Walter Brackett Lancaster, MD (1863-1951)

The name Lancaster is instantly recognizable to anyone with an interest in ocular motility for the eponymic Lancaster red-green test, the Lancaster Course, and in the Orthoptic profession, the Lancaster Award.

Walter Brackett Lancaster was born in Newton, Massachusetts on May 11, 1863. He had a brilliant record in school, entering Harvard College at the age of 17 graduating magna cum laude in 1884. Despite missing two years due to illness, he graduated from Harvard Medical School in 1889.

Exposure to ophthalmology during medical school was limited and, like others seeking post-graduate education, Lancaster traveled to Europe to study in Vienna, Paris, Edinburgh, and London. He was a fellow student with Ernest Maddox while studying in Edinburgh and a contemporary and admirer of the work of Duane, Chavasse, Duke-Elder, Maddox and Bielschowsky.

After returning from Europe, Lancaster practiced general medicine in the Boston area before devoting himself fully to ophthalmology. He joined the Massachusetts Eye and Ear Infirmary in 1897 where he combined teaching with clinical practice and continued as a consultant until his death. Lancaster was also drawn to the cadre of researchers in physiological optics at Dartmouth Eye Institute in Hanover, New Hampshire, and conducted research there with Alfred Bielschowsky.

Toward the end of World War 1, Lancaster was attached to the Air Service Division of the Surgeon General’s office in Mineola, Long Island, New York. There was considerable interest in both the US and in Britain in the visual and binocular capabilities of pilots, especially on landing when most accidents occurred. Lancaster did basic research with physiologists, psychologists and a few ophthalmologists studying stereopsis, heterophoria, color vision and night flying. He believed that stereopsis was of secondary importance to flyers as it was only effective for objects relatively close to the observer.

He realized the importance of teaching the basic sciences of ophthalmology and developed a strong interest in postgraduate education. Lancaster believed for many years that a basic science course in ophthalmology was needed and in 1945, with other colleagues, established what became known as the Lancaster Course.

Lancaster was an early supporter of the Orthoptic profession. He encouraged all of his colleagues who were devoted to strabismus to avail themselves of an ‘orthoptic technician’ believing that “an ideal relationship should exist where ophthalmologist and orthoptist fully discuss and jointly arrive at the best lines of treatment for each patient.”

Within a year or so of the initial summer course for ophthalmologists-in-training, Lancaster realized the need for a didactic training program to supplement the clinical work of orthoptists. He established the first summer course in 1948. Like Ernest Maddox in England whose daughter Mary, working closely under the guidance of her father, became the profession’s first orthoptist, Lancaster’s daughter Julia was one of the early orthoptists to be trained in America. Lancaster knew many of the pioneering orthoptists well, interacting with them as instructors or students at his summer course or at the annual meetings of the American Academy of Ophthalmology and Otolaryngology (AAOO) held at the Palmer House in Chicago. Some orthoptists worked with his own close colleagues including Nancy Capobianco with Hermann Burian, Dorothy Thompson
with Richard Scobee, and Dorothy Bair with Frank Costenbader.

Lancaster’s reputation as an educator of young ophthalmologists was well known, but it was his early advocacy of our Orthoptic profession, and his summer training courses that von Noorden said earned him recognition as the ‘Father of Orthoptics in America.’

He was a founding member of the American Orthoptic Council in 1938 and served on several committees and as its president. Lancaster published extensively in the ophthalmology literature, the most well-known article being his red-green test introduced in 1939 in a long article on detecting, measuring, plotting and interpreting ocular deviations. He presented a more succinct description called simply the red-green test at the AAOO in October 1949. In 1951 he contributed an eleven-page article to the inaugural edition of the American Orthoptic Journal. (The first Editor of the new journal was Richard G. Scobee.)

Lancaster was known internationally as an experienced strabismologist. He was endowed with a rare skill as a surgeon and was well regarded by his peers. He attended many meetings and was always actively involved in lively discussions following the presentations. He was ahead of his time with his understanding of the neural basis for strabismus and tried to dissuade colleagues from referring to “weak eye muscles” stating that “the trouble is not with the muscles but the mechanism of coordination.” He taught that the control of eye movements was neuromuscular with supranuclear control. He supported the fusion faculty theory of Claud Worth, arguing that “it is natural for the eyes to deviate - it is only when ‘something’ holds them to alignment that they do not deviate.”

The AACO Walter B. Lancaster Award

Dr. Lancaster died in December 1951 and this Award was established in his memory and in recognition of him as “a leading ophthalmologist in the United States for many years with an international reputation and an ardent interest in Orthoptics.”
The first Lancaster Award was bestowed in 1953 and the recipient was his daughter, Julia Lancaster. Julia was a pioneer of Orthoptics and president of the American Association of Orthoptic Technicians (AAOT) from 1940-1941 and again in 1951 at the time of his death.
The Lancaster Award Committee is comprised of the previous five recipients, chaired by the longest serving member. The Award is given to an orthoptist who has made outstanding contributions to Orthoptics either in teaching, publishing articles or books, devising materials, designing instruments, or developing new techniques. The Award is the highest honor that our organization can bestow and is an honor to receive it and be recognized by one’s peers. It is awarded to the recipient at the annual AAO/AOC/AACO Sunday symposium.
Lancaster award Recipients