The Evolution Of Cataract Surgery: Modern Techniques And Outcomes

Cataract removal is one of the most common ophthalmic surgeries globally, with 26 million operations performed every year, on average. This procedure removes the cloudy lens, called a cataract, to restore a patient's vision. 

Cataracts, the excessive protein build-up in the lens of the eye, are one of the leading causes of vision impairment among adults, especially those over 55. 

With various medical breakthroughs and the integration of advanced technologies, cataract operations have become more effective, less invasive, and safer over the years. Cataract surgery techniques have been evolving alongside other vision-corrective methods, including revolutionary techniques like laser eye surgery.

Allow us to take you on a journey through time, discussing the milestones that paved the way for this common and safe procedure.

Couching: An ancient cataract-removal technique

According to some accounts, the earliest form of cataract surgery was performed around the fifth or sixth century BC. It wasn't until centuries later that the method earned a name: couching. 

As you may have guessed, it was an extremely risky procedure and often resulted in vision loss. Eye surgeons used a sharp needle to pierce the end of the cornea. The cloudy lens is then pushed downward to allow light to pass through the eye. While less risky than the ancient method, complications were common, and the sufferer's vision remained problematic.

Extracapsular cataract extraction (ECCE): 1747 and beyond

In 1747, French surgeon Jacques Daviel performed a cataract-removal method that was more effective and safer than couching. To complete the procedure, he had to make a large corneal incision to extract the lens cortex.

ECCE involved removing the entire lens but leaving the surrounding capsule intact, marking a notable advancement in cataract-removal surgery. This new technique helped significantly reduce the risk of complications, yet today's standards still consider it invasive.

While boasting higher success rates than couching, extracapsular cataract extraction may expose a patient to potential complications, including astigmatism and infection.

Intracapsular cataract extraction (ICCE): 1753 to 1980s

In 1753, another trailblazing surgeon, Samuel Sharp, introduced intracapsular cataract extraction (ICCE). The operation involved removing the entire lens and capsule to expel the cloudy protein formation from the affected eye.

Two centuries later, in 1957, Joaquin Barraquer introduced alpha-chymotrypsin, an enzyme known to limit tissue destruction and swelling, as an advanced method to eliminate cataracts through ICCE.

ICCE vs. ECCE

While intracapsular cataract extraction (ICCE) was developed after ECCE, it was generally harder to perform and, in most cases, carried higher risks of complications. As ophthalmic surgery methods and advanced surgical equipment were released, ECCE became more pervasive than ICCE as the standard for cataract-removal operations.

Additionally, the medical community discovered through years of study that extracapsular cataract extraction was more effective and provided better outcomes than intracapsular cataract extraction.

Phacoemulsification: Revolutionizing cataract surgery

Developed in 1967 by American ophthalmologist Charles Kelman, phacoemulsification revolutionized the cataract extraction procedure. The operation, also known as phaco, uses ultrasound waves to break up the eye's lens into tiny fragments, which are then suctioned out of the eye. The lens capsule remains intact and is often used to support the implanted intraocular lens (IOL).

Phacoemulsification easily replaced ECCE as the go-to procedure for eliminating eye protein build-up. This standard extraction procedure is much less invasive than ECCE or ICCE, requiring a small incision of around three millimeters compared to 10mm for the other techniques.

Phaco carries a much lower risk of complications and has become the safest and most preferred method in several progressive countries. Most phacoemulsification surgeries are outpatient, and a patient can go home on the same day.

While phacoemulsification remains the gold standard for cataract surgery, other methods have been introduced to make eye operations safer, less invasive, and more accurate while providing the best visual outcomes. These include laser-assisted surgery and intra-ocular lenses (IOL).

Custom intraocular lenses (IOLs): 1950s to the present

In the past, cataract surgery patients were left without a lens in their eyes. They needed to wear thick glasses or contact lenses to see clearly. 

The introduction of intraocular lenses (IOLs) in the 1950s transformed the lives of cataract patients. IOLs are artificial lenses implanted in the eye to replace the removed cataractous lens, restoring vision and eliminating the need for prescription lenses.

IOL technology has advanced significantly, offering various options to address individual patient needs. They’re made of various materials, including acrylic, silicone, and hydrogel. IOLs can also be designed to correct astigmatism and presbyopia, further enhancing post-operative vision.

Laser-assisted surgery: 2008 to the present

Laser technology was first used in cataract surgery in 2008, allowing doctors to perform several steps of the procedure with extreme precision. This method enables bladeless incisions and astigmatism correction. More advanced techniques employ optical coherence tomography, a 3D eye imaging test, to perform the surgery.

Outcomes of modern cataract surgery

Advanced cataract surgeries have shorter healing times and have a success rate of around 99%. As such, the vast majority of patients experience significant improvement in their vision after surgery without surgical trauma and complications.

Still, patients should watch for any symptoms of a possible complication after surgery and alert their doctor to any pre-existing health conditions during their initial preoperative consultation.

Conclusion

Cataract-removal surgery has evolved substantially through the years. From the early, risky procedures to today's sophisticated, minimally invasive techniques, cataract surgery has transformed into a life-changing intervention.

These modern methods and techniques boast an impressive safety profile and remarkable success rates. They're a testament to the transformative power of medical innovation, restoring sight safely to countless individuals worldwide. 

Dr. Rachel Foster

Dr. Rachel Foster is an ophthalmologist and expert in cataract surgery, specializing in modern techniques and outcomes. With a dedication to vision care, Dr. Foster has been at the forefront of the evolving landscape of cataract surgery. When not in the operating room, she enjoys staying updated on ophthalmic advancements, attending medical conferences, and participating in eye care outreach programs.

(Disclaimer: Devdiscourse's journalists were not involved in the production of this article. The facts and opinions appearing in the article do not reflect the views of Devdiscourse and Devdiscourse does not claim any responsibility for the same.)