Removal of the clouded lens (the cataract) in its entirety
by surgery, usually followed by replacement of the lens with an intraocular lens
(IOL) made of plastic, silicone, acrylic or other material. The operation typically
takes about an hour, is done under local anesthetic only, and does not require hospitalization.
Most cataract surgery today is performed using a technique called phacoemulsification.
Before the advent of this technique, people with cataracts could expect a 10-day
hospital stay followed by a lengthy recovery. Today, it is an outpatient procedure.
Instead of making a large incision in the eye and removing the lens, the ophthalmologist
can make a tiny one and then insert an ultrasonic tip which, vibrating thousands
of times a second, breaks up the cataracts without damaging the surrounding tissue.
The remains of the cataract are suctioned out.
Phacoemulsification was introduced in 1967 by Charles D. Kelman, an American
ophthalmologist (1930-2004). In his memoir, "Through My Eyes: The Story of a Surgeon
Who Dared to Take On the Medical World" (Crown, 1985), Dr. Kelman described how
he went to a dentist have his teeth cleaned. "I sat in his chair, as he reached
over, took a long silver instrument out of its cradle and turned it on," Dr. Kelman
wrote. "A fine mist came off the tip but the tip didn't seem to be moving. He applied
the tip to my teeth, and I felt an exquisite vibration and heard a high-pitched
sound." Dr. Kelman asked, "What is that thing?" An ultrasonic probe, came the reply.
"I knew this was the moment," Dr. Kelman wrote.
Cataract surgery has a long history. It was first done in India in the 5th century
BC by a surgeon named Susruta who did a procedure called couching (or reclination)
in which the clouded lens is pushed into the back of the eye, permitting better
but by no means normal vision. Couching was still done in some countries until the
mid-20th century. The first description of the cataract and its treatment In the
West was in 29 AD by the Latin encyclopedist Celsus who performed the practice of
needling (also called discission) of cataracts to break up the cataract into smaller
particles to facilitate their absorption. Modern cataract surgery was first done
in 1748 in France by Jacques Daviel who removed the cataract from the lens. Today,
the IOL is now usually the best type of cataract surgery.
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