I did some of the controls software for an automated IOL manufacturing line roughly 8 or 9 years ago. It's very cool technology, I was proud to work on it.
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 wife had both eyes done over the past year. I would guess that her new lenses did not have UV protection, because she has a most interesting side effect.
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.
> Last I heard, the rate of complications for a repeat surgery is significantly higher, but I assume it is improving all the time.
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.
They might, eventually. But the older you get, the more difficult it is to adapt or accept change.
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.
>> Patients tend to find it jarring if the lens is perfectly clear.
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.
One of my best friends is a corneal surgeon at a university hospital, and does cataract surgery when there are other special complications. This is in Western Europe.
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.
This sounds a bit like the Sunrise Hospital Emergency Room treating patients from the Mandalay Bay shooting in 2017
> 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.
That's a really awesome article. It shows the power of just thinking about the what if scenario comes in very handy, because you begin to note information that might be useful.
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.
At my old gig the on-call rota involved doing a randomized fire drill at the start of your on call week. Think "the site is slow" or "users are seeing 500 errors." This included a TUI program to walk you through the fire drill with your partner. That same TUI was the tool to walk you through debugging a real fire, including alerting the right slack channels. It was very much inspired by how commercial pilots handle failures using checklists, allowing you to do as much of the problem solving as possible before the problem.
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.
>> 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.
As a patient, I'm not sure if I'd be comfortable with the doctor operating on me doing a speedrun.
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.
It's not a binary choice between a civil war surgeon's saw and an immaculate cleanroom, safety exists on a spectrum. Better safe enough than so incomprehensibly safe that the procedure is unaffordable and the doctor has 1/10th the experience and 100x as much paperwork!
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.
That's fair, except that sometimes there aren't enough resources (qualified surgeons, facilities, etc) for everyone to get that kind of care. I'd rather cheap care that is 95% good enough than none at all. (For things I really need - I think a majority of what the healthcare industry does is counterproductive but there is also plenty of stuff that's good like cataract surgery for example.)
This one is a tough sell, in that regime the doctors will have a significantly higher amount of practice which might translate into mastery. On the other hand I would expect post-procedure tracking and reporting be significantly better in the west.
One person's waste is another person's more comfortable routine; one person's efficiency is another person's grueling day. (Even setting aside possible complications from not re-sterilizing, in this specific example.)
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.
> 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 an hour isn’t unusual at a dedicated center in the US.
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.
> Where each surgery here requires full sterilization from scratch, there they kept their wrapping etc between surgeries, and had two beds side by side.
I imagine the pace in India was also borne out of necessity - there are just so many more cases to go through there, that the surgeons had no choice but to adapt.
I only got it through the story my friend told me, so I really don't know any details.
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.
People here are rightly pointing out that there's still room for improvement with this (and almost any) kind of surgery, and the article talks about the accessibility challenges of making procedures like these more widely available, but after reading up on the history of this procedure it's hard not to see modern surgical techniques as a kind of man-made miracle. Great read.
It's nuts to read this technology has only been around since 2008. It seems like it's been around forever.
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.
Eye surgeon here:
FLACS isn't really that amazing. I would actually argue that a man made incision using steel or diamond (yes, diamond) is better than the incision made using the femto laser for long term safety/sealing. Number of studies have borne this out.
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 here already - at least for the developed countries. It's both thanks to this multitool used to handle the surgery - destroying, removing natural lens and replacing it with an implant, and technology that allowed creating customized intraocular lenses pretty fast.
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.
The miracle is when they put a _graduated_ lens and you get cured of cataracts and myopia in a procedure where you are awake and can perfectly ntoice how while the lens is being inserted the blinding lights on top of you become more and more defined.
It's nothing short of a man-made miracle but I have to say it's also very umconfortable and stressful for the patient.
The surgery is not fun. The worst part was the cannula for the subtenon block - not painful, but my anxiety at something being poked into my eye socket went through the roof. My sister opted for sedation after she heard of my experience.
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.
Most people don't get blocks nowadays for cataract surgery. I will do so for patients with wandering eye movements or for more difficult cases, or for more invasive surgery besides cataract surgery. I just did a cataract surgery on a young patient today using topical numbing drops. But I have them monitored by an anesthetist with mild sedation during the entire case.
For my second operation the surgeon basically suggested using some drug ending in -pam (perhaps it was Valium) and they wouldn't provide it over the counter so I had to get a proper prescription, which somehow pissed the surgeon off. At the end of the day, yes, a dentist is worse but the phobia of someone tinkering with your eye remains.
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!
I had it done about eight years ago... there's nothing quite like waking up after a fifteen minute procedure and seeing better than you have without correction since you were five.
> 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.
> 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 worried about this too. I had surgery for a congenital cataract at 27 or so. I was conscious-ish and remember hearing the surgeon talking and doing something to my eye, but they put you on some _wild_ drugs and I absolutely did not care.
Not to worry there, either! I think the drugs are pretty standard, are not opiates, and honestly I think that most humans understand that “if you’re gonna poke me in the eye, at least make sure I’m good and sloshed” is a pretty reasonable ask.
I swear there would be nothing but heaps of smoking machinery and mangled human limbs and entrails in the operating theatre in my wake and they'd find me cowering in some far corner of the building curled up in a foetal position.
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.
At least cataract surgery once done won't be likely repeated. But there's also the age-related macular degeneration that goes by... AMD acronym. The treatment method for wet form involves intraocular injections, which basically means a series of shots in the affected eye, up until a "pocket" seen during eye tomography scan sizes down and vision improves.
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.
Me and you think the same. For me, even just knowing they’re going to be cutting on my eye and or using lasers to burn parts of my eye, combined with the nonzero risk of permanent vision worsening has made me permanently uninterested in eye surgery (such as lasik). Even if I could be put under for it.
General anestesia is pretty secure, but 1:100.000 still end deadly.
Thats why general anesthesia is avoided whenever possible, especially for small procedures like that.
It’s also way more complicated, requiring a pre-medication talk, an anesthetist being present and supervised rooms where patients can wake up.
I've wondered quite a lot about this. Look, the last thing you want to hear while the procedure is being performed is the surgeon saying: "Please, stop moving your eye. Help me out here".
Would like to see the stats behind the 5% complication rate. My understanding was under the NHS in the UK, the major complication rate was under 1%
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
According to the reference provided [0], that's for all cataract surgery, and cataracts can arise for multiple reasons, half are genetic and so might have attendant complications. The success rate for the most common surgery performed in the West, age-related cataracts, is likely much higher.
Reminds me of my first eye exam as a nearsighted youngster. The doctor told me to go look out the window with a pair of temporary lenses. I exclaimed to my mom that those dark splotches on hillsides were trees!
When I first got glasses circa age 9, my first remark upon leaving the shop was, "oh, wow, I can see the leaves from here!" (standing under ca. 20-30 foot tall tree)
My mother later said she had never felt so guilty.
At the beginning of the day I would take note of what color clothing my friends were wearing so that I could find them at recess, and assumed it was a problem everyone had.
And the ones that have a bad time, have a really bad time, to the point of suicide in cases. Not sure if I would risk it if I didn't have 20/15 vision tbh
For those of you who don't know of it, I really recommend the novel "The Physician" by Noah Gordon. It tracks the story of a young urban worker's son whose father dies early in early 13th century London and who gets taken as an orphan by a barber (the 13th century's country doctors basically) who teaches him what he knows of basic medicine.
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.
Unfortunate that there is so much focus on treatment of advanced symptoms. Cataracts may be caused in part by metabolic disease which can be detected and treated before cataracts develop. Kind of reminds me of how my great grandfather wouldn't pay for his children or grandchildren to go to the dentist because they would lose all their teeth by their mid twenties anyway.
Funnily, when I read up on the state of the art, I felt let down that we are apparently still far away from being able to dissolve cataracts with eye drops. I'm hoping for that when my time comes.
> 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.
A shame that cataract surgery has become a money making scheme in some countries (Canada), where surgeons often push unnecessary expensive lenses to patients and focus exclusively on simple cataract cases to fuel their high income lifestyles.
I’m not surprised. India produces very experienced surgeons due to the very high volumes of surgeries they’re able to perform. I think part of this is the high population from which to draw both doctors and patients coupled with the intensely competitive academics and standardized testing.
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.
I can so relate to this. I just had cataract surgery (both eyes) back in August. Amazing. The procedure took about 20 minutes, was totally pain free (thanks to anesthesia), and my vision is markedly improved. And even more important than the point that I can see better now, is that I just plain feel better and to a degree that's hard to put into words.
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 had cataract surgery about one year ago. Prior to surgery I needed glasses for longer distances (e.g. driving) but not for near objects like the computer screen or newspapers. I was not a candidate for the panoptix lenses for reasons not related to cataracts. Post surgery I have 20/20 vision for distance so no glasses. But for the computer screen I now need 1 diopter glasses and for newspapers or books I need 2.5 diopters, so two pairs of cheap drugstore glasses. This is livable, except when I have to work with a piece of paper and the computer at the same time. Switching glasses back and forth is a PITA. I got a set of bifocals but can't seem to get used to them. Sometimes I'll even scan the sheets of paper so I can also display them up on the screen.
It's falling pretty quickly, down to about ~60% of male infants as of 2022. General prevalence is higher (because that's how decreasing rates work), somewhere around 80%, but I'd suspect it's highly regional.
Common, but a lot of people never get it. Either they didn't grow wisdom teeth at all, or they aren't pressing into the rest of the teeth in a way to cause a problem, or they lack dental insurance.
It's one of those super low-priority surgeries for most people. I'm very glad I got it done myself, though!
I was under the impression that modern replacement lenses could flex under muscular control like the lenses of pre-presbyopic people. That was not mentioned in the article though. I am not hoping for cataracts but I thought that would be a nice boon to having the surgery, not needing progressives.
> In 4,000 years, cataract surgery went from a crude procedure involving thorn instruments to a 20-minute operation with a 95 percent clinical success rate.
I did go “yikes” a bit at 95%, a 1 in 20 failure rate is pretty rough when its about your eyes
Anecdote: my mother in law had cataracts in both eyes in her mid 70s. She went to NYC to have the procedure done because there was a doctor there she was told was very good.
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.
Just guessing, but likely “clinical success rate” here doesn’t mean “didn’t make it worse” but actually means “improved the underlying condition significantly”.
I waited until I was mostly blind in my left eye and the right was maybe 6-9 months behind, assuming it continued to progress consistent with the left.
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.)
Something missing from the article is the discovery of local anesthetic (cocaine) by Dr. Carl Koller an opthamologist in 1884. It must have improved the success rate tremendously.
This was a really interesting read, and really makes me appreciate how much medical technology has improved. I have been considering getting ICL surgery or similar for years, but the improvements are still happening and I find that I wait 5 years or so and something new is developed. At some point I will get eye surgery, but until then, I'm very happy to see that we continually improve.
Any opinions on the best IOL? My understanding is the trifocal are best if you want to go without glasses but they also have the halos at night because they are diffractive.
There’s a new spiral lens that hasn’t been FDA approved that sounds promising: RayOne Galaxy
Flud vision IOL has been in trials for years and looks very promising. Unless you really need an IOL NOW, I'd wait a few years for accommodating IOLs to hit the market. They make monofocals/trifocals seem like medieval technology as they work at all distances, in the same manner as a natural lens (ie. continuous focus). For someone with myopia/presbyopia, they're an occular enhancement that can give better than 20/20 vision.
The only thing that's really guaranteed is presbyopia in middle age. The lens will become harder and you will not be able to focus on near objects as well.
I had cataracts when I was 48 and my ophtalmologist told me that everybody gets cataracts but there are factors that make it appear sooner, like smoking (and yes, I am a smoker). But it's more or less unavoidable.
While protein buildup is somewhat natural with aging, my understanding is that e.g. looking into the sun too much (which exposes your eyes to UV light, among other things) exacerbates it.
Cataracts aren’t about age. They happen when the lens loses energy and the water inside it loses structure. Getting real sunlight, eating for metabolism, and avoiding stress and fake blue rich light keeps your eyes clear and alive.
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.
There's no evidence that "fake blue rich light" at normal exposure levels has any effect, and not for lack of investigation. Ironically, "real sunlight" which you highlight as a benefit is actually a risk factor, given that UV-B and UV-A damage the lens - which is why sunglasses are recommended.
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.
Yeah, their claim that it is the most common procedure is incorrect. There are more colonoscopies performed every year, too. I followed the citations and they are citing a 2007 paper that was meta-analysis regarding cost effectiveness of cataract surgery, so the claim gets more dubious the deeper you dig.
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).[
I meant recorded as in procedure, but yes earlier depictions were present. I looked at the picture and the interpretation of the tool that is depicted is still kind of vague.
I was trying to track down what the 5% failure looks like. The article source is here[1] for the 95% stat, which then references here[2], but I honestly can't find it, [2] refers to "Recent studies reveal that in most of the cases, the prognosis is excellent after surgery, almost 70 to 80%", which refers to here[3], which seems to refer to patient happiness(?), so I haven't the foggiest where that 5% stat comes from.
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.
I did some of the controls software for an automated IOL manufacturing line roughly 8 or 9 years ago. It's very cool technology, I was proud to work on it.
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 wife had both eyes done over the past year. I would guess that her new lenses did not have UV protection, because she has a most interesting side effect.
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.
> Last I heard, the rate of complications for a repeat surgery is significantly higher, but I assume it is improving all the time.
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.
> UV protection can be put directly into the lens to protect your retinas even without sunglasses
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.
Fascinating - I’d think your brain would compensate pretty quickly for a no-longer-yellow lens? Given a choice I’d be all for the clear one.
They might, eventually. But the older you get, the more difficult it is to adapt or accept change.
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.
>> Patients tend to find it jarring if the lens is perfectly clear.
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.
One of my best friends is a corneal surgeon at a university hospital, and does cataract surgery when there are other special complications. This is in Western Europe.
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.
This sounds a bit like the Sunrise Hospital Emergency Room treating patients from the Mandalay Bay shooting in 2017
> 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's a really awesome article. It shows the power of just thinking about the what if scenario comes in very handy, because you begin to note information that might be useful.
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.
At my old gig the on-call rota involved doing a randomized fire drill at the start of your on call week. Think "the site is slow" or "users are seeing 500 errors." This included a TUI program to walk you through the fire drill with your partner. That same TUI was the tool to walk you through debugging a real fire, including alerting the right slack channels. It was very much inspired by how commercial pilots handle failures using checklists, allowing you to do as much of the problem solving as possible before the problem.
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.
That's a really good plan.
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.
[dead]
>> 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.
That is seriously cool!
As a patient, I'm not sure if I'd be comfortable with the doctor operating on me doing a speedrun.
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.
It's not a binary choice between a civil war surgeon's saw and an immaculate cleanroom, safety exists on a spectrum. Better safe enough than so incomprehensibly safe that the procedure is unaffordable and the doctor has 1/10th the experience and 100x as much paperwork!
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.
Exactly this. 10x the experience is very valuable.
That's fair, except that sometimes there aren't enough resources (qualified surgeons, facilities, etc) for everyone to get that kind of care. I'd rather cheap care that is 95% good enough than none at all. (For things I really need - I think a majority of what the healthcare industry does is counterproductive but there is also plenty of stuff that's good like cataract surgery for example.)
You’d accept a 1 in 20 chance of acquiring a staph infection?
Depending how bad my situation was and what my alternative options are.
don't you have that just going to the hospital now a days?
This one is a tough sell, in that regime the doctors will have a significantly higher amount of practice which might translate into mastery. On the other hand I would expect post-procedure tracking and reporting be significantly better in the west.
One person's waste is another person's more comfortable routine; one person's efficiency is another person's grueling day. (Even setting aside possible complications from not re-sterilizing, in this specific example.)
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.
It sounds like you're implying that doctors in the West have a more relaxed work schedule and really prefer their pace over an Indian doctor.
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.
> - The massive amount of soul crushing paper work in the West.
This sounds like a problem in the US only.
Not sure how much worse it is in the US, but here in NL it's a huge problem for GPs too.
No "here's how these other doctors are more efficient" in-the-OR practices would change that.
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.
No doctors ever deal with insurance companies in France
This is what makes Electron apps.
Sounds like they do something similar!
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.
6 an hour isn’t unusual at a dedicated center in the US.
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.
> Where each surgery here requires full sterilization from scratch, there they kept their wrapping etc between surgeries, and had two beds side by side.
This is like the old soviet block model:
https://www.youtube.com/watch?v=Kr_wcrX0d_A
I imagine the pace in India was also borne out of necessity - there are just so many more cases to go through there, that the surgeons had no choice but to adapt.
I can't help but think that they could spread disease from one patient to the next. Even if it is a minimal chance, the statistics would add up.
and this doesn't even take into account something like prion diseases, which can be spread by equipment which might be impossible to sterilize.
I only got it through the story my friend told me, so I really don't know any details.
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.
People here are rightly pointing out that there's still room for improvement with this (and almost any) kind of surgery, and the article talks about the accessibility challenges of making procedures like these more widely available, but after reading up on the history of this procedure it's hard not to see modern surgical techniques as a kind of man-made miracle. Great read.
It's nuts to read this technology has only been around since 2008. It seems like it's been around forever.
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.
Eye surgeon here: FLACS isn't really that amazing. I would actually argue that a man made incision using steel or diamond (yes, diamond) is better than the incision made using the femto laser for long term safety/sealing. Number of studies have borne this out.
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 here already - at least for the developed countries. It's both thanks to this multitool used to handle the surgery - destroying, removing natural lens and replacing it with an implant, and technology that allowed creating customized intraocular lenses pretty fast.
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.
His name is Sanduk Ruit and he's Nepali. A huge inspiration!
Thank you; I managed to find that documentary but it seems it was a part of large thing: https://www.youtube.com/watch?v=TXYokXfbrWs
Here's another by DW: https://www.youtube.com/watch?v=xz729FOOk94
The miracle is when they put a _graduated_ lens and you get cured of cataracts and myopia in a procedure where you are awake and can perfectly ntoice how while the lens is being inserted the blinding lights on top of you become more and more defined.
It's nothing short of a man-made miracle but I have to say it's also very umconfortable and stressful for the patient.
The surgery is not fun. The worst part was the cannula for the subtenon block - not painful, but my anxiety at something being poked into my eye socket went through the roof. My sister opted for sedation after she heard of my experience.
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.
Most people don't get blocks nowadays for cataract surgery. I will do so for patients with wandering eye movements or for more difficult cases, or for more invasive surgery besides cataract surgery. I just did a cataract surgery on a young patient today using topical numbing drops. But I have them monitored by an anesthetist with mild sedation during the entire case.
For my second operation the surgeon basically suggested using some drug ending in -pam (perhaps it was Valium) and they wouldn't provide it over the counter so I had to get a proper prescription, which somehow pissed the surgeon off. At the end of the day, yes, a dentist is worse but the phobia of someone tinkering with your eye remains.
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!
Possibly Lorazepam[0]? Relatively common anti-anxiety drug (I have a couple of them in my pocket all times because it can help during seizures).
https://en.wikipedia.org/wiki/Lorazepam
Probably, yes.
I had it done about eight years ago... there's nothing quite like waking up after a fifteen minute procedure and seeing better than you have without correction since you were five.
> 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.
> 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 worried about this too. I had surgery for a congenital cataract at 27 or so. I was conscious-ish and remember hearing the surgeon talking and doing something to my eye, but they put you on some _wild_ drugs and I absolutely did not care.
Ah thank you, that alleviates my concerns a lot. Now I just hope they don't think I'm a drug-seeker when I tell them to dial the drugs up to 11 :-D.
Not to worry there, either! I think the drugs are pretty standard, are not opiates, and honestly I think that most humans understand that “if you’re gonna poke me in the eye, at least make sure I’m good and sloshed” is a pretty reasonable ask.
I swear there would be nothing but heaps of smoking machinery and mangled human limbs and entrails in the operating theatre in my wake and they'd find me cowering in some far corner of the building curled up in a foetal position.
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.
At least cataract surgery once done won't be likely repeated. But there's also the age-related macular degeneration that goes by... AMD acronym. The treatment method for wet form involves intraocular injections, which basically means a series of shots in the affected eye, up until a "pocket" seen during eye tomography scan sizes down and vision improves.
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.
Me and you think the same. For me, even just knowing they’re going to be cutting on my eye and or using lasers to burn parts of my eye, combined with the nonzero risk of permanent vision worsening has made me permanently uninterested in eye surgery (such as lasik). Even if I could be put under for it.
It sounds like it must inevitably be uncomfortable and stressful—why do they do it with the patient awake?
General anestesia is pretty secure, but 1:100.000 still end deadly. Thats why general anesthesia is avoided whenever possible, especially for small procedures like that. It’s also way more complicated, requiring a pre-medication talk, an anesthetist being present and supervised rooms where patients can wake up.
I've wondered quite a lot about this. Look, the last thing you want to hear while the procedure is being performed is the surgeon saying: "Please, stop moving your eye. Help me out here".
Would like to see the stats behind the 5% complication rate. My understanding was under the NHS in the UK, the major complication rate was under 1%
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
https://www.ncbi.nlm.nih.gov/books/NBK559253/
According to the reference provided [0], that's for all cataract surgery, and cataracts can arise for multiple reasons, half are genetic and so might have attendant complications. The success rate for the most common surgery performed in the West, age-related cataracts, is likely much higher.
[0] https://www.ncbi.nlm.nih.gov/books/NBK559253/
I will always remember how happy my wife was as I drove her back from cataract surgery on both eyes - the world suddenly looked an awful lot better!
Reminds me of my first eye exam as a nearsighted youngster. The doctor told me to go look out the window with a pair of temporary lenses. I exclaimed to my mom that those dark splotches on hillsides were trees!
When I first got glasses circa age 9, my first remark upon leaving the shop was, "oh, wow, I can see the leaves from here!" (standing under ca. 20-30 foot tall tree)
My mother later said she had never felt so guilty.
At the beginning of the day I would take note of what color clothing my friends were wearing so that I could find them at recess, and assumed it was a problem everyone had.
I distinctly remember the main effect being that everything suddenly looked way, way more "3D".
It actually briefly made me worse at batting, in baseball. Took some getting used to.
My mom got angry and asked why no one had told her how wrinkly she'd gotten.
95% success rate is actually a bit lower than I realized, and is somewhat scary.
But that doesn't mean 5% of the people walk out of the procedure completely blinded.
In many cases, failed surgery just means having to go again.
That success rate tracks with most common types of surgery, there are always edge cases.
The exception is back surgery, and the odds get worse and worse if revisions are necessary.
And the ones that have a bad time, have a really bad time, to the point of suicide in cases. Not sure if I would risk it if I didn't have 20/15 vision tbh
You will risk it, eventually. Cataracts appear and get worse to the point of you becoming blind.
I suppose in that case, possibly. I more mean for people that are doing it for cosmetic reasons (not to wear contacts)
You're thinking about Lasik, this is different from cataract surgery.
Oh, hard agree on that!
For those of you who don't know of it, I really recommend the novel "The Physician" by Noah Gordon. It tracks the story of a young urban worker's son whose father dies early in early 13th century London and who gets taken as an orphan by a barber (the 13th century's country doctors basically) who teaches him what he knows of basic medicine.
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 thought the first picture of the article was an USB-C connector...
Unfortunate that there is so much focus on treatment of advanced symptoms. Cataracts may be caused in part by metabolic disease which can be detected and treated before cataracts develop. Kind of reminds me of how my great grandfather wouldn't pay for his children or grandchildren to go to the dentist because they would lose all their teeth by their mid twenties anyway.
Reading about historical cataract removal methods was... difficult.
I feel truly lucky to have been born into a time of modern medicine.
Funnily, when I read up on the state of the art, I felt let down that we are apparently still far away from being able to dissolve cataracts with eye drops. I'm hoping for that when my time comes.
I know this project: https://clinicaltrials.gov/study/NCT00793091?term=Chakshu%20...
but I think it is stalled/abandoned
> 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.
Wait till you hear about how they used to wake people up before smelling salts (hint: they used it on horses too)
A factoid: probably Johan Sebastian Bach died from eye surgery complications.
https://interlude.hk/did-johann-sebastian-bach-die-from-eye-...
A shame that cataract surgery has become a money making scheme in some countries (Canada), where surgeons often push unnecessary expensive lenses to patients and focus exclusively on simple cataract cases to fuel their high income lifestyles.
They tried to up-sell me when I was in the chair during surgery. (sweden)
Countries like India where cataract surgery is for-profit tend to have higher success rates and broader accessibility than countries where it's not.
I’m not surprised. India produces very experienced surgeons due to the very high volumes of surgeries they’re able to perform. I think part of this is the high population from which to draw both doctors and patients coupled with the intensely competitive academics and standardized testing.
Source?
> 95 percent clinical success rate
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%.
0. https://my.clevelandclinic.org/health/treatments/21472-catar...I can so relate to this. I just had cataract surgery (both eyes) back in August. Amazing. The procedure took about 20 minutes, was totally pain free (thanks to anesthesia), and my vision is markedly improved. And even more important than the point that I can see better now, is that I just plain feel better and to a degree that's hard to put into words.
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 had cataract surgery about one year ago. Prior to surgery I needed glasses for longer distances (e.g. driving) but not for near objects like the computer screen or newspapers. I was not a candidate for the panoptix lenses for reasons not related to cataracts. Post surgery I have 20/20 vision for distance so no glasses. But for the computer screen I now need 1 diopter glasses and for newspapers or books I need 2.5 diopters, so two pairs of cheap drugstore glasses. This is livable, except when I have to work with a piece of paper and the computer at the same time. Switching glasses back and forth is a PITA. I got a set of bifocals but can't seem to get used to them. Sometimes I'll even scan the sheets of paper so I can also display them up on the screen.
I had heard that C-section was the most common surgery but that might just be in the US.
Before clicking on the link I assumed circumcision actually. Basically half the population has got it done :D
(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 falling pretty quickly, down to about ~60% of male infants as of 2022. General prevalence is higher (because that's how decreasing rates work), somewhere around 80%, but I'd suspect it's highly regional.
That's another good guess - whatever you think about it it's the surgery that's probably closest to being "routine".
If you wait a little it will go down on its own.
I was thinking maybe wisdom teeth extraction.
Common, but a lot of people never get it. Either they didn't grow wisdom teeth at all, or they aren't pressing into the rest of the teeth in a way to cause a problem, or they lack dental insurance.
It's one of those super low-priority surgeries for most people. I'm very glad I got it done myself, though!
Also that would come from a different data source, since it's a surgery done on luxury bones as opposed to regular bones.
Who's defining "surgery" here? Obviously not a dentist.
I was under the impression that modern replacement lenses could flex under muscular control like the lenses of pre-presbyopic people. That was not mentioned in the article though. I am not hoping for cataracts but I thought that would be a nice boon to having the surgery, not needing progressives.
> In 4,000 years, cataract surgery went from a crude procedure involving thorn instruments to a 20-minute operation with a 95 percent clinical success rate.
I did go “yikes” a bit at 95%, a 1 in 20 failure rate is pretty rough when its about your eyes
Anecdote: my mother in law had cataracts in both eyes in her mid 70s. She went to NYC to have the procedure done because there was a doctor there she was told was very good.
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.
Just guessing, but likely “clinical success rate” here doesn’t mean “didn’t make it worse” but actually means “improved the underlying condition significantly”.
The criteria for success seems to be "improved visual acuity"[1]. I tried to find what the failures actually looked like, but I hit a dead end[2].
[1] https://www.ncbi.nlm.nih.gov/books/NBK559253/ [2] https://news.ycombinator.com/item?id=45414718#45449810
I waited until I was mostly blind in my left eye and the right was maybe 6-9 months behind, assuming it continued to progress consistent with the left.
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.)
Many surgeries have a yikes success rate but when you need to do it you need to do it unfortunately.
True, but 95% success rate doesn't mean 1 in 20 people lost their eye or something dramatic.
True, but if the alternative is continuing to be blind?
Something missing from the article is the discovery of local anesthetic (cocaine) by Dr. Carl Koller an opthamologist in 1884. It must have improved the success rate tremendously.
This was a really interesting read, and really makes me appreciate how much medical technology has improved. I have been considering getting ICL surgery or similar for years, but the improvements are still happening and I find that I wait 5 years or so and something new is developed. At some point I will get eye surgery, but until then, I'm very happy to see that we continually improve.
Any opinions on the best IOL? My understanding is the trifocal are best if you want to go without glasses but they also have the halos at night because they are diffractive.
There’s a new spiral lens that hasn’t been FDA approved that sounds promising: RayOne Galaxy
Flud vision IOL has been in trials for years and looks very promising. Unless you really need an IOL NOW, I'd wait a few years for accommodating IOLs to hit the market. They make monofocals/trifocals seem like medieval technology as they work at all distances, in the same manner as a natural lens (ie. continuous focus). For someone with myopia/presbyopia, they're an occular enhancement that can give better than 20/20 vision.
Is there some way to prevent cataracts, or is that just another unavoidable fact of ageing, like graying hair.
Wear sunglasses (or your regular uv-protective polycarbonate glasses), even when it’s not real sunny out.
The only thing that's really guaranteed is presbyopia in middle age. The lens will become harder and you will not be able to focus on near objects as well.
I had cataracts when I was 48 and my ophtalmologist told me that everybody gets cataracts but there are factors that make it appear sooner, like smoking (and yes, I am a smoker). But it's more or less unavoidable.
While protein buildup is somewhat natural with aging, my understanding is that e.g. looking into the sun too much (which exposes your eyes to UV light, among other things) exacerbates it.
Cataracts aren’t about age. They happen when the lens loses energy and the water inside it loses structure. Getting real sunlight, eating for metabolism, and avoiding stress and fake blue rich light keeps your eyes clear and alive.
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.
There's no evidence that "fake blue rich light" at normal exposure levels has any effect, and not for lack of investigation. Ironically, "real sunlight" which you highlight as a benefit is actually a risk factor, given that UV-B and UV-A damage the lens - which is why sunglasses are recommended.
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.
>the water inside it loses structure.
It isn't the water that loses structure (how could it?), but the proteins that constitute the lens material.
More common than needing stitches? That’s hard to believe.
Yeah, their claim that it is the most common procedure is incorrect. There are more colonoscopies performed every year, too. I followed the citations and they are citing a 2007 paper that was meta-analysis regarding cost effectiveness of cataract surgery, so the claim gets more dubious the deeper you dig.
The article is still interesting, but they probably should have left that claim out.
Well, it's also an indicator for how well its other claims would hold up if you dug deeper on them too.
The article is pumped from a low income country, where they have questionable research procedures. What can you expect?
The SIVA foundation and the Hellen Keller institute are going NGOs to fund to help with those surgeries in third-world countries
Only 95% success? That is actually pretty bad, as anyone who has rolled a d20 enough times knows.
The 95% rate sounds good. But I routinely run into some of that 5%. It's not zero or even 1%.
I have mild cataracts and myopia. Should I get IOL lens or do ReLEx SMILE?
The first recorded instance of cataract surgery was in 600BCE India.
https://en.wikipedia.org/wiki/History_of_cataract_surgery
> 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).[
I meant recorded as in procedure, but yes earlier depictions were present. I looked at the picture and the interpretation of the tool that is depicted is still kind of vague.
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A lot of times those 5% people go blind :/
I was trying to track down what the 5% failure looks like. The article source is here[1] for the 95% stat, which then references here[2], but I honestly can't find it, [2] refers to "Recent studies reveal that in most of the cases, the prognosis is excellent after surgery, almost 70 to 80%", which refers to here[3], which seems to refer to patient happiness(?), so I haven't the foggiest where that 5% stat comes from.
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/
I was shocked when I saw a 5% failure rate, I would not take those odds.
Well the alternative is to go blind due to cataracts... So those are pretty good odds.
It's probably per-eye, right?
1 in 400 go blind, 19 in 400 become pirates, I assume something along the lines of The Crimson Permanent Assurance.