Through the lens of time: The evolution of cataract surgery

The first documented treatment for cataracts was nothing like today’s quick outpatient procedure. Known as couching, an ancient method observed along the Mediterranean shortly before the Common Era, it involved dislodging the clouded lens with a needle or a rod and pushing it into the back of the eye. Now, thousands of years later, cataract removal is one of the most common and most effective surgical procedures in the U.S., with ophthalmologists performing about 3.7 million cataract surgeries each year.  

Chris Leffler, M.D., an associate professor in the Department of Ophthalmology, led an effort to capture the inception of cataract treatment, the modern-day procedure and everything in between, in an 800-page tome called “A New History of Cataract Surgery.” It’s the second book by Leffler in a historical series from Kugler Publications about ophthalmology. He and a team of 43 co-authors — including faculty, residents and medical students at VCU School of Medicine and other institutions — spent years poring over medical records and historical archives, visiting libraries across the country and interviewing experts all over the world.  

“There’s a long chain of people through history, for several thousand years, who have been doing this surgery in one form or another,” Leffler said. “Seeing the big picture of how it all ties together has been a lot of fun.”  

Mary Daly, M.D., chair of the Department of Ophthalmology, commended Leffler and his co-authors for their commitment and contributions to the specialty. 

"Their love for our field is so strong that it permeates through the department and extends to our learners in an incredibly impactful way," Daly said. "The VCU faculty, residents and medical students who contributed to this text are all active participants in the living history of ophthalmology — not just through their beautiful retelling of the timeline of cataract surgery, but through their real-time, day in and day out efforts to improve the vision heath of each and every patient they meet." 

Digging into the history 

The two-volume book lays out a detailed history of cataract surgery from antiquity to the modern era. It includes major medical breakthroughs like the first removal of cloudy lenses in the 1750s, according to the previously unanalyzed log of a French ophthalmologist’s cases that was only discovered in 2004; the first intraocular lens (IOL) implant in 1950 at a hospital in London; and the development of silicone foldable IOLs in the 1970s, which allowed for smaller incisions and easier recovery. Patients today have a range of IOLs to choose from, including lenses to eliminate the need for reading glasses — which, Leffler noted, are still not perfect, as “the quest for perfect correction of presbyopia is still going on.”  

With so many innovations and improvements in cataract treatment over the past half-century, Leffler noted that some of the physicians who were at the forefront of those ophthalmic advances are still alive and able to reflect on their work and how far the field has come. There was a time when cataract surgery required a weeklong hospital stay, and patients were bedridden with their heads held still between two sandbags while the wounds healed — Leffler and the 43 co-authors wanted to hear as many of those recollections firsthand as possible. 

“There are just a lot of really great stories, but some of those people are older, so this is our last chance to really get all their recollections down,” he said.  

One of those co-authors, Stephen Schwartz, M.D., was program director of VCU’s ophthalmology residency from 2002-2004. He’s now a professor of clinical ophthalmology at the University of Miami Health System, and he commended Leffler for his commitment to the project.  

“This is probably the new standard on the history of cataract surgery, and I’m happy to have been a small part of it,” he said. “It is really a terrific achievement by Chris Leffler and a nice accomplishment for VCU.”  

For Schwartz, the hours spent researching and writing five chapters were worth it, because these stories deepen his understanding of and respect for the field.  

“It’s not that knowing this history will necessarily make you a better doctor or help you take care of patients,” Schwartz said. “But I do think it gives you a more complete appreciation for how we got here and why we do some of the things we do.” 

Send us your stories!

The School of Medicine communications team is always looking to highlight student success, faculty achievement, cutting-edge research and innovative initiatives around the MCV Campus. If you have an idea for a story, please submit your pitch to laura.ingles@vcuhealth.org.