For those who are not in the medical field, a brief, non scientific review of cataract and implant surgery may be indicated. The "Story of Tobit" may be the earliest documented surgical intervention for blindness. Various written texts mentioning this episode have been found, including mentions in the Dead Sea Scrolls. Scholars document that this could have been as early as 7th Century BC. The "Clinical history of Tobit, a man in later years who suffered a progressive loss of vision associated with whiteness of eyes leading to complete blindness," pretty much establishes that this, indeed, was a cataract. Some type of "couching was performed." Couching, from the french word Coucher, to lie down, is a surgical manipulation of a mature lens. This causes the lens to fall backward and down into the Vitreous Gel of the eye, thereby allowing the patient to view the world. Now, viewing the world, is not what most would describe the resultant vision. Without a lens the world was significantly unfocused, but better than nothing. Fast forward several thousand years, and spectacles became available, allowing those who did have surgery to see a bit better. (Still not very good) It is now generally accepted that spectacles were ‘invented’ (more likely improvised) no later than the last quarter of the thirteenth century by the Italians (rather than the Dutch or even the Chinese) and that their specific area of origin centered possibly on the Veneto, Italy region.
For those patients who ask if an intraocular implant is necessary (after cataract removal), I inquire whether they remember the 1977 movie "Oh God" starring John Denver and George Burns. (I know I'm dating myself) If they do remember, I point out the very thick glasses, (coke bottles glasses as laymen refer to), that George Burns was wearing. They were necessary because he had previous cataract surgery and implants were not common at that time. I was an active cataract surgeon and remember that era well. Although wearing these glasses were an improvement over cataracts, there still was significant problems associated with the optics and subsequent vision.
In the technology era, new discoveries and techniques are adopted and refined very quickly. That was not always the case. The next huge innovation that occurred in Ophthalmology began to be developed during and immediately after WWII, in England, and required decades to become universally accepted. This innovation was the intraocular implant (lens), which led to superb post operative vision. The story of Dr. Ridley in my next post.