8
doc • Spring 2014
Kentucky
Cataract Treatment:
Shifting Focus in a Long Search
By Martha Evans
Sparks, Staff Writer
Cataract, the clouding or
discoloration of the lens in
human eyes, cannot be prevented or cured. It remains
the leading cause of blindness worldwide.
The search for treatment has gone on since
the dawn of time and continues to this
moment.
The problem remains the same from ancient
Babylon to Lexington. Normally absolutely
clear, a human lens is convex on both sides
and somewhat smaller than an M&M candy.
It sits in a capsule between the iris (the colored part of the eye) and the retina at the
back of the eye. It helps focus the light entering our eyes, forming an image on the retina.
Many things, including injury or disease, may
produce a cloudy lens, but by far the most
common cause is aging. As we get older, the
lens becomes more opaque until finally, if we
live long enough, we are blind. Fifty percent
of people over age 60 have some degree of
cataract formation. That figure rises to 100
percent by age 80.
Archeologists have found bronze instruments thought to have been used for cataract treatment in excavations in Babylonia,
Greece, and Egypt. The Babylonian Code of
Hammurabi, dating from 1750 B.C., refers
to cataract surgery. Susruta, a famous Indian
surgeon, wrote treatises about 600 B.C. concerning cataract removal. The first references
to treatment of cataract in the West are in
29 A.D. in De Medicinae by Roman
medical writer Aulus
Cornelius Celsus.
Early treatment consisted of the surgeon
using a lance to push
the clouded lens backward into the jelly-like
vitreous that normally
fills the back of the eye
where it remained, hopefully
out of the field of vision.
The procedure was called
couching, depression of
the lens rather than its
removal from the
eye.
From earliest times until the mid-eighteenth
century couching was the standard operation for cataract. Couching is still used by
traditional healers in Africa and parts of Asia.
It did not restore good vision, but it was better than seeing nothing. Until the late 1840s
when general anesthesia was introduced for
surgical procedures, and 1884, when cocaine
eye drops for anesthesia of the eye came
into use, one very necessary member of the
surgical team for couching was a strong man
whose job was to hold the patient’s head still
during the surgery.
The ailment was called “cataract,” meaning
“waterfall,” from medieval Latin translations
of Arabic writings concerning the supposed
cause of the condition. A thickened humor,
that is, some condensed bodily fluid, was
thought to flow down into the eye collecting
between the pupil and the lens. By clearing this space in couching, vision could be
restored.
In the middle of the seventeenth century,
observers began to think cataract might be a
dysfunction of the lens itself. In 1656, Werner
Rolfinck, German physician, scientist, and
botanist, demonstrated an actual opaque lens
in cataract.
Extracapsular
cataract extraction (ECCE),
removing the
lens from the
eye instead
of pushing
it aside, was
first performed by a French surgeon, Jacques
Daviel, in 1747. It was the first significant
advance in cataract surgery since couching
was invented.
In 1865 the German ophthalmologist,
Albrecht von Graefe, improved the operation
by removing the lens through a much smaller
incision in the sclera (the white) of the eye.
An older method is the intracapsular cataract
extraction (ICCE) in which the surgeon
removes the lens, capsule and all. In order to
have good vision after these procedures it was
necessary for the patient to wear extremely
thick eyeglasses, sometimes referred to jokingly as “coke bottle glasses.” When contact
lenses came into wide acceptance in the
1950s and 1960s, patients were sometimes
fitted with contact lenses instead of the glasses. In those decades of the twentieth century,
patients routinely spent ten days in the hospital recovering from cataract surgery.
Two vast breakthroughs were the invention of
the operating microscope and of the implantable intraocular lens (IOL). Both were first
used in 1948. The operating microscope is a
low power microscope with special lighting
so that the surgeon, looking down through
the pupil of the patient’s eye, can see the lens
and other eye structures accurately. In 1948
British ophthalmologist Dr.
Harold Ridley, over the
objection of the medical
community, implanted the
first IOL in the eye of a
cataract patient.