A Caveman Walks Into a Whole Foods…

By Andrew S. Morgenstern, OD

Imagine the excitement of a caveman walking into a Whole Foods. That’s the level of excitement I feel when I think about how far cataract surgery has come!

Right now is the best time to have cataract surgery in the history of mankind. Think about what we can do and how far we have come. The earliest form of cataract surgery was couching, which is said to have been referenced in the Code of Hammurabi in nearly 2000 bc and was first documented in approximately 800 bc by the Indian surgeon Maharshi Sushruta. Couching was performed only when there was complete opacification of the lens. The surgeon used a sharp needle-like device to create an entry wound in the globe near the limbus and pressed the lens out of its normal anatomic position until the patient perceived light. The lens was left to fall inside the eye. Outcomes were poor, and patients frequently were blinded by the procedure.

I think that eye care providers take this common surgery for granted and forget the miraculous nature of modern cataract surgery. Imagine a couching patient sitting with his family in the waiting room (or rather, waiting tent) of an Indian ophthalmologist in 400 bc, listening to the screams of unanesthetized patients undergoing the procedure in the OR (or rather, operating tent), and then seeing victims (or rather, patients) on their way to the post-op tent. The patient would be right to question whether this was medicine or torture.

Imagine that ancient patient entering a time machine and landing in 2017 at Virginia Eye Consultants. He’s in the exam chair of my co-Chief Medical Editor Walt Whitley, OD, MBA, then undergoing surgery with Elizabeth Yeu, MD. I suspect that this patient would much rather the time-travel scenario than the tent one.

I think that eye care providers frequently forget the incredible nature of cataract surgery. How unbelievable is it that we can fold up an optical device that has the consistency of a gummy bear and place it inside the eye, only to have it unfold on its own and fall right into place? Or that we can fix astigmatism with this gummy bear? Or that a magical beam of light called a laser can painlessly make the cuts?

From couching to advanced IOL placement using femtosecond laser incisions. Technology has enabled us to preserve patients’ most precious asset: their vision. We can only hope that our patients feel like a caveman entering a Whole Foods. It’s our job to get them there.

Andrew S. Morgenstern, OD, FAAO
Chief Medical Editor