2014 Silver Parks Medalist: David L. Guyton
David Guyton is a problem solver, a clinical innovator, an inventor, a teacher, and a communicator. With an undergraduate degree in physics, he followed his grandfather, father, and uncle into medicine, becoming the first of a record ten siblings all physicians. He graduated summa cum laude from the University of Mississippi (winning the Taylor Medal in Physics), graduated magna cum laude from Harvard Medical School in 1969 (receiving the Maimonides Award for Outstanding Achievement), completed a fellowship at the Laboratory of Neural Control at NIH, and published one of his first research papers in the journal Science.
He subsequently completed his residency in ophthalmology at the Wilmer Eye Institute at Johns Hopkins in 1976. After a fellowship in ocular motility and strabismus with Dr. Gunter von Noorden at the Baylor College of Medicine, he returned to Johns Hopkins as the Chief Resident at Wilmer before being appointed Director of Pediatric Ophthalmology and Adult Strabismus in 1978. He continues to serve as the Zanvyl Krieger Professor of Ophthalmology in the Krieger Children’s Eye Center at The Wilmer Institute.
Dr. Guyton was not actually exposed to medicine in his youth. Rather, as the eldest child in the Arthur Guyton household, he served as the arms and legs for his father, who had been crippled by polio at the beginning of a cardiac surgery residency. Although David was not aware of it at the time, this tragic circumstance led to the best education he could have had. Arthur Guyton, the physiologist, had an inventive mind and took pride in self-sufficiency. He maintained a machine shop at home to construct apparatus for his research and to enable his children to repair, and to design and build, anything and everything. If something broke, and a new part was needed, that part would be built rather than bought.
At age 8, David made brass bullets on the metal lathe for his toy six-shooter, and at age 9 he welded together his first electric go-cart. They built their own house when David was in junior high school, of poured concrete, complete with a large workshop at one end, and a swimming pool and tennis court at the other. David was entrusted with tasks from surveying the plot, to laying the sewer line, to mixing the concrete with his younger brothers, to completing the cabinet work. In the summer between high school and college he built a 24-foot fiberglass sailboat, including sewing the sails and welding the trailer. It was not surprising, therefore, that David gravitated toward a career in which he used his hands, guided by those who came before him, and flourishing from his own ingenuity.
In his ophthalmic career at The Wilmer Institute, Dr. Guyton’s contributions to both clinical strabismus and ophthalmic optics have achieved international recognition. He combines his expertise in clinical optics with his facility in the design and construction of optical/mechanical instruments, which he does in his own basement machine shop in his home. In addition to the numerous research instruments that he has developed, he invented and built one of the first commercial automated refractors for the measurement for glasses, as well as the Potential Acuity Meter for assessing the potential visual acuity in patients with cataracts. Early in his career he elucidated the proper techniques for prescribing cylinders, how to hold ophthalmic prisms, and the proper methods for centering corneal surgical procedures.
In the strabismus realm, he gave us insights into subjective versus objective ocular torsion, the exaggerated traction test for assessing oblique muscle tightness, a resurrection of the Lancaster red-green test for the diagnosis of cyclovertical strabismus, key insights into understanding strabismus from local anesthetic myotoxicity, a comprehensive treatise that explains the long-elusive origins of oblique muscle overaction and A and V patterns in patients with strabismus, eye movement recordings that he used to explain the origins and purpose of dissociated vertical deviation, a diagnostic test and management pearls for the dragged- fovea diplopia syndrome, new techniques for adjustable suture strabismus surgery in children as well as in adults, the cause and proper treatment of the “inverted Brown pattern,” theories of how and why strabismus changes over time, and the concept that many cases of “congenital” superior oblique paresis are simple “basic cyclovertical deviations,” not caused by paresis after all.
For his contributions, he received the prestigious Mildred Weisenfeld Award from the Association for Research in Vision and Ophthalmology in May, 2007. He had already received the Alcon Research Institute Award, the RPB Senior Scientific Investigator Award, and the RPB Disney Award for Amblyopia Research.
For more than 30 years Dr. Guyton has been the primary teacher of ophthalmic optics and clinical refraction in the major basic science courses and ophthalmology review courses in the United States. It was at the Lancaster Course in Maine where he developed a strong bond with Dr. Marshall Parks and his extended family. He has also played active roles in the American Academy of Ophthalmology and the National Eye Institute. He has served on the Board of Directors, and as President, of both the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) and the Association for Research in Vision and Ophthalmology (ARVO).
The most recent of his 300+ publications and 11 U.S. Patents deal with remote optical systems and automated screening devices for detection of strabismus and defocus in infants and children.
He and his talented and devoted wife Jan have three sons and eight grandchildren, and together they still pursue the elusive balance between academic ophthalmology and family life.