A technique called couching has been around for thousands of years(2). In fact, the first historical record of this technique was found in writings on the wall of the tomb of Skar, the chief physician of one of Egypt’s Fifth Dynasty rulers; these writings indicate that the Ancient Egyptians had performed cataract surgery. The tomb was built around 4,600 years ago, in c.2630 BC, and also contained some bronze surgical tools – the oldest ever found**.
Furthermore, the Ancient Egyptians provide us with more documentation of their knowledge of cataracts, in the form of another artefact: a small statue, which is now housed in the Egyptian Museum, in Cairo, and dates from c.2450 BC**.
The wooden statue is of a man, the priest, Ka-aper, and depicts a white cloud in the left eye, that doesn’t appear in the right eye of the statue. As such, historians believe that the statue’s sculptor was illustrating that the subject had a mature cataract in his left eye; confirming that the Egyptians knew of cataracts.
The technique known as couching could only be carried out once the cataract had reached full maturity, and become completely opaque and rigid, as the technique involved using a lancet to dislodge the cataract from its moorings (zonules) and enable it to fall into the vitreous cavity of the eye. This technique restored a limited amount of vision to its recipients, but the vision they regained was completely unfocused.
The downside of the couching procedure was that it could cause the loss of the eye, and in some cases, even death, if performed badly, or if infection set in.
The first recorded instance of a cataract operation in the modern sense – surgically removing the cataract from the eye – was carried out in Paris, on April 8th, 1748, by the French ophthalmologist, Jacques Daviel, who later became the Royal Oculist to King Louis XV.
Sir Nicholas Harold Lloyd Ridley, dissatisfied with the quality of vision left to patients after unilateral cataract extraction treatment, researched and created the first Intraocular lenses (IOLs). His research, and later creations, focused around the use of polymethylmethacrylate (PMMA), which was used for the canopies of aeroplanes at the time. He had noticed that Royal Air Force pilots who survived aerial combats, in the Second World War, and were left with fragments of PMMA in their eye had no adverse reaction to the material. Their eyes didn’t reject PMMA. On November 29th, 1949, he successfully implanted the first IOL at St. Thomas’ Hospital in London**.
Unilateral cataract extraction, pioneered by Jacques Daviel, and the use of IOLs, pioneered by Ridley – though massively advanced since their introductions to give us the modern tools and materials we use for cataract surgery today – are the absolute foundations of cataract surgery as we know it.
Glasses – Why do I need glasses after cataract surgery?
Surgery – What does an eye look like after cataract surgery?
Surgery – How is a cataract operation performed?
Near-sighted – Does cataract surgery correct near-sightedness?