Cataracts are to the eyes as wrinkles are to the skin.  They are an inevitable part of ageing, and the older one lives, the more pronounced the cataracts get.  Some cataracts never get problematic enough to warrant removal, while others do.  Current cataract surgery consists of a surgeon utilizing a small tool to enter the eye and remove the cataract via suction after it is has been broken down into small fragments with either a laser or ultrasonic waves. It is performed using a very small incision into the front of the eye, and is completed with the insertion of a new crystal-clear lens into the eye at the spot the cataract had previous resided.  With advances in technology, surgeons have become incredibly accurate at performing this procedure, and with the continued improvements in the vision enjoyed post surgery (to the point where eyesight after cataract surgery may no longer require glasses), the procedure is being performed sooner than ever, before cataracts even have the slightest chance to reduce quality of life.  Today, cataract surgery is the most commonly performed surgery in North America, and boasts success rates touching 99%.  In fact, people will now elect to get cataract surgery even before the cataract is "ripe",  just to rid themselves of glasses.

Cataract surgery hasn't always enjoyed these levels of success, and when combined with the tremendous prevalence of cataracts and their sight-robbing abilities, it's not hard to imagine the outsized impact this particular eye disease has had on human history and culture.  One particular interesting (or terrifying) case involves the famous 18th century German composer, Johann Sebastian Bach and a quack doctor named John Taylor.

  Couching procedure has been around since atleaset 600 BC, and is still practiced in certain areas of Africa, where a needle or thorn is used to push the catarct out of the way.  The risk of blindness can apporach 80%.

Couching procedure has been around since atleaset 600 BC, and is still practiced in certain areas of Africa, where a needle or thorn is used to push the catarct out of the way.  The risk of blindness can apporach 80%.

Bach had begun to notice his vision was failing in his fifties, and was becoming increasingly frustrated with his rapidly deteriorating eyesight, which at the time was correctly attributed to cataracts.  He was desperate for help.

At the same time, an occulist named John Taylor was travelling around Europe drumming up business for himself.  He dubbed himself "Ophthalmiater Royal", and was the self-proclaimed personal eye-surgeon of King George II and the pope.   He was a shameless self-promoter in the truest sense, and was more of a PT Barnum than anything resembling a medical doctor.   History now shows that he had already blinded hundreds of patients in Switzerland before he took his show on the road.  He would set up his tent in the centre of town, and attract huge crowds to come and watch him "restore sight" and "fix eyes".  At the time, tales of people having their eyes being fixed by Taylor on the spot where legendary.  Have a crossed eye?  No problem, a small nick to the bad eye to draw some blood for dramatic effect, and quick bandage over the good eye would instantly straighten the lazy eye, to the crowds roaring approval.  The patient would be whisked off the stage, with strict instructions about not taking the bandage off the good eye for 1 week to allow the eye "to set" properly.   Now, as any person with a lazy eye knows:  if you cover the good eye, the lazy eye always straightens itself until the good eye is uncovered again, at which time the eye returns to being crossed.  So by the time the patient finally removed his bandages, Taylor was long gone and onto his next victim in the next town by the time the hoax was revealed.  Cataracts surgery was of a similar style, involving an instant "fix" to the approval of the crowd, with the true outcome of the surgery only to be observed weeks after (although instead of a reversion back to a pre-surgery state, as in the lazy eye example, this was more sinister:  the days following cataract surgery by Taylor included an extreme likelihood of permanent blindness.)  

The clear glass-like object located towards the front the eye is the crystalline lens, which becomes cloudy when a cataract is present. In couching, the lens is simply knocked out of its 'holder', whereas in present day surgery its actually broken down and removed to avoid complications.

In March 1750, Taylor performed surgery on both of JS Bach's eyes. Taylor performed a variant of cataract surgery known as "couching", in which the crystalline lens (and the cataract it contains) is simply pushed out of the way using a needle inserted into the front of the eye.  Contrast this to modern day cataract surgery, in which the crystalline lens (and cataract) is broken up and removed out of the eye.  Couching was the predominant method of cataract surgery at the time, and had been performed since at least 600 BC. It had a terrible success rate all throughout history, which goes to show just how desperate cataract patients were to at least attempt to regain vision in the face of such high risks.  (Sadly, couching is still practiced in certain areas of sub-Saharan Africa, mainly due to lack of access to proper medical care, and unfortunately, tradition.)

Setting aside the lack of anesthesia, or the lack of any understanding of bacteria and sterile technique, the simple fact that the cataract is not actually removed in a couching procedure, but simply knocked out of the way and left inside the eye like a sunken ship wreck is shocking.  The lens material left in the eye can bounce around leading to a retinal detachment or cause an intense inflammatory reaction as the body tries to attack it.  But most likely, it can cause glaucoma, since the extra material stuck in the eye can clog up some pretty important "drainage grates" in the eye, resulting in a backup of fluid in the eye, and leading to a subsequent painful increase in eye pressure.  It is this high eye pressure that squeezes on the optic nerve and causes blindness, and it is thought that glaucoma secondary to "couching" is what led to Bach's blindness.  Sadly, this was very painful, and the treatments imparted on Bach to alleviate his pain likely worsened his health further, to the point where he ultimately passed away 4 months after the surgery.

John Taylor continued on, leaving a trail of blindness in his wake, including blinding another famous composer, George Frideric Handel in 1751.  Eventually he either ran out of victims, or his butchering ways caught up with him, and he lived out the rest of his life in obscurity, dying in 1772 penniless and, ironically, blind. 

 

Dr. Burke is an optometrist practicing at Calgary Vision Centre.  He is definitely not an "Ophthalmiater Royal".  Opinions above do not constitute medical advice, and readers should consult with their optometrist if they have questions or concerns about their eye health