the pioneers there. I remember going up to Port Huron Michigan and taking a course from Nick Douvas and he had invented a rotor rooter vitrector at that time because there were no vitrectomy instruments. And who was my partner in the lab? I don't know if you remember the name Steve Shearing.
Polly Neely: Yep.
Dr. Manus Kraff: Steve Shearing nobody could get lenses then. At that time, I had just shifted from a four-loop Binkhorst lens iris supported, to a Medallion Worst Lens. So you had to beg, borrow and steal to get lenses. And so I had gotten these 50, four-loop lenses from one of the companies and I didn't need them anymore. So I sold them. I sold those lenses, those four-loop lenses to Steve Shearing. Steve Shearing later became the father of the two-loop lens. There was a great debate on that and in many suits. Which is what Steve Shearing ended up doing. He cut off the two front loops and part of the back loops and made the first posterior chamber two-loop lens. They haven't changed too much since then. And that's 1975, '76. So, I was there when that was born. It was in '77, I went to the Academy meeting and I ran into a friend John Sheets. So at that time, I would fly all over the country just to watch these guys operate. He lived lived in West Texas Odessa, the oil capital of the world where they make all the machinery.
So I flew to Odessa. And on the way, I stopped in Oklahoma City and I watched Jim Little operate. That was a great story because we used to call Jim the “John Wayne” of ophthalmology. He’s a big red headed guy, kinda talked slowly. And he moves slowly. But he had the greatest pair of hands I ever saw in ophthalmology to this day. I watched those hands operate and I've never seen it better. Everybody said, Jim was the best. And at that time, there were anterior chamber lenses too early in the game. They were either of these. So we're kind of figuring it out. Anterior chamber lenses came in four sizes. 11, 11 1/2, 12 and 12 1/2 sizes. Remember those?
Polly Neely: I do remember those. I'm dating myself now.
Dr. Manus Kraff: Okay. I said to Jim, "Jim, you mean that you have to carry four different sizes of inventory to put these lenses in?" He said, "No." And remember Jim would stop between each case, have a cigarette and then go back to operate, an unbelievable surgeon. So I said, "Nah, nah," he said, "Let me show you what I do. See the lens here." And there were those little choice lenses with these four haptics. What Jim had done, he had taken a little nail clipper, sterilized it, he only bought one size, and he would clip. He would clip off the ends, just like you clip your nails and then he'd sterilize it. They were rough, so I may be talking about being innovative and innovative. Jim would clip the four and say, "Well, it needed to be a little smaller. It's a little too big." I saw it with my own eyes. I mean, it's nothing like that today. There's nobody that innovative today, that I know. Amongst that, he's the greatest surgeon I've ever seen operate.
Polly Neely: That's a story, that's awesome.
Dr. Manus Kraff: That was a story about early lens implantation. I've been there, through the extracaps, because the interesting thing at that time was the extracap or the intracap. All of the new modern guys were doing extracap opening a lens through phaco. And all the regular guys were doing intracap. And we used to have a little saying that, the guys who are on more than wife number one were the extracap guys, and all the guys were so on their first wife were they intracap guys.
Polly Neely: When did you get to the SRK formula? How long after all this did this happen?
Dr. Manus Kraff: That was very interesting, because the formulas talk about lenses. First of all, we didn't have A-scans. So when I started putting lenses in '75, A-scans didn't come along till about '78 or '79. So how would we figure out what kind of power we put in the eye? So we had asked, "Do you ever wear corrective glasses? Do you ever wear glasses? Do you have an old pair of glasses to wear? Do you have your old prescription? Are you blind? And are you near blind? Do you have any glasses from your parents?” We were looking to get some kind of guesstimate. And I had just gotten the A-scan and so I did one of these, my history. I put it in. This is the first case I did on my first A-scan. And the next day, a patient comes in, and the patient is -10, and I said,”Well, that's the edema of the cornea” Comes back a week later, and I see the patient is -10. So I had just had the A- scan for about a week, and I hadn't used it yet. So I take that patient. I give them to my technician, who's doing it. She's working away for about an hour trying to figure the thing as she comes back. "Dr. Kraff, there's something wrong. This says you should have put in a -11 lens." She was very high myope, but I had no way of knowing it. She needed like a +3 or something or a -3, something like that. And we put in a -10, and she needed a -10. So, she needed glasses to over-correct the inpower lens. That's when we knew there would be better formulas coming out. The A-scan was just coming out. Jim Gills was working on a regression formula.
Don Sanders and I, at the University of Illinois, were working on a regression formula. And somebody that we didn't know, named John Retzlaff out in Medford, Oregon, was also working on it. And they were starting to get these first couple of papers coming out. John was a very smart guy from Harvard. Don was a very, very smart guy. And there was me with these two smart guys. And so what I got, as I supplied the patients, because I was the one that had this busy practice. And John was doing the mathematical formulas, and Don who was not a surgeon, he was a researcher at the University of Illinois was calculating and doing with the formulas. So the Academy was in Chicago that year and you'd have to look back to '77, '78. So the three of us decided we would meet at the Academy and make plans to have a formula. Sanders, Retzlaff, and Kraff. Well, at that time we didn't have any arrangements and said we're going to meet at nine o'clock at the Academy before it starts. It was down at McCormick place. I got there a half hour late. John and Don met without me because I was late. So he said, "Manus, don't feel bad." We couldn't decide how the names would go. So we figured it out this way. We would flip a coin. If it came up heads, it was Sanders, Retzlaff, and Kraff. If it came up tails, it was Retzlaff, Sanders, and Kraff. But it came up and landed, on its edge then it was Kraff! Kraff, Retzlaff, and Sanders. I was never late to a meeting after that. That's how the name came. So that's a little story with the SRK formula. And we still meet at the Academy every year. This is 35, 40 years later since SRK we have a few pictures of the three of us when we were younger. And a current picture.
Pictured Above (Left to Right): Dr. Don Sanders, Dr. John Retzlaff, and Dr. Manus Kraff.
Polly Neely: Well, Dr. Kraff, let me ask you a question. Why did you choose to be an ophthalmologist?
Dr. Manus Kraff: That's a very interesting question. I was an intern at County Hospital. And at that time, as I told you previously there was a doctor draft. And when you'd finished your internship they drafted you in the service for two years. And you were just a regular doctor. But if you had been accepted for a residency, they would defer you going into the service until you finished your residency. And then they would take you. It was called the Berry Plan. And so I said, okay and said, I want to go in as a specialist. I don't want to go in as a general physician. Problem was I didn't know what I wanted to go into. So I was still an intern. So I started looking through it all, internal medicine.
At first, I thought when I graduated medical school I wanted to go into general surgery or OB-GYN. Well, I knew after a month at the County Hospital, I didn't want to do either one of those. But I didn't know what I wanted to do. So I started going through each one of the specialties figuring out what would be good and what would be negative. There would always be something negative, and there would always be something positive. I got into ophthalmology and was another intern but I knew I was going into ophthalmology. I did not know one thing about ophthalmology. But consequently, there was nothing that I didn't like about ophthalmology. So I applied for a residency and I was accepted for it. So with that, I was deferred for my residency. So for three years, I did my residency with the basic science course, and then I went into the Navy. So that's how I got in surely, purely, serendipitously.
Polly Neely: That's interesting. I didn't know that story either. I thought I knew a lot about you. I want to ask you a question off of ophthalmology.
And you're going to have a tough time with this because you read a lot. What's your favorite book and why?
Dr. Manus Kraff: There are so many great books. Absolutely great books that are meaningful to me. And that I'll never forget one. This isn't necessarily a favorite, but it had a meaning for me. When I was in the Navy, I started reading a lot, because we had a lot of time between patients. Nobody killed themselves, having 40 patients a day. 10 in the morning, and 10 in the afternoon, that was fine. So I bought a book called, "How to Develop a Super Power Memory" by Harry Lorayne. And Harry Lorayne used to go around and perform these great feats of memory. So I read that book. And with that I started this intensive reading. Now I read about a book a week.
Polly Neely: I know you've got a ton, but tell me a story about a patient that sticks out in your mind the most? Whether it's a funny story or a memorable story or whatever.
Dr. Manus Kraff: There was a little girl. You always like to think you do something unusual. When I say there was a little girl, she was about 20 or 22. And she came to me because the Polish doctor that worked for me said, “Dr. Kraff, they have a Make-A-Wish Foundation, and she heard about you doing a laser vision correction, and maybe you could come on, and you might volunteer to do this for her." I said, “Sure." So she came to the office. I haven't told you the interesting part about Anna. Her name was Anna. You can go on YouTube and look up Anna's Dream where we put the video. What made Anna unusual? Anna didn't have any arms. She was born without arms. Beautiful face, sweet girl in her early twenties. And she had a two or three-year-old son.
Polly Neely: Wow.
Dr. Manus Kraff: So I suggest we could do laser vision correction on her. And we did laser vision, because she couldn't obviously with no arms and hands, she couldn't put a contact lens in. She is able to drive a car with her feet. She is amazing, okay? And she could put her glasses on with her toes. So we did laser vision correction on her. And then we put that video on Facebook. So you can go to Anna's Dream and see it, amazing stories. So that's one that just of all the things I've done, that just kind of stands out as unusual. We've all been fortunate enough to do people that are absolutely blind. And when we take their cataracts out and put lenses in, they can see 20/20. And fortunately, a lot of us have those experiences. But this one with the armless young girl. It was amazing.
Polly Neely: Well, I want to end with your 30 year anniversary of excimer laser.
Dr. Manus Kraff: I started it in 1975, and I'd gone all through them. The iris-supported, the anterior chamber, and the posterior chamber lenses. I've gone through all those. We did early studies with the corneal cell counts, and in 1989 with the excimer laser. I was friendly with Steve Trokel and Marguerite McDonald, and Steve and I were at a meeting and talking and he's telling me what he's doing. Marguerite's telling me, and I said, "I would really like to be an investigator for you guys." So, one day I got a call in about 1989 or '90, from Marguerite McDonald. And she says, "Would you like to be an investigator? We're picking 10 people out from VISX." They just formed VISX. And I said, "Would I?" And so that's how Colby and I got selected. And we did our first case as I told you, in February of '91.
Polly Neely: Dr. Kraff, I'm going to end with this. I have two questions I want to end with. One, I want to ask you, what advice would you give right now to someone coming out of their residency and wanting to hang their hat somewhere?
Dr. Manus Kraff: Well, the problem is these young people getting out of the residencies today, is it was much easier for us than it is for them. For us, we could go to a bank and borrow $50,000. Outfit a complete office and hang up your shingles, so to speak. And you had a practice in a year. People can't do that today. For many, many reasons. The government is in there, all the insurances. There's not much patient pay. It's a different thing. So I think the most important thing, as you mentioned in the beginning, is to pick something that you love to do. And today there's so many things. There's genetics, there's pharmaceuticals with the eye. These fields weren't even working in existence then. So, today just pick something you like and study that. And if you don't like it after you start a fellowship, leave it and do something else. But the main thing is pick something you can see yourself doing for the major part of your professional career.
Polly Neely: And would you advise them to go solo or join a practice?
Dr. Manus Kraff: Well, you can't go solo anymore. It's just the economics of the situation. You can't go to a big city. You might be able to do it in a rural community, in North or South Dakota, or Montana, or people without a large population. With a large population, you just can't do it anymore.
Polly Neely: Here's the last question I want to ask you though. We've asked everybody this question. Since you started in ophthalmology, what is the biggest impact of technology? Or how has technology transitioned in your career and where do you see it going in the next 10 years?
Dr. Manus Kraff: I always feel I lived through the golden age of technology. The golden age has been nothing like this before and I don't think that ever will be. Number one. Let's even talk about what I'm not involved in. And that's the retina. Retinal detachment, and macular degeneration, diabetic retinopathy, we never heard those when I started practice. When somebody would come in with diabetic retinopathy, all we could give them was vitamins and I know they would be blind within five years. That's what it was in the 1960s and '70s. So that's changed. I wasn't involved in that. When I came out in ophthalmology, people wore big thick cataract glasses after they had their lenses taken out, they were taken out, you were admitted to the hospital the day before you did that and you kept them in the hospital, usually for the rest of the week before they left. And they could go with the pair of very thick glasses to cut down on your side vision. That's gone now. We can now do a small incision surgery. They get off the table in 45 minutes and they can go home. And they can either see immediately or by the next day. That's a major change.
The other major change is where we're reshaping the cornea so people didn't have to wear glasses and contact lenses. And that's a major thing, Polly. If there's a next revolution in ophthalmology, it'll be on the genetic level. It will not be at the mechanical level. Right now, we're still doing mechanical things. But that'll stop. We're doing mechanical things in retina, mechanical things in glaucoma, mechanical things in cataract and cornea. The next phase is going to be on a molecular level. So if I were to go out today, I think that's what my studying would be. That will certainly keep me interested for many, many, many years.
Polly Neely:
It's amazing. Your career in ophthalmology has led so many people. And you've taught so many people. Not just about ophthalmology, but you've also taught them about life, and choices and consequences of choices and opportunities and how to grab those. I'm one of those recipients of all those things from you. And I know lots of other people are. So I want to thank you, for being with me today. And for the things that you do for ophthalmology and for people. You're amazing to me and these stories, I'm sure no one has heard these stories. These are going to be awesome stories for people.
Dr. Manus Kraff: You only got a piece of them today, Polly. We can do an episode or two or something.
Polly Neely: Oh we will, we will. I really want to go back and explore a lot of the stories that you have and be able to put these together, because I think they're beautiful stories. And I think that there are stories that people will learn from but also they're funny stories. I mean, there are stories that bring life to ophthalmology, bring personal to ophthalmology personality, which a lot of people don't think ophthalmologists have a personality, but you do. So I think it's going to be a good series. You have no idea how much I love having you and knowing that you'd do that for me. Thank you so much.
Dr. Manus Kraff: Thank you, very much. And I call you my friend, my very good friend.
Focus Through the Generations is supported by Bruder Healthcare Company.
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