Cataract Cataract Surgery

History of Cataract Surgery

History of Cataract Surgery

History of Cataract Surgery | Randall Wong, M.D.This article is part of a series to recognize Cataract Awareness Month.

Cataracts—the clouding of the lens of the eye is a natural part of the aging process and today cataract removal is one of the most common surgeries performed and one of the safest and most effective surgeries, but there was a long history of failure before the modern age of safe and effective cataract surgery.

Couching – The First “Surgery”

The first cataract surgery was described in a textbook written by  Sushruta who was an Indian physician who lived on the banks of the Ganges river around 1000 BC. The method he used was called “couching” and consisted of using a needle or a thorn to push the clouded lens downwards into the eye.  The stick was used as a tool to displace the clouded white cataract to clear the visual axis.  Once the patient claimed that he or she could see clearly the couching stopped. The method had abysmal results with only about a 30% success rate. Today couching is still performed in some remote areas of the third world.  The cataract is not actually removed from the eye, but dislodged so that the visual axis is clear.

Completely removing the cataract was first done in 1747 by Jacques Daviel in Paris. Again, the surgery had a high failure rate and many patients died from the procedure.  A major difficulty was infection and lack of understanding of “germs.”  This was the state of cataract surgery for about 150 years.

Intraocular Cataract Surgery

In the early part of 20th century, cataract surgery patients were given an anesthesia, sometimes cocaine, and the cataract was removed through an incision. Irrigation was used to remove the cataract and the incision was sutured shut. The surgery lasted for hours and patients had to lie flat and keep their heads immobilized for two weeks and once they healed from the surgery they had to wear thick glasses that replaced their removed lenses.  There was no such thing as an intraocular lens.  As the natural lens had been removed, thicker glasses were required to make up for the focusing power lost by removal of the cataract.

Intraocular Lenses

In 1949 Harold Ridley implanted the first intraocular lens. He was also the inventor of the intraocular lens which made him a pioneer in the emerging biomedical engineering field and paved the way for more developments in implanted medical devices.  During WWII, Ridley noted that when shards of acrylic from aircraft cockpit windows became lodged in pilots’ eyes, inflammatory rejection did not occur as did in the case of glass.  Making intraocular implans of acrylic were the solution.  The eyes don’t react to acrylic and there was now a medium to create intraocular lenses. 

Finally, patients were freed from the coke-bottle thick cataract glasses that had never worked well as replacements for their natural lens. 


The technique of phacoemulsification, which emulsifies the clouded cataract lens using ultrasound, was introduced in 1967 by Charles Kelman. His inspiration was his dentist’s ultrasound descaler used to break up and remove deposits on teeth.

The first foldable intraocular lens was used in 1978. A foldable lens can be rolled and will fit inside smaller incisions.

Laser Cataract Surgery

In 2009, laser cataract surgery was introduced. It is a bladeless procedure that uses a computer to create a three-dimensional map of the eye and using that map the computer-aided device precisely removes the cataract and suctions it out. Laser cataract surgery is theoretically allows certain steps of  cataract surgery to be done more accurately.  Not all ophthalmologists believe laser cataract surgery is worth the cost noting that results are comparable to phacoemulsification.

Today cataract surgery is usually done under a local anesthesia and can correct refractive errors, which means that nearsightedness, farsightedness, and astigmatism can all be corrected with multifocal and accommodating intraocular lenses

Even though modern cataract surgery is extremely safe and effective, make sure you find an ophthalmologist with whom you are comfortable. Get recommendations from friends who have had the procedure or from your family eye doctor. Make sure to find someone who answers all your questions. There are also many intraocular lens options from which to choose.

Cataract Surgery

Cataract Surgery after a Vitrectomy

This article is contributed by Alaina Kronenberg MD, a cataract specialist in Dearborn, Michigan. I asked her to write this article to better explain cataract surgery after a vitrectomy. I hope you enjoy the article.




A vitrectomy is an operation when a retinal specialist cleans out the jelly in the back of the eye (the vitreous). This is may need to be performed if you have a retinal detachment, bleeding into the vitreous and to sometimes obtain better access to the retina so your surgeon can fix many various problems on the retina.

Cataract DevelopmentCataract Surgery After a Vitrectomy

If you need to have a vitrectomy, it is very likely that the surgery will cause you to develop a cataract. A cataract is when the natural lens inside the eye becomes cloudy. The cataract can sometimes develop fairly quickly after your retinal surgery.

If the cataract develops to the point that it interferes with your day to day vision, your comprehensive ophthalmologist may recommend that it is removed. The purpose of the cataract surgery is to improve your vision as much as possible.

If you have the start of a cataract before your require a vitrectomy surgery, often your comprehensive ophthalmologist and retinal surgeon may agree to remove the cataract before your retinal surgery. This is often recommended because it is safer to remove a cataract before retinal surgery.

Cataract Surgery After a Vitrectomy

Cataract surgery after a vitrectomy has a higher risk of a complication. The vitreous usually supports the capsule of the cataract. If the vitreous has been removed, it is often more floppy with a higher risk of being damaged during cataract surgery. Also, sometimes the capsule that surrounds the cataract was damaged during the vitrectomy. There is a higher chance you will need more that one surgery to completely get out the cataract if you had a prior vitrectomy.


Patients who have had cataract surgery after a vitrectomy need to have realistic expectations on the improvement in vision they may experience. If you have had a prior vitrectomy you also may not be a good candidate for some of the premium implants that help correct both distance and near vision.

Alaina Kronenberg, M.D.
Cataract Specialist
Comprehensive Ophthalmologist
Dearborn, Michigan 48126

“Other” Eye Conditions Macular Degeneration My Opinion

Does Cataract Surgery Cause Macular Degeneration?

Does Cataract Surgery Cause Macular Degeneration?  Randall Wong, M.D., Ophthalmologist, Fairfax, VirginiaCataract surgery does not cause macular degeneration.  Macular degeneration, however, is often discovered just after cataract surgery when the vision fails to improve as hoped, causing many patients (and their frustrated families) to wonder if the cataract surgery caused macular degeneration.

Failure for Vision to Improve

In most cases of cataract surgery, vision gets better just after the surgery is completed.  In the normal circumstance,  surgery improves the vision quickly within  a day or two.

Patients who fail to improve may be referred to a retina specialist for further evaluation.

Cataracts and ARMD

Both eye diseases become more common as we get older.   Most of the time, it’s easy to distinguish between cataracts, macular degeneration or some other cause of visual loss.

Sometimes we can’t diagnose AMD because we can’t examine the retina.

When patients are referred for cataract evaluation, we do our best to ensure the cataract is indeed the cause of vision problem.  In other words, can the degree of cataract cause all of the patients symptoms?  A dilated eye exam is performed.

If there is an inconsistency, say when there is vision loss, but not much cataract (remember, cataract is clouding of the natural lens of the eye) then other causes of the visual loss must be considered, such as retinal disease, glaucoma, etc.

At times, however, the cataract is pretty dense (cloudy) making direct examination of the retina very difficult.  Just as the patient is unable to see “out” of the eye, we are unable to see “in.”

Disappointing Results

When cataract surgery is performed, but the vision does not improve, everyone is disappointed…the patient, the family and the doctor.  From our end, it is very difficult to explain that something else, for example, macular degeneration, is really causing the problem.

Not surprising, patients start to question if cataract surgery causes macular degeneration.

What Does This Mean?

Ideally, patients with dense cataracts and/or severe vision loss might benefit from an evaluation with a retina specialist.  This “objective” evaluation might avoid some of the disappointment and frustration that results from a “surprise” diagnosis of macular degeneration.

In the end, every one would benefit, because surprises and disappointment erodes…trust.


Cataract Treatments

When a Cataract Comes Back

While not a retinal problem, cataracts can “return” and can mimic the symptoms of the original cataract; blurred vision, glare and distortion.  This can usually be remedied by a simple painless laser procedure called a YAG capsulotomy.

Cataract Surgery with Implant

Like grey hair, everyone gets cataracts.  With time, the natural lens of the eye clouds with time.  This clouding decreases vision.  The lens is similar to an “M&M” piece of candy both in size and shape.  An M&M is a core of milk chocolate surrounded by a candy coated shell.

Cataracts Cause Decreased Vision

When cataract surgery is performed, the cataract surgeon cuts a hole in the outside candy coating.  The “chocolate”  (core of the lens) is then sucked out leaving the empty candy coated shell.  In the real eye, this shell is actually a clear tissue very similar to plastic wrap used to cover food.  This shell is called the “capsular bag.”

Once the cloudy natural lens material is removed, a clear plastic implant is used to replace the natural lens.  Vision is restored.

Plastic Wrap Gets Dirty

With time, from weeks to years, this clear plastic wrap-like material can get cloudy.  The original symptoms of blurry vision and glare return.  Decreased vision from “posterior capsule opacification” occurs in almost every cataract patient.

Using a “laser” to Restore Vision

A YAG laser is a type of laser that uses its energy to cut.  By focusing the laser beam on the back portion of the candy coating shell, just behind the implant, a small hole is created.  This removes the cloudy/hazy tissue out of the line of sight and vision is restored.

YAG Laser Used for Posterior Capsulotomy
Laser Cut Hole in Posterior Portion of Shell (Capsule)

Does the Implant Fall

Properly performed, a YAG capsulotomy will not cause the implant to move.  While it has happened (and to me!), it is unusual as the implant is usually scarred in place.

In theory, there may be a slight increased risk of a retinal tear that could lead to a retinal detachment.

What Does This Mean?

Many of my patients have had cataract surgery.  It is a relief when we find the cause of the decreased vision is only due to PCO (posterior capsule opacification) and not due to diabetic retinopathy or macular degeneration.

Many people erroneously believe (and perpetuated by some docs) that cataracts “come back.”  They don’t.

This is also why many people believe cataract surgery is performed with laser.  It isn’t, but now you know why, and how, the rumor started.

Reblog this post [with Zemanta]
Verified by MonsterInsights