Today cataract surgery is a routine, safe procedure that has improved vision for millions of people. Though the technology and technique are modern, cataract surgery has a long, fascinating history. Learning about the evolution of cataract surgery gives us greater appreciation for the procedure we are familiar with today.
Ancient (and not so Ancient) History
Long before modern surgical protocols were invented, ancient cultures performed cataract surgery using a technique known as “couching“. This procedure, dating back to Egyptian times, involves using a metal instrument to move the cataract to the back of the eye. Though couching gave poor results at great risk, it was practiced across the world for thousands of years.
It wasn’t until 1747 that someone made a change. French physician Jacques Daviel revolutionized cataract surgery by developing a process to remove the entire cataract. Daviel’s technique showed better results than couching with a success rate of 50%. However, patients risked infection and blindness. Though far from perfect, Daviel’s procedure marked the beginning of a new age for cataract surgery.
Daviel’s success inspired ambitious surgeons to continue discovering better ways to perform surgery. Dr. Albrecht von Graefe invented a specialized surgical knife for cataract removal in the mid 1860’s. Dr. von Graefe’s design was so efficient that surgeons regularly used the knife until the 1960s. Advances in technique and technology improved patient safety and couching was abandoned almost everywhere.
The Invention of the IOL
Today’s cataract surgery patients have many choices of intraocular lenses, or IOLs, available to suit a variety of lifestyles. These IOLs replace the natural lens of the eye which has become diseased (the cataract) and help restore vision. Though it seems like a logical part of cataract surgery, the IOL is a fairly recent advancement in optical technology.
Sir Harold Ridley, a British ophthalmologist, became inspired to design an artificial lens for cataract patients in the 1940s after working with wounded World War II pilots. He noticed that pilots’ eyes did not reject shards of windshield material like they rejected glass. Using this knowledge, Sir Ridley implanted the first intraocular lens in 1949. Despite great opposition from the medical community, Sir Ridley and a team of like-minded physicians worked for years to improve IOLs and surgical technique. His colleague Peter Choyce designed the first FDA approved IOL in 1981.
IOL technology improved in 1978 when Dr. Kai-yi Zhou created a foldable lens from silicone. This IOL could be rolled up and inserted into smaller openings, avoiding larger incisions required by other lenses.
Traditional IOLs replace the natural lens of the eye but don’t replace glasses or correct astigmatism. For years these were the only available lenses. In 1998 the toric lens was introduced, freeing patients from astigmatism during their cataract procedure. Lens technology improved even further in 2003 with the introduction of multifocal IOLs. These lenses can reduce or even eliminate the need for glasses after surgery.
Lasers and Beyond
Inspired by ultrasonic probes at his dentist’s office, Dr. Charles Kelman developed a technique called phacoemulsification. It utilizes ultrasound to break up the cataract and make it easier to remove without a large incision. Dr. Kelman introduced phacoemulsification in 1967, which meant less pain and a shorter hospital stay for patients.
Dr. Patricia Bath developed the laserphaco probe in 1986 as part of her ongoing quest to prevent blindness. The probe uses a laser to quickly dissolve the cataract and prepare the eye for IOL insertion. The process is fast and involves very little pain. The laserphaco probe introduced laser technology to cataract surgery, an innovation still used by surgeons today.
We owe the success of modern cataract technology to the dedicated doctors of the past who pioneered the techniques and technology we have today. Thanks to them, cataract surgery is one of the safest and most common procedures today. At LoBue Laser and Eye Medical Centers, we are committed to doing our best to follow in their footsteps.
One of the first surgeons in the area to adopt the LenSx and ORA surgical guidance system, Dr. LoBue believes in providing the best technology available to his patients. He also does his part to advance medicine by performing clinical trials of medications that may one day make a difference in someone’s life.