The Evolution of Cataract Surgery
- The first reported surgical removal of a cataract was in 1748 in Paris. The early techniques involved removing the entire opaque lens in one piece using an incision that went halfway around the circumference of the cornea. It was critical that the lens remained intact as it was being removed, so surgery was restricted to so-called ripe lenses (cataracts so hard that they would not break into pieces as they were being removed).
- The most significant change was the introduction of phacoemulsification surgery in 1967 and is the most wildly used type of cataract surgery performed in the United States. In phaco, the surgeon makes a tiny incision on the side of the cornea, and inserts a probe through this opening. The probe emits ultrasonic waves that soften and break up the cloudy lens, which is then suctioned from the eye in small pieces.
- Originally, no lens implants were used following cataract surgery, and patients had to rely on “Coke bottle” glasses.
- Howard Ridley, a British ophthalmologist recognized that the penetration of shattered fragments from airplane windshields into the eyes of World War II fighter pilots when their planes had been hit did not always lead to damage of the eye. He created the first artificial lens from this material, leading to the creation of an entire industry.
- The evolution of smaller surgical incisions was matched by the development of new lens implants created out of different materials (such as acrylic and silicone) that could be folded to allow the lens to be inserted through a tiny wound.
- Today, Lenses are manufactured in a variety of different optical powers. Prior to surgery, patients undergo a series of measurements determining the length of their eye and the focusing power of their cornea to determine what will be the optimal intraocular lens power for them.
- Intraocular lens implants are now available that can correct myopia or hyperopia and also a variable degree of astigmatism.
- New advancements in laser technology are under development that will allow most steps of the cataract surgery procedure to be performed using a laser.
- Cataract surgery complications are few, and it is among the most common and most successful surgical procedures performed today. According to the American Society of Cataract and Refractive Surgery (ASCRS), 3 million Americans undergo cataract surgery each year, with an overall success rate of 98 percent or higher.
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