Dr John Nottingham's 1854 Landmark Treatise on Conical Cornea Considered in the Context of the Current Knowledge of Keratoconus

Abstract

John Nottingham has been widely credited with the first accurate description of keratoconus in his treatise on conical cornea, published in 1854. Contained within the 270-page treatise are accounts and theories of keratoconus postulated by authors such as Scarpa, von Carion, von Ammon, and Mackenzie, synthesized by Nottingham in a treatise containing his own original observations. Nottingham's work delves deeply into keratoconus, with coverage reminiscent of a modern review, albeit in a far less succinct manner. He extensively describes the epidemiology, clinical presentation, underlying cause, and treatment of keratoconus. However, the concepts put forth are limited largely by the contemporary lack of understanding of the underlying anatomy and physiology of the eye, and the observations, by technological limitations. He postulates a similar treatment algorithm to that used today; optical devices being the management option of choice in the mild stages with surgery being a last resort. None of the surgical methods discussed are used in the modern era, but he does make reference to the possible efficacy of corneal transplantation. Nottingham's treatise was published over 160 years ago, yet his ideas and observations are surprisingly accurate. It is very possible that he was the first person to publish an accurate, comprehensive description of keratoconus.

Evolution of Keratoconus: From Diagnosis to Therapeutics

“…Despite the numerous earlier descriptions of keratoconus, credit is often given to John Nottingham, a British surgeon, who published a comprehensive review of the subject in his 1854 treatise "Practical Observations of the Conical Cornea and on the Short Sight and Other Defects of Vision Connected with It" [1, 3 -4]. Despite the limited knowledge of anatomy and physiology at the time, his ideas and observations were surprisingly accurate in the context of our current understanding of keratoconus [3].…”

Keratoconus Treatment Algorithm

“…John Nottingham is considered the first author to describe keratoconus and its associations [ 2 ]. Interestingly, his proposed treatment algorithm has many similarities to the one used today—optical devices being the management option of choice in the mild stages with surgery being a last resort [ 3 ].…”

Graft survival rate of deep anterior lamellar keratoplasty for keratoconus

“…[ 1 – 4 ] Researchers estimate that the prevalence of keratoconus varies worldwide [ 5 , 6 ] and affects about 1 in 2000 people. [ 7 , 8 ] Keratoconus was first described by the German oculist Burchard Mauchart [ 9 ] in 1748 and later understood comprehensively on the basis of the exhaustive 270-page treatise by John Nottingham [ 10 , 11 ] in 1854. It is characterized by noninflammatory thinning of the corneal stroma, irregular astigmatism, myopia, and protrusion, and decrease in visual acuity.…”