A Quick Lesson in the History of Cataract Treatments

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As a health professional, you need to make sure you know the history of your field. The evolution of medical technology contains lessons in how society views and treats bodily dysfunction. By knowing how your medical field has evolved, you’ll be able to give far better advice to your patients and peers based on social, as well as scientific knowledge. 

If you are working in eye medicine, you’ll likely already know of the benefits of cataract surgery. Knowing the medical benefits, however, is only part of the picture. Modern medicine is the ever evolving result of historical innovation. 

The human relationship with our senses has been a major factor in changing societies. Heidegger and Sartre famously asked us to consider the role of phenomenological perception of self in place – we base our analysis of what we perceive on complex intents and perceptual limitations. Our sensory perspective shapes our world.  Likewise, the ways in which we treat extraordinary sensory deprivation reflects our commitment to level the phenomenological playing field. 

Here is a (very brief) chronology of cataract treatments throughout the ages. It can feel wonderful to know that you are working at the tip of a driving force that stretches back generations. 

Ancient Couching

Couching is the oldest form of known cataract treatment – having been performed since the 5th Century BC. Couching involves the movement, but not the removal, of a mature cataract. In the most ancient form of the procedure, a sharp needle was used to dislodge and slide the cataract away from the visual axis of the eye. 

In the ancient world, Aristotelian medical thinking prevailed. This kind of medical thinking emphasized the importance of ‘humors’ needing to be balanced in the body. A cataract was thought to be the physical manifestation of out of control bad humors.  

This immediately improved the vision of the patient, but could have disastrous effects in the long term. Tools were not standardized and were not truly sterile. This meant that infections often took hold after surgery. Quite often, this would lead to blindness in the patient. 

Extraction

The first genuine cataract extraction (as opposed to repositioning) was undertaken by the pioneering French surgeon Jaques Daviel in 1747. Daviel’s method involved making a large incision in the corneal tissue. The cataract was then pulled out with thin prongs or needles. 

This was truly amazing progress. The success of Daviel’s new surgery was around 50% – far higher than couching had been. 

Many patients still had trouble healing their wounds and blindness among patients was still a huge issue. 

Modernity

Modern cataract surgeries are far more safe and effective. In 1967, Charles Kelman developed the phacoemulsification technique. Using this technique, surgeons could emulsify and remove the cataract through a tiny hole as opposed to needing a large corneal incision. This greatly reduced the invasiveness of the procedure and paved the way for new kinds of cataract surgery involving the insertion of interocular lenses that replaced tissue lost in surgery. 

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