The history of cataract surgery
asimov.press
asimov.press
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.
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.
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.
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.
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.
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.
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.
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.
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.
This sounds like a problem in the US only.
Let's say you're a hospital administrator who reads about how many more surgeries a doctor in India can do per day.
You say "hey, docs! you need to up your throughput! Take these surgical-workflow steps, like two patients prepped at once!"
Now the doctor has twice as much paperwork.
Full sterilization before each surgery is a good thing. Better safe than sorry. Same for only having one patient in the operating room - reduced risk of contamination and human error.
Imagine, for a minute, that there's a physical lever at the FDA that controls the amount of cost, bureaucracy, and triple-checks that occur in hospitals. Think one of those steam engine throttles, with the big pawl release lever, it's set in front of an angle gauge with colors from red to green. One side is marked "Anarchy" and the other is marked "Better safe than sorry". Right now, that lever (or the metaphorical regulatory lever, the physical lever doesn't actually exist AFAIK) is as far over to the "safe" side as I can imagine it possibly being. The US lags behind on many modern medications and procedures, health care is unaffordable for somewhere between many and most, it's so miserably difficult to enter the field that we're not educating and training enough people, and the people that we do have trained are spending too much of their time doing paperwork and fighting the insurance system to take care of people. If you or a loved one have ever gotten a refusal of treatment or needed to wait for your disease to get worse before you can get care, you know how real this lever is.
If you ever get access to that lever, please, bring it at least one click back off the limiter. Maybe two. The potential harms that you imagine could caused by contamination and human error, at the moment, are less than the actual harms that are happening right now due to lack of affordable access.
People are going blind, in pain, or dying right now because it's too far towards the "better safe than sorry" side. If you were on a fixed income and found yourself unable to afford a $8000 cataract surgery as the world slowly grew dim, you'd wish you could visit an efficient practice and get it done for $150, even if that meant there was another patient on the other side of the OR.
> I said, “Bring all your patients together.” They brought them all towards me, and I was at the head of multiple beds, spiraling out like flower petals around its center. We pushed drugs on all of them, and they all got intubated, transfused, chest tubed, and then shuffled to Station 1.
> the respiratory therapist, said, “Menes, we don’t have any more ventilators.” I said, “It’s fine,” and requested some Y tubing. Dr. Greg Neyman, a resident a year ahead of me in residency, had done a study on the use of ventilators in a mass casualty situation. What he came up with was that if you have two people who are roughly the same size and tidal volume, you can just double the tidal volume and stick them on Y tubing on one ventilator.
Groovy in an emergency scenario, but I, a humble non-doctor, like the idea of fewer compromises of sterility as the de rigueur way of doing things for non emergency surgeries.
https://epmonthly.com/article/not-heroes-wear-capes-one-las-...
That is seriously cool!
I have written a few disaster/emergency plans and they are often forgotten about almost immediately, to the point they forget they even had them after a year.
It feels gross to compare it to ER docs saving lives in a mass casualty scenario but, well, I have a boring life but can relate to one aspect of theirs.
Its not the same but when your business is dead because one of the sysadmins accidentally deleted all the users from the system, its not all that different because many people's lives are on the line but the choices are different but some can become fatal.
This is like the old soviet block model:
From TFA:
> Aravind uses a two-pronged approach to addressing the lack of ophthalmologists: First, it enhances the efficiency of the existing staff. The hospital has an innovative “assembly line” operating theatre that allows a single surgeon to alternate between two fully prepared tables, each supported by dedicated instrument sets and nursing teams. This approach enables six to eight cataract operations per hour compared to an industry norm of one, while delivering clinical outcomes that even surpass those achieved in the UK’s National Health Service.
6–8x throughput is very impressive.
I had early cataract surgery at a “mill” here in NJ. There are similar centers all over. In talking both with my eye doctor and my cousin who is an eye surgeon in on the other side of the country, I was told it was better to go with a doctor who specialized in this surgery at a dedicated center (common called a mill). The rate of complications is less because they have really dialed in the procedure and have seen everything. The first day I saw him, I was literally the last patient. He said he had operated on 80 eyeballs that day. I think it was a long day, with more than eight hours but he does a few of those days a week at different centers. He has a large crew of support staff and multiple rooms to achieve this throughput. He did a good job. It was not inexpensive. He was driving a nice Porsche. He didn’t have time for a pleasant bedside chat.
I still don’t know why I had to get the surgery at 50. I haven’t had any other weird health issues like that. The one odd thing is that my grandfather was the first person to do cataract surgery in Lithuania, back in the 1920s. I always wonder if there was a link.
and this doesn't even take into account something like prion diseases, which can be spread by equipment which might be impossible to sterilize.
That being said, these people are being treated for a health issue, most of the successfully. There might be more risk, but the benefits might outweigh them.
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.
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?
It's nothing short of a man-made miracle but I have to say it's also very umconfortable and stressful for the patient.
This is what concerns me. If someone took a blade to my eye, I would be screaming, vomiting, and thrashing until I lose consciousness even though my rational brain knows the surgeons are helping. Are there options for the irrationally mutilation-averse people such as myself (like general anesthesia) or are my options just go blind or re-enact a Saw movie?
I can't even tolerate a glaucoma test and cut the optometrist off mid-sentence when he starts to suggests it.
But that's me. I think my wife would do her own eye surgery with just a mirror and some kitchen knives. Ugh, I wish I hadn't thought of that. Excuse me while I go try to stop the panic.
My mother is going to have 8th shot this year and 13th total since doctor decides to test her. She describes the injection as "potent hard pop". All patients gets the anesthetics and some moisturising-softening agent so needle could get in easier.
Seeing the queues many times I can tell this problem concerns senior women, less frequently men and people of both sexes below 60. Tho, I once saw a guy who was around mid 40.
It's surely not fun to get a needle into your eye month by month but mum and all the other people in the clinic are beyond that already.
The second operation was easier as I told the surgeon about my reaction to the subtenon block and he put some topical in the right place making it much easier. However the residual anxiety from the first operation remained. All that said, I've had rougher times at the dentist.
I opted for optimal vision at arm's length with a monofocal lens. We spend most of our days around the house. Bifocals with plano below work fine for outdoors, driving and flying (check with your aviation doctor before lens selection as aviation authorities are strict in what lens options are allowed). The depth of field has turned out better than I expected, but I use 1.25 diopter drug store readers when I'm using my tablet at home and put it at arm's length in the coffee shop.
The results are absolutely wonderful and I feel gratitude every time I step outside.
I wanted something simple and didn't want to mess with multifocal lens inside my eye, so opted for monofocal and high myopia correction like around -12 diopters, so after a couple of weeks my far vision felt like I was Superman and my near vision remains poor with zero accommodation.
5 years down the line, it seems the myopia is keeping its course and I need some small correction for far, middle, and reading distances so my drawers are a mess of glasses.
But I keep being grateful for this, I can walk the streets without anything in my eyes and this is something I don't have any memories I can recall. So it's a wonder.
I would gladly go again for that surgery even through the discomfort!
> It's nothing short of a man-made miracle but I have to say it's also very umconfortable and stressful for the patient.
I think I must be strange, either in my reaction to the stress or the way I chose to manage it during my surgery.
I explicitly wanted to be somewhat awake during the procedure to see what was going on (how many chances do you get to see your lens emulsified from the inside)... and I remember having short conversations with the surgeon during the procedure. (She'd been concerned about zonular laxity, and we discussed during the procedure that she didn't see evidence.)
This is not something I'd want to reproduce if I didn't have to, nor would I suggest it as a general approach, but given that it was necessary for me, it was amazing to see it first hand.
My second procedure (second eye) was a little more stressful than the first, but for me all the material stress (which was significant) was in the run up and anticipation.
My mother had her eyes done 2 years ago with one month break between. I did set timer on second surgery and it was just 20 minutes once she was inside. The only thing we had to care about were drops administered 4 times a day before and after the procedure - for once multiple alarms on my phone were useful. And of course control visit with dressing removal that happens for every patient on second day.
In my city a duet of two doctors runs an ophthalmology clinic and seems they have some good contracts with health services because they're always busy and have shorter waiting lists than clinic at our local hospital. Both women handle a queue of about 20 people and each weekday is dedicated to a different issues, with serious surgeries reserved for weekends.
I ask one of doctors if failed cataract surgeries happen because I was concerned before the first time my mum had it. She said that these are extremely rare but if a patient needs another it happens again pretty fast. The issue might be with lens that moved inside due to e.g. patient activity shortly after the procedure.
I do remember some short documentary about probably an Indian surgeon who treated eyes of North Korean elderly people. He also visited other places around the world as sort of personal goal to give new eye care technology in places where is needed but socio-economic conditions do not allow it. I'll try to find that unless someone happen to know that man's name.
Here's another by DW: https://www.youtube.com/watch?v=xz729FOOk94
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
It actually briefly made me worse at batting, in baseball. Took some getting used to.
My mother later said she had never felt so guilty.
In many cases, failed surgery just means having to go again.
The exception is back surgery, and the odds get worse and worse if revisions are necessary.
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.
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.
but I think it is stalled/abandoned
https://interlude.hk/did-johann-sebastian-bach-die-from-eye-...
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.
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.
(I know that the rate has lowered over the last years, but USA still has what... 85+% ? Even higher in South Korea e.g.)
It's one of those super low-priority surgeries for most people. I'm very glad I got it done myself, though!
I did go “yikes” a bit at 95%, a 1 in 20 failure rate is pretty rough when its about your eyes
[1] https://www.ncbi.nlm.nih.gov/books/NBK559253/ [2] https://news.ycombinator.com/item?id=45414718#45449810
She had one eye done and immediately after said: something is wrong -- I can't see anything in that eye. They hushed her and said, don't worry, in a couple days after giving your eye a bit of time it will be good as new. Well, she remained blind in that eye for the rest of her life. She never had the other eye done for fear that she'd end up totally blind and lived another 12 or so years with one cataract-clouded eye.
She didn't sue -- she was a "I don't want to make a fuss" kind of personality. She did follow up with them a few times in that first year, but they kept putting her off and downplaying that she really couldn't see more than vague light and shadow in that eye. Eventually she stopped contacting them.
Driving at night had already been out-of-the-question for a while, and soon I would be unable to work, at least without learning an entirely new physical workflow.
At that point 1/20 is great. (It all worked out very well for me.)
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.
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.
It isn't the water that loses structure (how could it?), but the proteins that constitute the lens material.
There’s a new spiral lens that hasn’t been FDA approved that sounds promising: RayOne Galaxy
The article is still interesting, but they probably should have left that claim out.
> 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).[
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/ [2] https://www.ncbi.nlm.nih.gov/books/NBK539699/ [3] https://pmc.ncbi.nlm.nih.gov/articles/PMC10243645/