Ancient Cataract Surgery

  • By Anna Rothschild
  • Posted 09.24.15
  • NOVA

Doctors have attempted to remove cataracts for thousands of years, and the results weren't always pretty. In this episode of Gross Science, learn about the history of cataract surgery, and the safer and more effective methods doctors use today. 

Running Time: 02:39


Ancient Cataract Surgery

Posted: September 24, 2015

Lots of people get cataracts in their eyes as they age. And for most of human history, surgeons couldn’t really help... But that didn’t stop them from trying.

I’m Anna Rothschild, and this is Gross Science.

The lens of your eye is a clear structure that sits just behind the iris and helps focus the light coming in. But sometimes the aging proteins in the lens clump together and form a white spot. This is a cataract, and it makes your vision cloudy. This happens to more than half of Americans by the time they turn 80, and it’s not a new phenomenon. Surgeons started operating on cataracts thousands of years ago—long before they knew what the lens even did. And before anesthesia. So patients could feel every slice and jiggle.

An early description of cataract surgery comes from the Indian doctor Sushruta, over 2500 years ago. First, he said, use a sharp tool to poke into the eyeball. Then, sprinkle the eye with breast milk. The last step is a little unclear, but while the patient blows air out of one nostril, the doctor should attempt to either remove the lens or push it down into the eyeball.

Dislodging the lens and pushing it into the eye is called “couching.” And doctors in many countries throughout the ancient world practiced it. You might think the surgery became so popular because it worked well—but you’d be wrong. Couching did let light back into people’s eyes. But because it left their lenses out of place, their vision was completely unfocused. They often went blind from the procedure, assuming they didn’t first die of infection.

Believe it or not, couching is still performed in some countries in the developing world. But today, most people with cataracts are lucky to have some better options. Surgeons can use a tiny incision of just two or three millimeters to reach the cloudy lens and break it up with ultrasound before removing it. Then they can slide in a brand-new lens.

Interestingly, the first artificial lenses were inspired by World War II fighter pilots. Sometimes shrapnel from shattered windshields got lodged in these pilots’ eyeballs. A British eye doctor realized that the windshield bits could stay in their eyes without a problem, so he used the same material to build the first replacement lenses. So now, when patients have cataract surgery, they can actually see afterwards.

Eyeballs are gross... Ew.



Host, Animator, Editor
Anna Rothschild
Elizabeth Preston
DP, Sound
Ceri Riley
Gulag Archipelago
Composed and Performed by
Tim Cahill and Benjamin Ouellette


Cataract in human eye
Wikimedia Commons/Rakesh Ahuja, MD
WMS 990 Monk performing eye operation Wellcome L0041072
Wikimedia Commons/Wellcome Images
Augenoperation 1195
Wikimedia Commons/British Library MS Sloane 1975, f. 93.
Couching for cataract. Wellcome L0021165
Wikimedia Commons/Wellcome Images
Operation for Cataract. Wellcome M0007416
Wikimedia Commons/Wellcome Images
Operation on the eye Wellcome M0007426
Wikimedia Commons/Wellcome Images
Sustruta. Pen drawing. Wellcome V0006619
Wikimedia Commons/Wellcome Images
Navy Fighter Pilots Aboard a British Aircraft Carrier. 4 January 1943, Aboard HMS Formidable. A14193
Wikimedia Commons/Imperial War Museums, Roper F G (Lt)
Whirlwindfighterproject FA 18181s
Wikimedia Commons/Royal Air Force official photographer
Cataract Surgery


(used with permission from author)
Squeak Pack/squeak_10
Produced by WGBH for PBS Digital Studios


Operation for Cataract. Wellcome M0007416
Wikimedia Commons/Wellcome Images


Want more info?

Facts About Cataracts from the National Eye Institute:

More on Sushruta:

Couching in the Modern World:

More on the development of the first replacement lenses:

Sawbones Podcast on Cataracts:

Related Links