They stuck needles into the eye without anaesthesia: The brutal history of cataract surgery
Half of us develop cataracts by the age of 75. Researchers believe that cataract surgeries were performed as early as in ancient Egypt.
The earliest known surgrical method comes from Indian medicine around 600 BCE, says ophthalmologist Helle Medin. Back then, a needle was used to push the cloudy lens out of the line of sight, without any form of anaesthesia. The method Medin uses when she operates on her patients today is fortunately pain-free.(Photo: Siw Ellen Jakobsen)
Removing cataracts is the procedure ophthalmologist and researcher Helle Medin at Ullevål University Hospital performs most frequently.
In just 15-20 minutes, she can remove the cloudy lens and replace it with an artificial one. Completely pain-free.
Afterwards, the patient can return home.
"Many no longer need distance glasses after the operation, though most still need reading glasses. In nearly 98 per cent of cases, there are no complications," she says.
But the road to this point has been long and at times painful.
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May have begun in ancient Egypt
Researchers believe that cataract surgeries were performed as early as ancient Egypt.
The Swedish researcher Patric Blomstedt wrote in an article from 2014 that wall paintings and findings from Egyptian tombs suggest that this is a procedure with a long history.
In a tomb outside Cairo, archaeologists have found more than 30 surgical instruments, including needles that may have been used for eye operations.
Other researchers argue that the evidence is not conclusive, though there are many signs suggesting that the Egyptians attempted this type of treatment.
On the left: A wall painting from ancient Egypt likely showing an eye doctor treating a worker's eye, researchers believe. On the right: An eye surgical procedure using a long, sharp instrument, taken from a manuscript from the late 1100s titled Practica Chirurgiae (Surgical Practice).(The illustrations come from the British Library, London, and are reproduced in the Journal of Cataract & Refractive Surgery in 2014)
A needle in the eye
The early methods were very risky.
"The surgeon would insert a needle or a sharp knife into the side of the eye to loosen the cloudy lens, before it was pushed to the back of the eye," Medin explains.
This moved the lens out of the visual axis, allowing vision to become clear again. But the risk of infection was enormous.
"There were certainly many who became blind from these procedures, and anaesthesia did not exist at that time," she adds.
High risk of infection
It was not until the 18th century that doctors understood cataracts were caused by a cloudy lens.
Around 1750, the French surgeon Jacques Daviel took the bold step of removing the lens from the eye.
"However, this required a large incision in the eye, which carried a high risk of infection. But towards the end of the 19th century, the technique had improved and became standard treatment in Europe and America," says Medin.
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Anaesthesia finally arrived
The introduction of anaesthesia in the 1840s marked a turning point, allowing patients to undergo surgery under general anaesthesia.
From 1928, it became possible to use local anaesthetia behind the eye, making the procedure much simpler.
After surgery, patients had to wear extremely thick 'cataract glasses,' often with a strength of around +10 to compensate for the missing lens.
"Patients remained in hospital for days afterwards and had to avoid bending over or lifting heavy objects for months," says Medin.
Fighter pilots got plastic in their eyes
A major breakthrough came in 1949. The British surgeon Harold Ridley discovered that plastic fragments from plane crashes did not damage pilots' eyes.
This led him to develop the first artificial lens.
"It was rigid and required large incisions. Many were sceptical about placing a foreign material inside the eye," Medin explains.
Even so, this marked the beginning of a new era.
With the arrival of ultrasound technology in the 1960s, surgeons gained the ability to break the cloudy lens into tiny fragments, which could then be suctioned out through small incisions.
Safe and effective
Soft, foldable lenses were introduced in the 1980s. These could be injected into the lens capsule without the need for stitches.
Once in place, the lens typically remains secure and stable, without needing to be attached. But in rare cases, the lens can slip out of position.
Medin’s doctoral research focused on methods for repositioning such lenses.
"I found that the techniques we use today provide equally good improvements in vision, with no difference in complication rates," she says.
Foldable lenses
"When ultrasound technology arrived in the 1960s, it allowed the lens to be broken into very small pieces that could be removed through tiny incisions. This was gentler and reduced recovery time," she says.
It wasn't until the 1980s that foldable lenses became available. These are folded and injected through microscopic openings.
"No stitches are needed, and the whole procedure is performed with high precision under a microscope," says the ophthalmologist.
Today's lenses are foldable and injected directly into the eye.(Photo: Siw Ellen Jakobsen)
Many still become blind
Around 20-25 per cent of people aged 65 have cataracts. By the age of 75, about half the population is affected.
Cataract surgery is now one of the most commonly performed procedures worldwide.
If the lens is not replaced, vision gradually deteriorates, eventually leading to blindness.
In Norway, the procedure takes 15-20 minutes, and vision typically improves within a few days. Globally, however, the situation is very different.
"Around 17 million people worldwide are blind due to cataracts. For many living in developing countries, healthcare is either not available or too expensive," says Medin.
