Friday, January 9, 2009


The history of intervention for cataract, though shrouded in the mists of time, is as ancient as any surgical discipline. Before 2000 BC, the code of Hamurabi is unspecific on surgery, but it is possible that the Babylonians used lens depression for cataract by forcing the lens from its zonular attachments by digital pressure on the globe. Japanese surgeons, about 2000 BC or before, had access to relatively advanced metallurgy and used sharp needle knives and fine gold canulae to suck out hyper mature (liquefied) cataracts. There are early Hindu references to Couching surgery for cataract by Susruta, using incision and instruments pressing on the lens itself in order to displace it from the pupil into the vitreous gel. If the lens capsule remained intact (intracapsular couching) this approach could be quite successful, giving brighter albeit unfocused vision. In cases where the capsule was ruptured (extra capsular couching), severe uveitis would later usually destroy the eye, and there would be the ever-present hazard of severe infection (endophthalmitis). It is uncertain whether Susruta lived before or after Alexander in India (339 BC), and whether he influenced (or was influenced by) the Aesculapius's period of Greek medicine of which Hippocrates of Cos (460-377 BC) is best recognised. These Greek surgeons undoubtedly used couching and much of their knowledge was passed to Alexandria and later to Rome, but the written records of Alexandria were lost with the destruction of the great library. However, Roman records do exist, particularly the Greek ophthalmological terminology, which the Romans largely adopted and which persists to the present day.

Let's bring this closer to home. In the early winter of 1966, my grandfather, Benhard, had surgery for his cataracts in Grand Forks. Grandma had died in November and he didn't wish to spend Christmas without her. They took his lenses out of his eyes and sold him glasses which, of course, were thick as Coke bottle bottoms. There was no side vision, only forward, (which makes sense when you think about him running into cars on his bicycle when he didn't judge the distance properly). For those of you who had relatives with these kinds of glasses, you know it was an in hospital stay which part of the time your head was sand bagged so you couldn't move your head. You also know that person's eyes were distorted because of the thick lenses. Grandpa's baby blues just never were the same afterwards.

While working in Kansas, I met a lady who loved to read. At that time in the cataract surgery process, one had to lay on their backs for four hours after the surgery. She had a back problem and since she could not lay flat, she was denied sight. Shame isn't it?

Mother complained to us about how she had her house interior painted and what a terrible job they did. She had called them back to repaint the entire interior and was still not happy with it. My sweet Thomas, in his serious way, suggested she may have cataracts which had clouded yellow and the paint was fine, it was her lenses. And it came to pass that mother had surgery and found the painters had done an excellent job. The two of them talked about glasses; she had understood she would no longer need them. Tom stated that wasn't always so.

A former family member by marriage had worn glasses since she was eight. She opted to have lenses which were for distance and close up installed.

The process now is much different than grandpa's day. Now, one goes to a surgery center, checks in, you are made ready and a lens is installed on one eye; two weeks later, the other one is done. A pre-op physical is required. Although there are some limits for lifting and other, basically, you are driven home, spend the day and go back to work the next and use eye drops for three weeks. You are required to wear a button down top/shirt to make the placing of the electrodes easy.

Medicine as come along way. Grandpa had to wait until the cataract was big enough to be 'plucked'.

In Roman times, there were different ways of performing couching, one is with a blunt stick to 'knock' the eye hard from the outside, thus dislodging the lens from the zonules by sheer blunt force. Radical, don't you think?

What Old Trunks wishes for all people having cataract surgery is the ability to say...........I C U. And if the doctor states you won't need glasses but you do, get glasses.


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