[HN Gopher] The history of cataract surgery
___________________________________________________________________
The history of cataract surgery
Author : mailyk
Score : 181 points
Date : 2025-09-29 15:04 UTC (3 days ago)
(HTM) web link (www.asimov.press)
(TXT) w3m dump (www.asimov.press)
| kvmet wrote:
| 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.
| rogerrogerr wrote:
| 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.
| catlikesshrimp wrote:
| 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.
| pantulis wrote:
| > 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.
| traceroute66 wrote:
| > 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.
| tlavoie wrote:
| 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.
| BrokenCogs wrote:
| 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.
| kragen wrote:
| Countries like India where cataract surgery is for-profit tend
| to have higher success rates and broader accessibility than
| countries where it's not.
| BrokenCogs wrote:
| Source?
| chongli wrote:
| 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.
| Snoddas wrote:
| They tried to up-sell me when I was in the chair during
| surgery. (sweden)
| cactusfrog wrote:
| A lot of times those 5% people go blind :/
| jelsisi wrote:
| I was shocked when I saw a 5% failure rate, I would not take
| those odds.
| BrokenCogs wrote:
| Well the alternative is to go blind due to cataracts... So
| those are pretty good odds.
| moduspol wrote:
| It's probably per-eye, right?
| SketchySeaBeast wrote:
| 1 in 400 go blind, 19 in 400 become pirates, I assume
| something along the lines of The Crimson Permanent
| Assurance.
| SketchySeaBeast wrote:
| 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/
| madcaptenor wrote:
| I had heard that C-section was the most common surgery but that
| might just be in the US.
| runxel wrote:
| 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.)
| onychomys wrote:
| I was thinking maybe wisdom teeth extraction.
| Night_Thastus wrote:
| 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!
| madcaptenor wrote:
| Also that would come from a different data source, since
| it's a surgery done on luxury bones as opposed to regular
| bones.
| OkayPhysicist wrote:
| 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.
| madcaptenor wrote:
| That's another good guess - whatever you think about it it's
| the surgery that's probably closest to being "routine".
| bregma wrote:
| If you wait a little it will go down on its own.
| phito wrote:
| I thought the first picture of the article was an USB-C
| connector...
| yapyap wrote:
| > 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
| kragen wrote:
| True, but if the alternative is continuing to be blind?
| efitz wrote:
| Just guessing, but likely "clinical success rate" here doesn't
| mean "didn't make it worse" but actually means "improved the
| underlying condition significantly".
| SketchySeaBeast wrote:
| 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
| zindlerb wrote:
| Many surgeries have a yikes success rate but when you need to
| do it you need to do it unfortunately.
| k__ wrote:
| True, but 95% success rate doesn't mean 1 in 20 people lost
| their eye or something dramatic.
| tasty_freeze wrote:
| 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.
| jmull wrote:
| 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.)
| arethuza wrote:
| 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!
| Snoddas wrote:
| My mom got angry and asked why no one had told her how wrinkly
| she'd gotten.
| sowbug wrote:
| 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_!
| rockercoaster wrote:
| 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.
| MandieD wrote:
| 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.
| pantulis wrote:
| A factoid: probably Johan Sebastian Bach died from eye surgery
| complications.
|
| https://interlude.hk/did-johann-sebastian-bach-die-from-eye-...
| colinbartlett wrote:
| Reading about historical cataract removal methods was...
| difficult.
|
| I feel truly lucky to have been born into a time of modern
| medicine.
| selimthegrim wrote:
| Wait till you hear about how they used to wake people up before
| smelling salts (hint: they used it on horses too)
| pedro_caetano wrote:
| > 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.
| m0llusk wrote:
| 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.
| nluken wrote:
| 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.
| onlyrealcuzzo wrote:
| 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.
| pantulis wrote:
| 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.
| JadeNB wrote:
| It sounds like it _must_ inevitably be uncomfortable and
| stressful--why do they do it with the patient awake?
| junikaefer wrote:
| 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.
| pantulis wrote:
| 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".
| craftkiller wrote:
| > 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?
| el_benhameen wrote:
| 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.
| craftkiller wrote:
| 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.
| el_benhameen wrote:
| 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.
| xp84 wrote:
| 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.
| bregma wrote:
| 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.
| pndy wrote:
| 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.
| BXLE_1-1-BitIs1 wrote:
| 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.
| pantulis wrote:
| 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!
| mschaef wrote:
| 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.
| pndy wrote:
| 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.
| eyeundersand wrote:
| His name is Sanduk Ruit and he's Nepali. A huge inspiration!
| pndy wrote:
| 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
| Alex3917 wrote:
| More common than needing stitches? That's hard to believe.
| codingdave wrote:
| 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.
| Tzt wrote:
| Well, it's also an indicator for how well its other claims
| would hold up if you dug deeper on them too.
| navigate8310 wrote:
| The article is pumped from a low income country, where they
| have questionable research procedures. What can you expect?
| everdrive wrote:
| 95% success rate is actually a bit lower than I realized, and is
| somewhat scary.
| nwah1 wrote:
| 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.
| Jonovono wrote:
| 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
| pantulis wrote:
| You will risk it, eventually. Cataracts appear and get worse
| to the point of you becoming blind.
| Jonovono wrote:
| I suppose in that case, possibly. I more mean for people
| that are doing it for cosmetic reasons (not to wear
| contacts)
| pantulis wrote:
| Oh, hard agree on that!
| eloisant wrote:
| You're thinking about Lasik, this is different from
| cataract surgery.
| searine wrote:
| 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.
| bell-cot wrote:
| Who's defining "surgery" here? Obviously not a dentist.
| adolph wrote:
| > 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%. Retinal
| detachment, affecting 2 in 1,000 people. Infection,
| affecting fewer than 1 in 1,000 people.
|
| 0.
| https://my.clevelandclinic.org/health/treatments/21472-catar...
| phyphy wrote:
| The first recorded instance of cataract surgery was in 600BCE
| India.
| mac3n wrote:
| 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).[
| xhkkffbf wrote:
| The 95% rate sounds good. But I routinely run into some of that
| 5%. It's not zero or even 1%.
| Qem wrote:
| Is there some way to prevent cataracts, or is that just another
| unavoidable fact of ageing, like graying hair.
| jacobgkau wrote:
| 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.
| pantulis wrote:
| 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.
| jabroni_salad wrote:
| 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.
| el_benhameen wrote:
| Wear sunglasses (or your regular uv-protective polycarbonate
| glasses), even when it's not real sunny out.
| crisdux wrote:
| 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.
| 542458 wrote:
| 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.
| pcrh wrote:
| >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.
| tristor wrote:
| 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.
| jtwaleson wrote:
| 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.
| majormajor wrote:
| 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.
| recursive wrote:
| This is what makes Electron apps.
| givemeethekeys wrote:
| 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.
| soperj wrote:
| > - The massive amount of soul crushing paper work in the
| West.
|
| This sounds like a problem in the US only.
| jtwaleson wrote:
| Not sure how much worse it is in the US, but here in NL
| it's a huge problem for GPs too.
| BrandoElFollito wrote:
| No doctors ever deal with insurance companies in France
| matsz wrote:
| 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.
| lithocarpus wrote:
| 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.)
| TheJoeMan wrote:
| You'd accept a 1 in 20 chance of acquiring a staph
| infection?
| zamadatix wrote:
| Depending how bad my situation was and what my
| alternative options are.
| soperj wrote:
| don't you have that just going to the hospital now a
| days?
| LeifCarrotson wrote:
| 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.
| jtwaleson wrote:
| Exactly this. 10x the experience is very valuable.
| TrainedMonkey wrote:
| 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.
| elSidCampeador wrote:
| 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.
| 1-more wrote:
| 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-...
| koolba wrote:
| >> 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!
| zer00eyz wrote:
| > 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
| tyre wrote:
| 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.
| oulipo2 wrote:
| The SIVA foundation and the Hellen Keller institute are going
| NGOs to fund to help with those surgeries in third-world
| countries
| stoneman24 wrote:
| 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
| vhcr wrote:
| https://www.ncbi.nlm.nih.gov/books/NBK559253/
| pcrh wrote:
| 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/
| nick__m wrote:
| 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.
| trashface wrote:
| Only 95% success? That is actually pretty bad, as anyone who has
| rolled a d20 enough times knows.
| mindcrime wrote:
| 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.
| 3shv wrote:
| I have mild cataracts and myopia. Should I get IOL lens or do
| ReLEx SMILE?
| SomeHacker44 wrote:
| 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.
| southernplaces7 wrote:
| 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.
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