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The history of cataract surgery
- kvmet 1y agoI did some of the controls software for an automated IOL manufacturing line roughly 8 or 9 years ago. It's very cool technology, I was proud to work on it. One problem at the time (at least from my understanding) was actually that some people needed a second round of surgery since people are living longer and cataracts are getting corrected earlier. Last I heard, the rate of complications for a repeat surgery is significantly higher, but I assume it is improving all the time. A fun fact: UV protection can be put directly into the lens to protect your retinas even without sunglasses (I assume this depends on the polymer type though). Also the lenses are usually tinted a slightly yellow color since our natural lenses shift color as we age. Patients tend to find it jarring if the lens is perfectly clear.
- rogerrogerr 1y agoFascinating - I’d think your brain would compensate pretty quickly for a no-longer-yellow lens? Given a choice I’d be all for the clear one.
- catlikesshrimp 1y agoThey might, eventually. But the older you get, the more difficult it is to adapt or accept change. My grandmother was forced (by us) to get her cataract surgery when she mistook a horse for a known person. She assured for the rest of her life that she had better vision before the surgery.
- pantulis 1y ago> Last I heard, the rate of complications for a repeat surgery is significantly higher, but I assume it is improving all the time. My complications apeared 2 years after the cataract procedure but were solved through laser capsulotomy, not sure if you're referring to that. But the capsulotomy is basically trivial compared to the main procedure.
- traceroute66 1y ago> UV protection can be put directly into the lens to protect your retinas even without sunglasses Stating the obvious here but just to remind people about basic eye anatomy.... The built-in UV protection does not remove the need to wear sunglasses. It does not protect the cornea. Only sunglasses can do that.
- tlavoie 1y agoMy wife had both eyes done over the past year. I would guess that her new lenses did not have UV protection, because she has a most interesting side effect. Basically, certain glass will (to her) essentially fluoresce in sunlight, so to her, it looks bright, bright purple. The glass in question looks like a slight, smoky grey to me, as does the glass vase at home with the same effect. I'd have to look for the link, but essentially, the new lenses filter less UV than the natural ones, and she's got a bit of sensitivity into that range of the spectrum. Similarly, a carved item made from yooperlite has the crystals showing orange to her in sunlight, where the rest of us need to hit it with a UV flashlight.
- andrehacker 1y ago>> Patients tend to find it jarring if the lens is perfectly clear. Yeah, funny. Light it up ! For.. reasons.. I only had one eye done for a bit and, boy, did the world look different with the old and new lens. Christmas trees, for example, either looked like lit with lemon lights or bright lights. I decided to do the other eye too and the world looks bright again... from both eyes.
- madcaptenor 1y agoI had heard that C-section was the most common surgery but that might just be in the US.
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- runxel 1y agoBefore clicking on the link I assumed circumcision actually. Basically half the population has got it done :D (I know that the rate has lowered over the last years, but USA still has what... 85+% ? Even higher in South Korea e.g.)
- onychomys 1y agoI was thinking maybe wisdom teeth extraction.
- Night_Thastus 1y agoCommon, but a lot of people never get it. Either they didn't grow wisdom teeth at all, or they aren't pressing into the rest of the teeth in a way to cause a problem, or they lack dental insurance. It's one of those super low-priority surgeries for most people. I'm very glad I got it done myself, though!
- madcaptenor 1y agoAlso that would come from a different data source, since it's a surgery done on luxury bones as opposed to regular bones.
- OkayPhysicist 1y agoIt's falling pretty quickly, down to about ~60% of male infants as of 2022. General prevalence is higher (because that's how decreasing rates work), somewhere around 80%, but I'd suspect it's highly regional.
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- BrokenCogs 1y agoA shame that cataract surgery has become a money making scheme in some countries (Canada), where surgeons often push unnecessary expensive lenses to patients and focus exclusively on simple cataract cases to fuel their high income lifestyles.
- kragen 1y agoCountries like India where cataract surgery is for-profit tend to have higher success rates and broader accessibility than countries where it's not.
- BrokenCogs 1y agoSource?
- chongli 1y agoI’m not surprised. India produces very experienced surgeons due to the very high volumes of surgeries they’re able to perform. I think part of this is the high population from which to draw both doctors and patients coupled with the intensely competitive academics and standardized testing.
- Snoddas 1y agoThey tried to up-sell me when I was in the chair during surgery. (sweden)
- cactusfrog 1y agoA lot of times those 5% people go blind :/
- jelsisi 1y agoI was shocked when I saw a 5% failure rate, I would not take those odds.
- BrokenCogs 1y agoWell the alternative is to go blind due to cataracts... So those are pretty good odds.
- moduspol 1y agoIt's probably per-eye, right?
- SketchySeaBeast 1y ago1 in 400 go blind, 19 in 400 become pirates, I assume something along the lines of The Crimson Permanent Assurance.
- SketchySeaBeast 1y agoI was trying to track down what the 5% failure looks like. The article source is here[1] for the 95% stat, which then references here[2], but I honestly can't find it, [2] refers to "Recent studies reveal that in most of the cases, the prognosis is excellent after surgery, almost 70 to 80%", which refers to here[3], which seems to refer to patient happiness(?), so I haven't the foggiest where that 5% stat comes from. Ultimately, I have no idea what the 5% failure means or looks like or if it even is a real statistic. Maybe I'm just thick and there's an obvious link or passage I missed. [1] https://www.ncbi.nlm.nih.gov/books/NBK559253/ https://www.ncbi.nlm.nih.gov/books/NBK559253/ [2] https://www.ncbi.nlm.nih.gov/books/NBK539699/ https://www.ncbi.nlm.nih.gov/books/NBK539699/ [3] https://pmc.ncbi.nlm.nih.gov/articles/PMC10243645/ https://pmc.ncbi.nlm.nih.gov/articles/PMC10243645/
- phito 1y agoI thought the first picture of the article was an USB-C connector...
- yapyap 1y ago> In 4,000 years, cataract surgery went from a crude procedure involving thorn instruments to a 20-minute operation with a 95 percent clinical success rate. I did go “yikes” a bit at 95%, a 1 in 20 failure rate is pretty rough when its about your eyes
- kragen 1y agoTrue, but if the alternative is continuing to be blind?
- efitz 1y agoJust guessing, but likely “clinical success rate” here doesn’t mean “didn’t make it worse” but actually means “improved the underlying condition significantly”.
- SketchySeaBeast 1y agoThe criteria for success seems to be "improved visual acuity"[1]. I tried to find what the failures actually looked like, but I hit a dead end[2]. [1] https://www.ncbi.nlm.nih.gov/books/NBK559253/ https://www.ncbi.nlm.nih.gov/books/NBK559253/ [2] https://news.ycombinator.com/item?id=45414718#45449810 https://news.ycombinator.com/item?id=45414718#45449810
- zindlerb 1y agoMany surgeries have a yikes success rate but when you need to do it you need to do it unfortunately.
- k__ 1y agoTrue, but 95% success rate doesn't mean 1 in 20 people lost their eye or something dramatic.
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- tasty_freeze 1y ago
- arethuza 1y agoI will always remember how happy my wife was as I drove her back from cataract surgery on both eyes - the world suddenly looked an awful lot better!
- Snoddas 1y agoMy mom got angry and asked why no one had told her how wrinkly she'd gotten.
- sowbug 1y agoReminds me of my first eye exam as a nearsighted youngster. The doctor told me to go look out the window with a pair of temporary lenses. I exclaimed to my mom that those dark splotches on hillsides were trees!
- rockercoaster 1y agoI distinctly remember the main effect being that everything suddenly looked way, way more "3D". It actually briefly made me worse at batting, in baseball. Took some getting used to.
- MandieD 1y agoWhen I first got glasses circa age 9, my first remark upon leaving the shop was, "oh, wow, I can see the leaves from here!" (standing under ca. 20-30 foot tall tree) My mother later said she had never felt so guilty.
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- Terr_ 1y agoAt the beginning of the day I would take note of what color clothing my friends were wearing so that I could find them at recess, and assumed it was a problem everyone had.
- pantulis 1y agoA factoid: probably Johan Sebastian Bach died from eye surgery complications. https://interlude.hk/did-johann-sebastian-bach-die-from-eye-surgery-complications/ https://interlude.hk/did-johann-sebastian-bach-die-from-eye-...
- colinbartlett 1y agoReading about historical cataract removal methods was... difficult. I feel truly lucky to have been born into a time of modern medicine.
- selimthegrim 1y agoWait till you hear about how they used to wake people up before smelling salts (hint: they used it on horses too)
- pedro_caetano 1y ago> I feel truly lucky to have been born into a time of modern medicine. Well it really depends on how you look at it... I would argue that the truly 'modern' aspect of cataract surgery is the IOL manufacturing and implantation image-guided systems. I have a massive respect for Ophthalmic surgeons but worth mentioning (most) current cataract surgeries still imply: 1. A manual incision (read stabbing you with a handheld scalpel) 2. Capsulorhexis (manually open the lens capsule) 3. Using a handheld ultrasonic 'jackhammer' to destroy the old lens and quite literally suck it out, working in a foggy environment with limited depth perception in a tiny chamber right next to a thin film behind the lens. 4. Finally then implanting the new IOL lens. So with so much of 'modern' surgery still depending on Human Perception and Human submilimiter dexterity, with surgeons who are likely doing 16 plus surgeries a day. It is truly a remarkable statistic that only 5% of Cataract surgeries suffer complications. And if you think the odds are against surgeons in Cataract surgery wait until you read up on retinal surgery, then it really drives the point home of how insanely skilled Ophthalmic surgeons are.
- wrp 1y agoFunnily, when I read up on the state of the art, I felt let down that we are apparently still far away from being able to dissolve cataracts with eye drops. I'm hoping for that when my time comes.
- CTOSian 1y agoI know this project: https://clinicaltrials.gov/study/NCT00793091?term=Chakshu%20Research,%20Inc&viewType=Table&rank=2 https://clinicaltrials.gov/study/NCT00793091?term=Chakshu%20... but I think it is stalled/abandoned
- m0llusk 1y agoUnfortunate that there is so much focus on treatment of advanced symptoms. Cataracts may be caused in part by metabolic disease which can be detected and treated before cataracts develop. Kind of reminds me of how my great grandfather wouldn't pay for his children or grandchildren to go to the dentist because they would lose all their teeth by their mid twenties anyway.
- nluken 1y agoPeople here are rightly pointing out that there's still room for improvement with this (and almost any) kind of surgery, and the article talks about the accessibility challenges of making procedures like these more widely available, but after reading up on the history of this procedure it's hard not to see modern surgical techniques as a kind of man-made miracle. Great read.
- onlyrealcuzzo 1y agoIt's nuts to read this technology has only been around since 2008. It seems like it's been around forever. I'm not that old, so that's part of it. And also, 17 years is a long time in tech. Regardless, it is a modern miracle that there's been this much progress in that short of a time period. The article stats a 95% success rate - which doesn't seem great, but <0.5% of incidents have serious complications, most of the other 5% are temporary minor complications.
- epmaybe 1y agoEye surgeon here: FLACS isn't really that amazing. I would actually argue that a man made incision using steel or diamond (yes, diamond) is better than the incision made using the femto laser for long term safety/sealing. Number of studies have borne this out. 95% success rate seems low. you need to define success in this scenario. Are we aiming for 20/20 vision outcomes? Just getting the cataract out in full?
- pantulis 1y agoThe miracle is when they put a _graduated_ lens and you get cured of cataracts and myopia in a procedure where you are awake and can perfectly ntoice how while the lens is being inserted the blinding lights on top of you become more and more defined. It's nothing short of a man-made miracle but I have to say it's also very umconfortable and stressful for the patient.
- JadeNB 1y agoIt sounds like it must inevitably be uncomfortable and stressful—why do they do it with the patient awake?
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- Alex3917 1y agoMore common than needing stitches? That’s hard to believe.
- codingdave 1y agoYeah, their claim that it is the most common procedure is incorrect. There are more colonoscopies performed every year, too. I followed the citations and they are citing a 2007 paper that was meta-analysis regarding cost effectiveness of cataract surgery, so the claim gets more dubious the deeper you dig. The article is still interesting, but they probably should have left that claim out.
- Tzt 1y agoWell, it's also an indicator for how well its other claims would hold up if you dug deeper on them too.
- navigate8310 1y agoThe article is pumped from a low income country, where they have questionable research procedures. What can you expect?
- everdrive 1y ago95% success rate is actually a bit lower than I realized, and is somewhat scary.
- nwah1 1y agoBut that doesn't mean 5% of the people walk out of the procedure completely blinded. In many cases, failed surgery just means having to go again.
- Jonovono 1y agoAnd the ones that have a bad time, have a really bad time, to the point of suicide in cases. Not sure if I would risk it if I didn't have 20/15 vision tbh
- pantulis 1y agoYou will risk it, eventually. Cataracts appear and get worse to the point of you becoming blind.
- searine 1y agoThat success rate tracks with most common types of surgery, there are always edge cases. The exception is back surgery, and the odds get worse and worse if revisions are necessary.
- bell-cot 1y agoWho's defining "surgery" here? Obviously not a dentist.
- adolph 1y ago> 95 percent clinical success rate I'm not certain if a 5% fail rate is good or not. Fwiw, Cleveland Clinic [0] claims "Surgery improves vision for 97% of people" and an infection rate of less than .1%. Retinal detachment, affecting 2 in 1,000 people. Infection, affecting fewer than 1 in 1,000 people. 0. https://my.clevelandclinic.org/health/treatments/21472-cataract-surgery https://my.clevelandclinic.org/health/treatments/21472-catar...
- phyphy 1y agoThe first recorded instance of cataract surgery was in 600BCE India.
- inquirerGeneral 1y ago[dead]
- mac3n 1y agohttps://en.wikipedia.org/wiki/History_of_cataract_surgery https://en.wikipedia.org/wiki/History_of_cataract_surgery > Cataract surgery was first mentioned in the Babylonian code of Hammurabi 1750 BCE.[13] The earliest known depiction of cataract surgery is on a statue from the Fifth Dynasty of Egypt (2467–2457 BCE).[
- phyphy 1y agoI meant recorded as in procedure, but yes earlier depictions were present. I looked at the picture and the interpretation of the tool that is depicted is still kind of vague.
- xhkkffbf 1y agoThe 95% rate sounds good. But I routinely run into some of that 5%. It's not zero or even 1%.
- Qem 1y agoIs there some way to prevent cataracts, or is that just another unavoidable fact of ageing, like graying hair.
- jacobgkau 1y agoWhile protein buildup is somewhat natural with aging, my understanding is that e.g. looking into the sun too much (which exposes your eyes to UV light, among other things) exacerbates it.
- pantulis 1y agoI had cataracts when I was 48 and my ophtalmologist told me that everybody gets cataracts but there are factors that make it appear sooner, like smoking (and yes, I am a smoker). But it's more or less unavoidable.
- jabroni_salad 1y agoThe only thing that's really guaranteed is presbyopia in middle age. The lens will become harder and you will not be able to focus on near objects as well.
- el_benhameen 1y agoWear sunglasses (or your regular uv-protective polycarbonate glasses), even when it’s not real sunny out.
- crisdux 1y agoCataracts aren’t about age. They happen when the lens loses energy and the water inside it loses structure. Getting real sunlight, eating for metabolism, and avoiding stress and fake blue rich light keeps your eyes clear and alive. I’ve improved my own eyesight and my wife’s by following these principles. Mainstream medicine would probably give other explanations or just dismiss it altogether.
- 542458 1y agoThere's no evidence that "fake blue rich light" at normal exposure levels has any effect, and not for lack of investigation. Ironically, "real sunlight" which you highlight as a benefit is actually a risk factor, given that UV-B and UV-A damage the lens - which is why sunglasses are recommended. I'd highlight that much of the publicly-perceived "dangers" of blue light are, at best, exaggerations of weak evidence by lens manufacturers who want to upsell blue light blocking spectacles or IOLs. It's not like there's some big medical conspiracy to keep the dangers of normal levels of blue light a secret - the medical manufacturers would love for it to be true so they could sell you more products.
- tristor 1y agoThis was a really interesting read, and really makes me appreciate how much medical technology has improved. I have been considering getting ICL surgery or similar for years, but the improvements are still happening and I find that I wait 5 years or so and something new is developed. At some point I will get eye surgery, but until then, I'm very happy to see that we continually improve.
- jtwaleson 1y agoOne of my best friends is a corneal surgeon at a university hospital, and does cataract surgery when there are other special complications. This is in Western Europe. He told me about a work trip to India he did and how amazed he was by the routine, efficiency and lack of waste there was over there in regular cataract surgery. Literally one doctor would handle 5x to 10x as many surgeries per day as their western counterparts. Where each surgery here requires full sterilization from scratch, there they kept their wrapping etc between surgeries, and had two beds side by side. The surgeon would do one surgery while the other patient would be changed. Then he turned around and did the next cataract surgery. We have a lot of waste in our medical practices.
- majormajor 1y agoOne person's waste is another person's more comfortable routine; one person's efficiency is another person's grueling day. (Even setting aside possible complications from not re-sterilizing, in this specific example.) Our goal should be to have a comfortable amount of capacity in the system so that we don't need to sweat the details, not to hyper-optimize everyone into human machines.
- recursive 1y agoThis is what makes Electron apps.
- givemeethekeys 1y agoIt sounds like you're implying that doctors in the West have a more relaxed work schedule and really prefer their pace over an Indian doctor. What you may not be taking into account are: - The massive amount of soul crushing paper work in the West. - Having to deal with insurance companies. - Having to deal with the demands of patients who think they know better. What compensates for the shit job: - How much more one can buy with USD / Euro. But, this is changing rapidly.
- soperj 1y ago> - The massive amount of soul crushing paper work in the West. This sounds like a problem in the US only.
- oulipo2 1y agoThe SIVA foundation and the Hellen Keller institute are going NGOs to fund to help with those surgeries in third-world countries
- stoneman24 1y agoWould like to see the stats behind the 5% complication rate. My understanding was under the NHS in the UK, the major complication rate was under 1% My private surgeon was quoting well under that. 6 weeks post op on both eyes and it’s slightly weird not needing glasses (unless I have small print in a book) as he fixed the cataracts and the astigmatism due to the more expensive than standard lens implants. Just a pity there wasn’t a option to have HUD display built into the new lenses
- vhcr 1y agohttps://www.ncbi.nlm.nih.gov/books/NBK559253/ https://www.ncbi.nlm.nih.gov/books/NBK559253/
- pcrh 1y agoAccording to the reference provided [0], that's for all cataract surgery, and cataracts can arise for multiple reasons, half are genetic and so might have attendant complications. The success rate for the most common surgery performed in the West, age-related cataracts, is likely much higher. [0] https://www.ncbi.nlm.nih.gov/books/NBK559253/ https://www.ncbi.nlm.nih.gov/books/NBK559253/
- nick__m 1y agoSomething missing from the article is the discovery of local anesthetic (cocaine) by Dr. Carl Koller an opthamologist in 1884. It must have improved the success rate tremendously.
- trashface 1y agoOnly 95% success? That is actually pretty bad, as anyone who has rolled a d20 enough times knows.
- gstrike 1y ago[dead]
- mindcrime 1y agoI can so relate to this. I just had cataract surgery (both eyes) back in August. Amazing. The procedure took about 20 minutes, was totally pain free (thanks to anesthesia), and my vision is markedly improved. And even more important than the point that I can see better now, is that I just plain feel better and to a degree that's hard to put into words. It turns out, apparently, that when you are dealing with constant severe levels of eye strain and eye fatigue as a result of cataracts, that feeling somehow permeates throughout your whole body and leaves you feeling like dogshit. At least that's the way it was for me. Within, say, 10 hours of my surgery, I felt better than I'd felt in probably a year. Now, are things perfect? No... I do have some (expected) side effects based on the lens replacement I chose (panoptix). Specifically I see rings around bright lights, especially at night. And reading text on a computer screen is a bit annoying since I sometimes see a bit of a halo or glow effect around fonts, especially with my preferred "green on black" terminal configuration. But I can live with that, and the only other side effects so far are the occasional day when one or both eyes seem a bit more light sensitive than normal. I understand that will fade over time. On balance though, for how much better I feel now, and for being able to read without glasses, it's totally worth it.
- litoE 1y agoI had cataract surgery about one year ago. Prior to surgery I needed glasses for longer distances (e.g. driving) but not for near objects like the computer screen or newspapers. I was not a candidate for the panoptix lenses for reasons not related to cataracts. Post surgery I have 20/20 vision for distance so no glasses. But for the computer screen I now need 1 diopter glasses and for newspapers or books I need 2.5 diopters, so two pairs of cheap drugstore glasses. This is livable, except when I have to work with a piece of paper and the computer at the same time. Switching glasses back and forth is a PITA. I got a set of bifocals but can't seem to get used to them. Sometimes I'll even scan the sheets of paper so I can also display them up on the screen.
- 3shv 1y agoI have mild cataracts and myopia. Should I get IOL lens or do ReLEx SMILE?
- SomeHacker44 1y agoI was under the impression that modern replacement lenses could flex under muscular control like the lenses of pre-presbyopic people. That was not mentioned in the article though. I am not hoping for cataracts but I thought that would be a nice boon to having the surgery, not needing progressives.
- southernplaces7 1y agoFor those of you who don't know of it, I really recommend the novel "The Physician" by Noah Gordon. It tracks the story of a young urban worker's son whose father dies early in early 13th century London and who gets taken as an orphan by a barber (the 13th century's country doctors basically) who teaches him what he knows of basic medicine. There's a scene later in the book, as he's apprenticing in his English country world, where he meets a jewish doctor who performs a cataract surgery. To this rustic apprentice of a mere barber, this seems like magic. He asks the jewish physician where he learned such a medical marvel and the man explains that he had studied in Al Andaluz, under doctors who had trained in Isfahan in the Caliphate under Ibn Sinna. Without going into too much further detail, the book is absolutely wonderful, especially as the English apprentice meets the legendary Sinna after managing to travel all the way to Isfahan to also study there.
- melling 1y agoAny opinions on the best IOL? My understanding is the trifocal are best if you want to go without glasses but they also have the halos at night because they are diffractive. There’s a new spiral lens that hasn’t been FDA approved that sounds promising: RayOne Galaxy
- armitron 1y agoFlud vision IOL has been in trials for years and looks very promising. Unless you really need an IOL NOW, I'd wait a few years for accommodating IOLs to hit the market. They make monofocals/trifocals seem like medieval technology as they work at all distances, in the same manner as a natural lens (ie. continuous focus). For someone with myopia/presbyopia, they're an occular enhancement that can give better than 20/20 vision.