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Year : 2021  |  Volume : 33  |  Issue : 2  |  Page : 222-225

The Ophthalmologist who won the Nobel Prize and declined one too

Additional Professor Ophthalmology, Regional Institute of Ophthalmology, Government Medical College, Trivandrum, Kerala, India

Date of Submission07-Jun-2021
Date of Acceptance08-Jun-2021
Date of Web Publication21-Aug-2021

Correspondence Address:
Dr. C Biju John
Regional Institute of Ophthalmology, Government Medical College, Trivandrum, Kerala
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/kjo.kjo_134_21

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How to cite this article:
John C B. The Ophthalmologist who won the Nobel Prize and declined one too. Kerala J Ophthalmol 2021;33:222-5

How to cite this URL:
John C B. The Ophthalmologist who won the Nobel Prize and declined one too. Kerala J Ophthalmol [serial online] 2021 [cited 2021 Nov 30];33:222-5. Available from: http://www.kjophthal.com/text.asp?2021/33/2/222/324215

Declining a Nobel Prize is not something that anybody would do in normal circumstances and is sure to cause controversy and consternation. However, nothing of that sort happened when it was quietly done for the first time by an ophthalmologist. In fact, it was considered a wise decision as he collected the same prize in another field which was closer to his heart.

The events that led to this interesting piece of history unfolded in 1911, when the Nobel Committee for Physics, decided to give the Physics Nobel to Allvar Gullstrand for his work in Geometrical Optics.[1] This was not surprising and considered overdue as Gullstrand was nominated for the same in the previous year also. At the same time, the Nobel Committee for Physiology or Medicine decided that they were going to award the Nobel Prize for Medicine to Gullstrand[1] for his works concerning the “Dioptrics of the Eye.” The prospective awardee came to know of this and declined the Nobel in Physics so that he would get the other Nobel Prize. He himself was a member of the Physics Nobel Committee and so could do it discreetly. The Physics Committee then changed its report, this time including Gullstrand as one of the signatories suggesting Wilhelm Wien for the prize in Physics while the Nobel Prize in Medicine or Physiology went to Gullstrand.

Allvar Gullstrand MD (1862–1930) [Figure 1] thus became the only ophthalmologist, who got a Nobel Prize for work connected with ophthalmology and the only individual with a claim to what is described in the title of this article. (There are 2 other Nobel prize-winning ophthalmologists namely Fritz Pregl, MD of Austria in 1923 and Walter Hess, MD of Switzerland in 1949, but these were for nonophthalmology works by scientists who had given up ophthalmology and moved to other areas.)
Figure 1: Allvar Gullstrand (source Wikipedia)

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The fact that Gullstrand was eligible for a Nobel prize in Physics, as well as Medicine at the same time speak volumes about the unparalleled and astounding scientific work of the great man.

  Maths to Medicine Top

Many brilliant scientific and mathematical minds have found primary education very stifling and unstimulating as a result of which they have been labeled as poor and often impossible students. Those brilliant young minds naturally grew up hating their schools. Albert Einstein and Thomas Alva Edison are prime example to this. Allvar Gullstrand also belonged to that category. He was born on June 5, 1862, in Landskrona, a small town in Southern Sweden as the eldest son of a respected physician, Pehr Alfred Gullstrand. He obtained his primary education in Landskrona and found roaming in the streets as a prankster preferable to going to school. However, things changed when the family, probably disappointed with the school moved to Jönköping. A brilliant mathematics teacher in this town recognized Gullstrand's mathematical genius and managed to challenge the ever-demanding Allvar Gullstrand with university-level mathematics. Infinitesimal calculus and other advanced mathematical procedures followed soon,[2] and were eagerly lapped up by the hungry student.

It was only natural that Gullstrand wanted to study Engineering but then was persuaded by his father to take up medicine. He entered the faculty of medicine at the University of Uppsala in 1880. His interest in Physics and Mathematics probably channeled his interest toward ophthalmology with its optics, lenses, etc. Even before graduation, he went to Vienna to learn ophthalmoscopy, otoscopy, and laryngoscopy and spent 1 year there. He completed his graduation in 1888 and then to specialize in ophthalmology entered the ophthalmology clinic of the Seraphim Hospital in Stockholm as an assistant to Johan Widmark. He had entered the Medical school possessing a skill set seldom found in medical students-university level knowledge in advanced mathematics and a sound grasp of infinitesimal calculus. His analytical mind pondered over several scientific problems and questioned established theories. One of those areas was optics and refraction.

He found the Strums' conoid an oversimplification of things and therefore not correct in most of the eyes. As per Gullstrand, Strum had not included most of the higher-order aberrations which are there in most eyes and including those will have given different results. So when he was presented with an opportunity to do some research in the form of his thesis for his MD, he zeroed in on exactly this area. His calculations and experiments were based on advanced mathematical principles and calculus and naturally completed his thesis without anybody to guide him. Well nobody could have even if they tried. He proved his assumptions and demonstrated to the world, how the light ray bundles actually refracted in the complex reality of the eyes as opposed to infinitesimally thin theoretical lens systems. The Strum's conoid is useful in explaining what astigmatism is and it has therefore stood the test of time in basic medical teaching. However, Gullstrand's thesis showed that it is misleading and useless as a description of what a pencil of light is like when passing through the optics of an astigmatic eye.[2] The thesis received the highest grade and probably shaped Gullstrand's life from then on, as for the remainder of his active life he was eternally in love with optical problems and optical instruments. Honors and recognitions chased him constantly. In 1891 itself, immediately after his MD, he was appointed as Lecturer of ophthalmology at the Karolinska Institute in Stockholm. In 1894, the Uppsala University reached out to him and appointed him as their first chair and professor of ophthalmology, which was a great honor. He was just 32 years old at that time and got the position without having to apply for it.

His landmark work on astigmatism was only the beginning of his lifelong tryst with optics and physics. His next goal was to present a complete theory for the refraction of the eye. His first obstacle was that nobody precisely knew until then the exact shape of the cornea, the major refracting part of the eye. He designed a method for measuring this by photographing the corneal reflexes made by concentric rings or squares. The method was quite laborious and cumbersome but gave reasonably accurate results for Gullstrand. However, this formed the basis of corneal topography one century later when computerized processing of the images could be done. By 1900, Gullstrand presented his completed work on astigmatism, taking into account the higher-order aberrations also. The paper was very hard to read and comprehend and many of his mathematical derivations were not explained in detail, which led to some of his contemporaries remarking[2] that “Gullstrand is so shrewd that nobody can understand him.”

  Gentleman Top

It was in 1901 that Gullstrand contacted the famous German Optical company Carl Zeiss in Jena for the feasibility of building a particular loupe for making precise measurements on photographs of the eye. To his pleasant surprise, M. Von Rohr at the company was able to build what Gullstrand wanted. Even though the “loupe” itself was very complex and expensive and hence did not sell, it turned his interest towards instrument design. Thus, began a lifelong successful collaboration between Gullstrand and the Carl Zeiss company. The Zeiss company made good microscopes useful for observing the surface of the eye, but not its interior. The inventive and intuitive mind of Gullstrand presented an idea to the Zeiss company–an idea which has ever since become the cornerstone of the modern ophthalmic examination: “illuminating the interior of the eye with a narrow bundle of converging light or a slit of light.” The Carl Zeiss corneal microscope was fitted with Gullstrand's invention and the slit-lamp [Figure 2] was born. It was such a big contribution to ophthalmology and has been referred to as “the greatest gift to ophthalmology”[3] by many. Quite aptly in the 1922 American Society of Ophthalmology Congress, Washington, the president De Schweinitz, impressed with Gullstrand's demonstration of the device, remarked that from that time medicine had not only the Lady with the Lamp (Florence Nightingale), but also a male counterpart– the Gentleman with the Lamp (Allvar Gullstrand).[2]
Figure 2: Gullstrand Slit lamp[2]

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The Gullstrand Carl Zeiss collaboration gave several other instruments to ophthalmology which had their place as valuable diagnostic instruments in that time. Some of these were:

  1. Gullstrand's grand stationary binocular reflexless ophthalmoscope in 1911

  2. This then formed the basis of the similarly very successful Zeiss-Nordenson fundus camera (Nordenson 1925), the gold standard for several decades.

  3. Gullstrand's Hand-Held ophthalmoscope
  4. Gullstrand's Kartal Glasses, which were used for the aphakic eyes.

Gullstrand's contributions as a theoretical physicist and mathematician

Physics and Mathematics was Gullstrand's passion and this was what led him to optics and refraction and it is in this field that he made a lot of landmark contributions, some of which are as follows.[3]

Gullstrand's formula

The Gullstrand formula, (Dg e s = D1 + D2–d/n × D1 × D2) a well-known formula in optics, is still the gold standard when calculating the total refractive power of optical systems.

Gullstrand's schematic eye

Based on his very precise measurements of the human eye, Gullstrand gave the exact position of the cardinal planes of the optical system of the eye.[2] The information provided by the “Gullstrand eye” is still regarded as the gold standard today and can still be found in all training books for ophthalmology.[3]

Gullstrand's theory of physiological optics

It was Gullstrand's landmark work making use of complex mathematics that gave the world understanding about the refraction of light in the eye. He developed his theory of physiological optics based on his doctoral thesis on astigmatism and on Helmholtz's theories. It is for this contribution to the field of optics that he received the Nobel Prize.

  Honors in Galore Top

Unlike many inventors and scientists who were never properly honored during their primes, Gullstrand was fortunate to have received heaps of them and deservedly so from quite early in his career. The Nobel Prize for Medicine in 1911 was of course the most precious jewel in his crown, but even before that, he had received awards from the Swedish Royal Academy of Sciences, Centenary Gold Medal of the Swedish Medical Association, Bjorken Prize of the Uppsala Faculty of Medicine, etc. In 1914, the Swedish parliament, as requested by the Academic Senate of the Uppsala University created a personal chair in physical and physiological optics to relieve Gullstrand from routine hospital work and clinical teaching and allow him to devote his time entirely to research. The Graefe Medal of the Deutsche Ophthalmologische Gesellschaft which is only awarded every 10 years was given to him in 1927. For his sixtieth birthday, the Swedish Medical Society coined a Gullstrand medal in his honor and created a Gullstrand fund to promote ophthalmic research.

Several administrative, academic and honorary positions chased him most of which he refused because of his engagement in science. In 1905, Gullstrand was elected member of the Royal Swedish Academy of Sciences, the body that awards the Nobel Prizes in chemistry and physics (as well as economics since 1969). He first entered its medical section, but later moved to its physics section in 1911, continued as a member till 1929, and served as its chairman from 1923 to 1929. During the academic year 1925–1926, he was president of the Royal Swedish Academy of Sciences. The Swedish Medical association also gave him honorary membership.

  Gullstrand and Albert Einstein Top

When Gullstrand received his first nomination for the Physics Nobel prize in 1910, there was another brilliant young scientist whose name also appeared along with. It was none other than the great Albert Einstein. However, if Einstein had to wait for 12 more years to get the Nobel despite being nominated 11 times during this period, it was mostly due to Gullstrand's opposition to the theory of relativity and finally, the award had to be given for his work on “Photoelectric Effect” and not for the theory of relativity.

Gullstrand took his vocation quite seriously and worked hard. He was an academician, a scientist, and a clinician all rolled into one. He sacrificed himself completely to research. How he managed his time surprised many and is answered by his own remark that “an academic teacher and scientist who is not trembling from exhaustion at the end of a semester has not done his duty.”[2] He never slowed down and continued in this fashion until his death from a cerebral hemorrhage on July 28, 1930. The inscription on the coveted Gullstrand Medal, coined in his honor provides an appropriate epitaph for the man who illuminated the ocular chambers with the now indispensable slit-lamp-”Obscura Oculi Illustravit” which translates as “enlightening the darkness of the eye.”[4]

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Conflicts of interest

There are no conflicts of interest.

  References Top

Ravin JG. Gullstrand, Einstein, and the Nobel Prize. Arch Ophthalmol 1999;117:670-2.  Back to cited text no. 1
Ehinger B, Grzybowski A. Allvar Gullstrand (1862–1930) – The gentleman with the lamp. Acta Ophthalmol 2011;89:701-8.  Back to cited text no. 2
Scholtz S, Auffarth G. 1911 – An ophthalmologist won the Nobel Prize: Allvar Gullstrand, surgeon, mathematician and creative inventor. Spektrum Augenheilkd 2011;25:204-9.  Back to cited text no. 3
Seregard S. Gullstrand's Nobel Prize100 years and counting. Acta Ophthalmol 2011;89:699-700.  Back to cited text no. 4


  [Figure 1], [Figure 2]


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