Scotsman Obituaries: Alistair Adams, Scottish ophthalmologist with an eye for innovation

An intensely practical man, Alistair Adams always had a solution to a problemAn intensely practical man, Alistair Adams always had a solution to a problem
An intensely practical man, Alistair Adams always had a solution to a problem
Alistair David Adams, ophthalmologist. Born: 3 July 1943 in Edinburgh. Died: 17 May 2024, aged 80

Alistair Adams became one of the most brilliant, if unsung, figures in ophthalmology across the world, though there was no promise of such a future when I first met him. He was pushing a trolley in the Royal Infirmary – covering the cost of the Victor Silvester dance studio, where he won a bronze medal.

Born in Edinburgh in 1943, he sailed through primary school and then with equal ease, through George Heriot’s. He casually disposed of the first year of his medical degree while still a schoolboy and went straight into the second year at Edinburgh University.

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After school he succeeded, to his own surprise, in the University bursary competition – an enigmatic examination paper to which there was no actual answer because there was no actual question. Instead, comments were invited on a proposition, apparently simple, the aim being to discover which candidates could see that it was actually complex – 20 years earlier, the prize would have been a one-way ticket to Bletchley Park.

The physiologists recognised from his pre-clinical performance that such a mind deserved scientific discipline. An honours BSc followed, and with it, a polished reverence for evidence-based medicine. Alistair had no time for the broad brush approach – particularly mine, he required detail and simmered with ideas to improve whatever he observed; but despite all this proven academic bravura, he passed through life tormented by self-doubt.

Although the photograph here is light hearted, there was another side to him, appearing uncannily in the Delacroix portrait of Chopin which could have been commissioned for Alistair – the tousle of hair, the eagle nose, the slightly remote air of artistic sensitivity as though his expression could not cope with the tumult of inventiveness behind it.

And inventiveness there was. Heath Robinson was his nickname, he was a master at devising functional elegant structures from the most unpromising material. As a silversmith, he designed and put together the most exquisite pieces. He took a course in the art of constructing and picking locks, and indeed, went further in assembling an instrument, using a slender fibre optic cable, to examine the interior of safes and to open them from within.

On the clinical front, he invented clips to help anaesthetists identify their different syringes and he produced a delightfully simple vitrectomy apparatus for £1,500, favoured by the surgeons at Edinburgh Eye Pavilion for over ten years but not by the major companies, whose commercial products could then fetch £25,000. They were, alas, more complicated and, having more to go wrong, they frequently did. Then there was the Boy Scout injunction – “Be Prepared”. Alistair was always prepared. The last time I spoke to him, his Swiss army knife came to the rescue of a wayward Sim card. When an examination colleague could not remember the code for his suitcase at the Jeddah customs, Alistair, a fragment of hacksaw in his pocket against just such a need, cut open the padlock while the fearsome border guard gaped in silence.

Then there was Alistair the Sea Scout. In the harbour at Coll on a yachting trip to the Western Isles, we misread the weather. Red sky at night turned out to be raging gale in the morning, two yachts aground, and ours tugging fiercely at a frayed mooring rope. Alistair, who was also our chef in the galley, produced a fishing rod he just happened to have and then, held fast by his legs over the heaving bows, he dropped a plumb line through the equally heaving mooring ring, an intact rope following like thread into a needle. And simple sea-sickness proved a welcome alternative to drowning.

Although a first class clinician, he was a scientist at heart. He spent 18 months as a fellow at Stanford University in California where, with no research funding and using material available at any stationer’s, he discovered and published a completely new and widely quoted concept about the function of conjunctival mucus.

By dint of persuasiveness and charm, he made it possible for people to make donations directly to the Eye Pavilion Treatment of Blindness Fund, over 15 years, raising £2,000,000. This sum, plucked from the capacious maw of the Royal Infirmary, funded replacement of expensive equipment and the construction of a third theatre.

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As chief examiner for the Royal College of Surgeons of Edinburgh, Alistair organised examinations in the UK, India, Hong Kong and Singapore. During this time, the role of the College in training and the nature of the examination came under great scrutiny. The upshot was his complete redesign of the entire examination with structured questions, a syllabus detailed as never before and a log-book to record the precise nature of a candidate’s experience and training.

Alistair, ever restless, was the first eye surgeon in Scotland to perform laser surgery for short-sightedness. Yet with principled firmness, after more than a hundred of these procedures he concluded that changing the corneal shape for refractive convenience was not the best use of a surgeon’s time.

He developed a technique for small-incision cataract surgery that did not require expensive, temperamental technology and published a method of repairing tear canals damaged in eyelid trauma.

Alistair was married twice, first to Anne, and he was a devoted and caring father to their children, Jonathon and Caroline. Their marriage, sadly, ended in divorce, but some years later he married Margaret, whose children and their children loved him as dearly as he did their mother

His final illness, carcinoma of the bile duct, struck without warning or reprieve, five months after his 80th birthday. He faced the inevitable with characteristic resolution, issuing instructions about what should happen. always with detail.

Alistair was a close friend and a loyal colleague for over 50 years. We shared a consulting room at 14 Moray Place and he was always ready with advice to make something serious appear less so. Though self effacing, he was a major player in the great game and one who never grasped that his terrible self-doubt was wholly without foundation.