The Evolution of Cataract Surgery

Cataract surgery goes back further than you may realize. It’s not only one of the most common surgeries on the planet, it’s also the oldest. In fact, cataract surgery is considered to be among the most successful treatments in the world of medicine.

In its infancy, cataract surgery was only called upon for the most advanced or mature cataracts, with vision impairment near that of blindness. Today, due to advancements in surgical techniques and improved safety procedures, the requirements for cataract removal have shifted significantly to a much earlier stage of development, says the National Center for Biotechnology Information.

Earliest Approaches

The earliest primitive form of cataract surgery is thought to have occurred as far back as 5th century BC. A method called couching was used, which involved a sharp needle piercing the eye to manually dislodge the cataract. Then, in 600 BC, an Indian surgeon named Sushruta started using extracapsular cataract extraction (ECCE), so called because the lens capsules are left in place.

However, it wasn’t until 1747 that the first true ECCE cataract extraction was performed in Paris by Jacques Daviel, a French surgeon. Dubbed the father of modern cataract extraction surgery, Davriel would make a corneal incision with a knife, then take a blunted needle to puncture the capsule. He would then extract the lens using a spatula and curette, according to the American Academy of Ophthalmology.

His success rate at that time was only about 50 percent. Even though this procedure showed great progress compared to other methods in years past, postoperative complications were high, including retained lens remnants, infection, and poor wound healing.

In 1753 a London surgeon called Samuel Sharp was the first to perform intracapsular cataract extraction (ICCE), whereby the lens and surrounding capsule were removed in one piece. Unfortunately, removing the lens capsule often caused vitreous prolapse and even retinal detachments. This procedure required a large incision, which came with higher infection rates and longer healing times.

Fast forward to 1949 with the advent of intraocular lenses (IOLs). Dr. Harold Ridley performed the first IOL operation at St. Thomas’ Hospital in London, which involved removing the cataract but replacing the lens. The benefits of this method included easier implantation and smaller incisions, but complications included glaucoma, inflammation, and frequent dislocation of the IOL.

Modern Cataract Surgery

As the decades progressed, foldable IOLs and the use of topical anesthetics came about. Modern cataract extraction became much more effective and safe. Phacoemulsification used ultrasound to break up each cataract and aspirate it from the eye, allowing surgeons to use smaller incisions – going from 10mm to less than 3mm. In turn, this ensured shorter recovery times and lower complication rates.

Today, incisions of between 1-3.0mm are typical, with micro-instruments used to divide the lens up into fragments and phacoemulsification to break up and remove the cataract. An IOL can then be easily inserted into the remaining lens capsule.

In 2010, Femtosecond Laser-Assisted Cataract Surgery (FLACS) was approved by the FDA, using a laser and imaging software to take photos of the cornea, lens, and anterior chamber. This special laser can make corneal incisions for not only entry into the eye but for astigmatism correction, lens softening, and capsulotomy as well.

ECCE has also made many advancements over the years with manual small incision cataract surgery (MSICS, also SICS or SECCE) for a lower cost, smaller self-sealing incisions, and suture-less wounds.

Today, the type of surgery performed is dependent upon your doctor’s preference and recommendation. While lasers can be used, we here at Broberg Eye Care prefer traditional cataract surgery, which uses handheld instruments such as a blade and forceps to make the incisions and remove the lens. Studies do not show that laser surgery results in fewer complications, or provides better outcomes. Your outcome depends in large part on the skill and experience of your surgeon.

Book Your Cataract Surgery Consultation With Broberg Eye Care

If you would like to schedule an appointment for a cataract surgery consultation, give us a call at (512) 447-6096 or complete our online form. For your convenience, our hours are Monday through Thursday 8am to 5pm and Friday 8am to noon. You will find our office at 4207 James Casey St #305 in Austin, TX.

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