How cataract treatment has changed

A cataract is one of the most common eye disorders usually occurring in people older than 40. A cataract is a condition in which the lens of your eye, that is usually clear, becomes clouded leading to blurriness or even loss of vision. The risk of developing a cataract is high in those people who smoke, consume alcohol, or have a family history regarding this disease.

Cataracts are removed surgically. Cataract surgery is one of the most common procedures performed worldwide. It is also one of the oldest and most successful treatments in the field of medicine. Cataract surgery has been greatly revolutionized.

The most primitive procedure to remove Cataracts was termed as “Couching” which came from the French word “coucher” which means “to put to bed”, dating as early as the fifth century BC. It was performed on mature Cataracts.  In this technique the cataract was not removed from the eye instead of with the help of a needle it was dislodged from the visual axis, hence the cataract remained in the eye but was no longer blocking light to reach the visual axis leading to a slight improvement in vision.

But as the aseptic technique was not known in the fifth century BC and the technique was also quite rough so, the outcomes were not too good. Some common post-surgical complications include the development of secondary glaucoma, hyphemia, endophthalmitis, and even complete blindness.

Extracapsular cataract extraction (ECCE) is a technique for the removal of cataracts that was first used by an Indian surgeon as early as 600 BC. The first true Extracapsular cataract extraction (ECCE) was performed in 1747, in Paris, by a French surgeon Jacqueline Davies. This technique involves the removal of the ocular lens while leaving the lens capsule in place. In this technique an incision of more than 10mm was made, puncturing the lens capsule and then taking the lens out. The post-surgical complications included poor wound healing, retained lens remnants, posterior capsular opacification, and infection.

In the 1970s, a technique called capsular cataract extraction (ICCE) was firstly performed by Samuel Sharp. This technique involved making a large incision and taking the lens out along with the lens capsule. As to remove the whole lens capsule a larger incision was made which led to slow healing and a greater amount of surgically induced astigmatism.

Lens replacement surgery is the modern way of replacement of cataracts. It includes phacoemulsification which uses ultrasound waves to break the cataract and then the cataract is aspirated from the eye. After that, an artificial intraocular lens (IOL) is placed in the place of the original lens. This technique led to a reduced size of incision (from more than 10mm to less than 3mm) which results in a small recovery period, stable surgery, and lower complication rate. This procedure either topical, sub-tenon, peribulbar, or retrobulbar local anesthesia is used which leads to little or no discomfort to the patient at all. Over 90% of the operations are successful and result in the restoration of vision with a low complication rate.

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