Cataracts and wine

Age appears best in four things: old wood to burn, old wine to drink, old friends to trust and old authors to read.

Francis Bacon, (1561–1626). Statesman, Philosopher

E. Donnall Thomas and colleagues at the Fred Hutchinson Cancer Research Centre in Seattle provided definitive evidence that hematopoietic cell transplantation (HCT) could cure leukaemia. Since their seminal publications in the mid and late 1970’s, HCT has been provided to millions of patients worldwide [1]. The undoubted success of HCT has been tempered somewhat by the toxicity of the intensive conditioning therapy used by Thomas and colleagues. Toxicity was also a result of graft versus host disease (GvHD) and its treatment with high dose steroids. One of the toxicities of HCT is cataract formation. This occurs most frequently after a single dose of total body irradiation (TBI). However a recent publication by Horwitz et al. [2] suggests that nearly everyone receiving TBI, even when fractionated, will develop cataracts with increasing follow-up. They also say that high cumulative steroid usage is a cofactor in cataract formation. Most evidence suggests that early diagnosis and treatment of cataracts is associated with the best outcome.

What has this to do with wine you might ask? The linking factor is a doctor called Robert Sinskey. Sinskey graduated from medical school in 1948. He attended The Massachusetts Eye and Ear Infirmary to take a basic course in ophthalmology and his talent was spotted by the chairman Dr David Cogan who had just returned from studying the effects of the atomic bomb in Japan after World War II (WWII). Sinskey was dispatched to Japan, as a lieutenant (junior grade) in the United States Navy, in 1950.

He began working for the Atomic Bomb Casualty Commission (ABCC) in Hiroshima city and conducted research on the effects of radiation on the eye. He was assigned a translator who was a Nisei (an American by birth whose parents were immigrants from Japan[Issei]) whose family was incarcerated in California during WWII). The ABCC had internists, paediatricians and pathologists and a lone ophthalmologist, Robert Sinskey. Sinskey conducted visual acuity, external eye examination, intraocular pressure measurement, slit lamp examination, and fundus examination of the retina on survivors of the A-bomb. His controls were age and sex matched who had not been in Hiroshima when the bomb was dropped. He discovered that the earliest stages of radiation cataracts in young survivors were exactly the same as age-related lens opacities. The changes occurred in the posterior part of the lens and were non-progressive. They did not cause enough visual loss to require surgery at that time.

After the war Sinskey was credited with several inventions. Although the intra-ocular lens (IOL) had been around for many years it was bedevilled with problems. Sinskey patented his ‘J-Loop IOL’ with new loops to fix the lens to the iris. He also invented the ‘Sinskey hook’, for manipulating the IOL into position although he never sought a patent for the hook. He was a pioneer of cataract surgery in children and infants. In 1980 he met Dr Aron-Rosa, a French retinal surgeon. She was an early pioneer of laser eye surgery, but more importantly she had removed Baron Élie de Rothschild’s eye (he was struck by a ball during a polo match) and for that he sent her 10 cases of Château Latour and Lafitte each year until he died and that was all she and her husband ever drank! I knew I should have been an eye surgeon instead of a haematologist.

The most important thing Sinskey did, depending on your world view, was that he bought a share in the Acacia winery in the Carneros area of the Napa valley. He subsequently bought land in the surrounding area and opened a vineyard in 1988. The road to the Sinskey Vineyard, the Silverado Trail, is now well surfaced but according to Robert Louis Stevenson in his book The Silverado Squatters; ‘you needed to take a stagecoach if you wanted to go any further north’ [3]. The Sinskey vineyard produces excellent Pinot Noir (Fig. 1) and some beautiful late harvested Pinot Bianco, a perfect dessert wine. They use glass stoppers (Fig. 2) which make an excellent closure system for white wines but are relatively expensive ($1.50 each) compared with cork and ideally require specially made bottles [4].

Fig. 1

A bottle of pinot noir

Fig. 2

Glass stoppers for white wine closure

From curing cataracts to making wine; what a varied career! As R L Stevenson said: ‘To be what we are, and to become what we are capable of becoming is the only end of life’.

I am indebted to Dr Robert Peter Gale for bringing Dr Sinskey to my attention.