See the Difference: Advancements in Cataract Treatment

Cataracts are the leading cause of worldwide blindness and result from the clouding and browning of the natural lens. It is like the difference between swimming with goggles in a crystal clear pool versus in an algae-blooming prairie lake in August. People with cataracts progressively lose their vision as their lens opacifies, mostly a process due to aging and sun-damage.

“Couching” – The First Cataract Surgery

More than 2,600 years ago, a physician from India was the first to write about cataract surgery. He described using a curved needle to push back completely clouded over lenses into the vitreous fluid in the middle of the eye, out of the field of vision. This reportedly would return some vision for people completely blinded in that eye by a cataract. He called the process, “couching.”

The vitreous is the sack of fluid that separates the iris, pupil, and lens at the front of the eye from the retina or light sensitive nerve blanket that catches the image in the back of the eye, which in turn sends the photo message to the brain. Pushing or couching cataracts back and hopefully to the side into that vitreous would allow light through to the retina. However, the vitreous would be disrupted, could possibly become infected, and there would be no lens to focus the light. Still this would be better than nothing.

Couching cataracts eventually spread to China, Arabia, Africa and Europe, but it is not difficult to understand why this procedure was used only as a last resort. Other methods to remove the lens completely from the eye, without disrupting the vitreous, gradually were developed during the Middle Ages and up to today. But until we learned how to control infection in the mid-1800s, this was still very dangerous and not commonly done.

Advancements in Practice and Sight

Eventually very thick external glasses were devised that would replace the lost natural lens, and starting in the 1940s, these removable glasses began to be replaced with lenses that are surgically implanted into the eye to replace the removed cataract.

Now the surgery to extract opaque and diseased cataract lenses is much better and keeps improving. The lenses we implant continue to advance, as well.

It is like cleaning out all that algae and swimming in a crystal clear pool.


Dr. Rick Holm wrote this Prairie Doc Perspective for “On Call®,” a weekly program where medical professionals discuss health concerns for the general public.  “On Call®” is produced by the Healing Words Foundation in association with the South Dakota State University Journalism Department. “On Call®” airs Thursdays on South Dakota Public Broadcasting-Television at 7 p.m. Central, 6 p.m. Mountain. Visit us at 

By Dr. Richard Holm

Internal Medicine Physician at Avera Brookings Medical Clinic

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