I deeply appreciate the honour of having been chosen to deliver this Snellen Lecture. It is a moment of pride for me and there is also a feeling of pleasure and personal gratification that I have been selected by a committee under the presidency of a man who -since our years of residency together -has for me personified the best in medicine.
I whish to express my gratitude to Prof. van Peperzeel, who drew my attention to some basic aspects of oncology, which are essential for the understanding of the natural history of uveal melanomas. The content and the conclusions of this lecture have been fundamentally influenced by her contribution.
Herman Snellen Sen., the first professor in ophthalmology at Utrecht, was described by one of his British friends (Obituary, 1908) as an honoured leader among foreign colleagues: dignified, courteous, genial towards all and full of burnout. He was an admirable surgeon who devised many new operations. Already at the age of 27, he gave ophthalmology his classical 'Optotypi' for determination of the visual acuity. His brilliant basic ideas in this field are still up to date, as appeared from an editorial in the September 1978 issue of the 'Archives of Ophthalmology' (Sloan & Enoch, 1978). Snellen also designed the modern Eye Hospital of Utrecht, dedicated to the memory of Donders, in which, shortly after its completion, the IX-th International Congress of Ophthalmology met in 1899 under his presidency. The most exciting novelty of this congress was microphotographs projected on the screen by a lantern; particularly striking were some coloured microphotographs. Snellen must have enjoyed this novelty; in his inaugural speech as Professor, he had stated that ophthalmology, as no other branch in medicine, lent itself admirably to anatomical and pathological research.
Turning to the subject of this lecture, it may be said that a century ago, the basic feature of the natural history of uveal melanoma was well understood. The experience that all these melanomas, if not treated by enucleation, eventually proved fatal, already at that time gave rise to the therapeutic dogma that every eye containing such a melanoma had to be removed. Fuch's monography (1882)proves that this dogma indeed was put into practice.