On a typical weekday afternoon in the waiting rooms of Dr. Manus C. Kraff, the din is like that at a hot River North eatery on Saturday night. There are as many as 75 people, mostly older patients with their younger friends and relatives accompanying them, talking and laughing and gossiping. Some have been waiting for hours.
In one wood-paneled alcove, several people sit on floral love seats, drinking coffee and munching butter cookies. Not far away, in a cozy living room complete with wooden shutters on the windows, a group watches The King and I on a VCR. In another room, standing room only, people are pacing back and forth, visiting the water cooler, and casually perusing a rack of brochures detailing various medical conditions.
People file in and out of preliminary examining rooms. Some are getting the length and width of their eyeballs ultrasonically measured; some are getting the insides of their eyes, from cornea to retina, photographed; others are getting the fronts of their eyes scanned by microscopic video.
Eventually the patients make it back to see the doctor. A bevy of knowledgeable and friendly nurses precede Dr. Kraff as he zips from room to room. In one room a priest from Saint Alphonsus gives the doctor a reverent look ordinarily reserved for the Almighty upon performing a miracle. In another, a longtime patient breaks down crying over his wife's death in the middle of an examination. And in another, a patient explains that he has traveled all the way from Saint Louis for this operation.
On another morning, Kraff struts back and forth outside two operating rooms between a huge stainless steel sink and a soap machine, washing and rinsing his hands at least ten times. In a few moments he will begin a ritual dance between two operating rooms. While he operates in one with one set of assistants, another group readies a patient in the other.
"I'm always thinking about the technique of the operation," Kraff says. "Ways to perfect it, to make it easier, smoother, better."
Cataract removal is the bread and butter of most ophthalmological practices. For Manus Kraff, it is everything. Cataract operations are all he does, sometimes as many as 14 a day. Some eye doctors run Kraff down for performing assembly-line surgery, but Kraff sees it differently.
"I don't believe in limiting the number of patients I see. People may complain about the wait in the office, but they don't complain about the results," he says. "There's nobody I enjoy more than my patients."
Very few of his detractors have anything negative to say about his surgical abilities, his dedication, or his skills as a clinical professor of ophthalmology at Northwestern. Since the early 1970s, when he traveled to India and saw doctors performing scores of cataract surgeries in one day, he has been driven to perfect his skills, to become known as the Mr. Cataract of Chicago.
Growing up in a small town in Washington state, he wanted to follow in the footsteps of an uncle in Chicago, an old-fashioned GP on the west side. As a student at Cook County Hospital, Kraff ruled out first gynecology, then general surgery, because they were too depressing. "In all the specialties," Kraff says, "there was something I didn't like, but in ophthalmology, there was nothing I didn't like."
As cataract surgery has become simpler--and more and more fail-safe, with a current success rate of about 95 percent--Kraff has tried to be the first in the city to learn new techniques. Over the years he has built relationships with optometrists who refer their cataract patients to him; today, though, he relies overwhelmingly on word of mouth. Kraff has so many patients (he has performed well over 10,000 surgeries since 1975), and his records are so intricately computerized, that drug companies and proponents of new surgical methods and materials often rely on his records as research data. Kraff is often asked to draw up detailed records and correlate statistics about hundreds of patients and their surgeries--everything from eye color and home address to surgical outcome and drug reactions. Kraff sees research as a way of giving back to society. "The money I get [from a drug company, for example] to cover a study doesn't come near to covering the cost of research in my office," he says. "The out-of-pocket costs are my way of contributing."
A cataract is a metabolic change in the cells of the eye's lens--the part of the eye responsible for focusing light on the retina--which causes the lens to slowly darken and eventually become opaque. More than a million cataract surgeries are performed each year in the U.S. Without such an operation, most cataract sufferers would go blind. No one knows exactly what causes cataracts. Researchers have blamed the aging process, ultraviolet light, environmental radiation, and diet. The newest theory blames a culprit called "free radicals," which are substances produced during cell metabolism; Kraff, in fact, is doing a study on this theory.
So what happens to a practice like Kraff's if someday soon someone (maybe even Kraff himself) discovers a dietary supplement to prevent cataracts or a quick-fix pill to clear the lens? "The excimer laser," Kraff says excitedly about his latest endeavor, a new surgical tool to correct refractive errors (e.g. near-sightedness). "This fall I'll be one of a handful of doctors around the country correcting refractive errors with this revolutionary new technique."
It is 9 AM on Monday morning, and Manus Kraff has been up since 5:30. A marathon runner, he's had a glass of juice, run ten miles around his Water Tower Place neighborhood, chatted with his neighbors, and driven out to the hospital at Addison and Central. His staff apologizes to a visitor that there will be only seven operations to observe today.
Kraff enters the first operating room. A nurse holds up the patient's chart and he glances at it as another nurse wraps him in his surgical garb. Kraff stations himself at the patient's head and lowers a microscope. A video recorder saves the operation for posterity, and strains of Beethoven, Dvorak, Strauss, and Chopin play softly in the background. A speculum is placed around the eyelid to keep it open; the eyeball is anesthetized with a shot softened with a massage. The patient is awake.
Kraff begins slicing open the eyeball above the pupil. A nurse swabs away some blood. By the time Kraff cuts deeply enough into the eye to remove the lens, he has decided how to get rid of it. Either he will gently press it out whole--and when it emerges it will look like a small piece of dark yellow jelly or, if "riper," a small black olive pit--or he will emulsify the lens with a tiny ultrasonic needle that vibrates 40,000 times per second and vacuum out the residue. Either way, precautions must be taken not to injure the inner side of the cornea, the outer clear layer of the eye, because the cells don't regenerate.
After the natural lens is gone, Kraff implants a small plastic lens in its place that the patient will wear for the rest of his or her life--the ultimate in extended wear. Kraff takes a few stitches to seal up the eyeball, yells out some numbers and code words to a nurse recording the surgical report (all details of which will be put into Kraff's computer bank), administers an antibiotic, and bandages the eye for one day only. In an hour or two the patient returns home, virtually pain-free, with a bottle of eyedrops and instructions to take it easy. Healing takes several weeks, and then most patients need a prescription for reading glasses.
On Tuesday, July 17, Dr. Kraff will treat nearly 5,000 of his former cataract patients (and their friends), who include former Cubs announcer Lou Boudreau and members of the Chicago Symphony, to a Cubs/Padres game at Wrigley Field. Several guests will undergo surgery the day before the game. Kraff is scheduled to throw out the first pitch, and all his guests, presumably, will be able to see it.
Art accompanying story in printed newspaper (not available in this archive): photo/Steven D. Arazmus.