History of cataract surgery
Posted on 15 January 2018
Physicians used to suction, bash or push the cloudy lens from a patient’s eye. Thankfully, today cataract surgery is a little more evolved.
Cataract is a clouding of the natural crystalline lens, which is located behind the pupil and iris of the eye, says Dr Mpopi Lenake, an ophthalmologist at Mediclinic Vergelegen. Cataracts are the leading cause of blindness worldwide and are the most common cause of vision loss in people over the age of 40.
The lens of the eye acts like a camera lens. Light from the outside travels through the pupil and the lens to focus on the retina at the back of the eye, where the light is translated into images by light-sensitive cells. “The lens is made up of mostly water and protein that is arranged in a special way to keep it clear. A cataract is formed when these proteins are disrupted and clump together,” Dr Lenake explains.
3 different types of cataracts
- A subcapsular cataract occurs at the back of the lens. People with diabetes or those taking high doses of steroid medications have a greater risk of developing a subcapsular cataract.
- A cortical cataract is characterised by white, wedge-like opacities that start in the periphery of the lens and work their way to the centre in a spoke-like fashion. This type of cataract occurs in the lens cortex, which is the part of the lens that surrounds the central nucleus.
- A nuclear cataract forms deep in the central zone (nucleus) of the lens. A nuclear cataracts are usually associated with ageing.
King Hammurabi of Babylonia offers any surgeon who successfully uses a bronze lancet to remove a cataract from a nobleman’s eye 10 shekels of silver.
Indian physician Sushruta describes using a curved needle to push ‘opaque phlegm’ out of an eye.
206 BC – 9 AD
Sushruta’s operation (known as couching) gains traction in China where it is known as jin pi shu.
Roman physicians insert different-sized needles into patients’ eyes to break up a cataract into smaller particles.
Persian physician Zakariya al-Razi details a cataract removal using a bronze oral suction instrument.
Anatomists correctly identify the true position of the lens and cataracts are now accurately defined as opacification of the lens.
French doctor Jacques Daviel performs the first surgical cataract extraction, manually removing almost the entire lens through a small incision.
Albrecht von Graefe reveals a new technique for cataract surgery – modified linear extraction. His linear corneal incision makes extrusion of the contents of the eye less likely as pressure in the eye forces the wound edges together.
Sir Nicholas Ridley pioneers artificial intraocular lens transplant surgery by placing a perspex lens on the eye once the cloudy lens has been removed.
American surgeon Dr Charles Kelman invents an ultrasonic device that emsulsifies (breaks) the cloudy lens so it can be aspirated (suctioned) from the eye. This procedure is known as intracapsular extraction. The cataractous lens is still replaced with an artificial lens.
1995 – 1997
Dr Ron Kurtz and Dr Tibor Juhasz develop the IntraLase femtosecond laser.
Dr Stephen Slade performs the first laser cataract surgery in America.
Towards the end of 2017, doctors at Mediclinic Durbanville and Welkom performed cataract removal procedures on public-sector patients as part of an ongoing partnership with the Department of Health. These life-changing surgeries formed part of a large-scale corporate social investment project focusing on public and private collaboration. Mrs Gadija Williams was one of the patients who received treatment. Her daughter, Ghaneemah, says the procedure has made a huge difference to her quality of life. “She was so used to working with vision in only one eye, and she is amazed by the change.”