The History of Cataract Surgery

The History of Cataract Surgery

Cataract surgery is one of the oldest known surgeries that is still performed today, and one of the most common surgeries performed in the US. This fast, painless surgery has success rates of up to 99% and serious complications are rare. New technology allows surgeons to operate with greater precision, resulting in optimal visual outcomes. But cataract surgery wasn’t always this way. Major advancements in surgical technique, equipment, and intraocular lens implants have made cataract surgery a safe procedure with the potential to greatly improve vision and overall quality of life. In this blog, we’ll discuss the history of cataract surgery and the many improvements it has seen throughout time.

The earliest written evidence of cataract surgery occurs in the Babylonian code of Hammurabi circa 1750 BCE. Descriptions of surgery being performed dates back to Indian surgeon Sushruta in the 6th century BCE. During this early form of cataract surgery, the affected lens would be pushed into the posterior chamber of the eye in a process known as “couching.” Couching effectively moves the cataractous lens aside so that the patient’s vision is no longer blocked, however this is not enough to improve vision. The natural lens of the eye serves as a magnifying glass, refracting light and focusing it on the retina. Due to the absence of the lens, focusing is not possible, and vision is never properly restored. Furthermore, this procedure leaves patients susceptible to complications such as infection, inflammation, secondary glaucoma, and blindness. While couching is considered an antiquated, ineffective, and dangerous technique, it is unfortunately still used in some developing countries

Couching persisted as the primary treatment for cataracts until 1747, when French surgeon Jacques Daviel is credited with performing the first extracapsular cataract extraction (ECCE). In this procedure, Daviel would make an incision around the cornea and remove the affected lens from the eye, leaving behind the surrounding lens capsule. This method, performed without the use of anesthesia or aseptic technique, was considerably more effective than couching, and became the primary method of cataract removal for the next century, although complications such as infection remained common. While ECCE fell out of favor for some time, it is again the primary method of cataract extraction, although technological advances and aseptic technique have considerably improved this procedure. 

Around the time that Daviel was performing ECCE surgeries, British surgeon Samuel Sharp began performing Intracapsular Cataract Extractions (ICCE). This procedure differed in that the entire lens and capsule were removed as one through a large incision in the eye. ICCE became the primary method of cataract extraction in the 19th century, though there were many drawbacks to this method. Removing the lens and capsule together required a larger incision, leading to longer healing time and greater induced astigmatism. Additionally, the absence of the lens capsule caused a lack of support for the posterior chamber of the eye, leading to complications such as retinal detachment and macular edema. While ICCE was the primary method of cataract extraction until the 1970’s, it is now only used in certain clinical circumstances.

In 1949, Sir Harold Ridley developed the first intraocular lens (IOL) implant. This development occurred after Dr. Ridley observed that a pilot in the British Royal Airforce had a piece of plastic shrapnel in his eye which his body seemed to tolerate without rejection or complication. With help from the Plastics Division of Imperial Chemical Industries, Dr. Ridley created the first IOL implant from polymethyl methacrylate (PMMA), a common component of airplanes at the time. While this achievement was a notable precursor to modern IOL implants, it was not considered a success as there were significant post-surgical complications. 

A significant advancement in cataract removal was introduced in 1967 when American surgeon Charles Kelman devised a system known as phacoemulsification. During this procedure, a needle is inserted through a small incision at the edge of the cornea. This needle delivers an ultrasonic vibration to the lens, breaking it up and allowing it to be aspirated through the needle while the lens capsule remains in the eye. This procedure revolutionized cataract surgery, as the smaller incision resulted in faster healing times and fewer complications. 

Cataract surgery progressed further in 1978 when Chinese surgeon Dr. Kai-yi Zhou implanted the first foldable intraocular lens made from silicone. This design allowed the surgeon to implant a lens without making a larger incision, resulting in favorable post-surgical outcomes. 

By 1998 IOL implants were available in multifocal and toric (for the correction of astigmatism) designs. In 2004, aspheric lenses were introduced. These new designs offered better visual outcomes and more personalized treatment options. 

In 2010 a new, more precise technology was introduced when the Federal Drug Administration (FDA) approved the use of Femtosecond Laser-Assisted Cataract Surgery (FLACS). This laser procedure uses imaging software to assist the surgeon in providing more precise, personalized surgical results. Further advancements in refractive cataract surgery imaging, such as the Optiwave Refractive Analysis (ORA) system, have provided surgeons with the tools to offer their patients optimal vision after cataract surgery.

In the earliest days of cataract surgery, providers simply offered a solution to remove or move cataracts. As time progressed, they focused on how to remove cataracts safely. Today, cataract surgeons perform a safe, effective procedure with a focus on giving their patients the best visual results. The premium surgical options available to patients today are made possible by great advancements in education, science, and technology. 

Dr. Johnson offers the latest technology to her patients. She performs over 450 cataract surgeries annually, and has performed over 10,000 surgeries since opening her practice in Fairbanks. Her average surgery takes just 6 minutes, and her results are consistently better than the national average as measured by ORA system data. If you are interested in learning more about cataract surgery, please call or text (907) 328-2920. Thank you for taking the time to read our blog. You can find all of the blog entries on our website at www.mountainvieweyes.com/blog.

References:

UCI, University of California, https://www.ucihealth.org/blog/2018/03/cataract-surgery

Ascaso, Francisco J. MD; Lizana, Joaquín; Cristóbal, José A. MD

Journal of Cataract & Refractive Surgery: March 2009 – Volume 35 – Issue 3 – p 607-608

doi: 10.1016/j.jcrs.2008.11.052, https://journals.lww.com/jcrs/Citation/2009/03000/Cataract_surgery_in_ancient_Egypt.43.aspx

Thomas S Harbin, MD, MBA, Sushruta, American Academy of Ophthalmology, Aug 04, 2016, https://www.aao.org/senior-ophthalmologists/scope/article/sushruta

Meda N, Bognounou V, Seni E, Daboue A, Sanfo O. Cataracte au Burkina Faso: facteurs de choix entre chirurgie moderne ou traditionnelle [Cataract in Burkina Faso: factors of choice between modern and traditional surgical procedures]. Med Trop (Mars). 2005 Nov;65(5):473-6. French. PMID: 16465818, https://pubmed.ncbi.nlm.nih.gov/16465818/

American Academy of Ophthalmology,  https://www.aao.org/biographies-detail/jacques-daviel-md

JOhnson && Johnson Vision, https://www.aao.org/bcscsnippetdetail.aspx?id=7850dcf5-4882-4f0e-a29c-1a03995ab444

American Academy of Ophthalmology, https://www.aao.org/biographies-detail/harold-ridley-md

Ophthalmology Management, 50 Years of Phacoemulsification

The Legacy of Charlie Kelman: Inside, and Outside, May 5, 2017, Https://www.ophthalmology management.com/issues/2017/may/phaco-at-50

Florian Kretz, Sibylle Scholtz, Gerd Auffarth, The Ophthalmologist, A Brief History of IOL Materials, 05/19/2014, https://theophthalmologist.com/subspecialties/a-brief-history-of-iol-materials

Written By:

Gina Stafford COA, LDO, ABOC

Posted in: Cataract, Cataract Treatment

 
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