Roman cataract surgery

For the past week, I’ve been suffering from the flu, and while I’m slowly improving, it did make me think a bit more about our upcoming issue on medical matters. I, for one, am very happy to be alive today rather than a thousand or two thousand years ago, since our medical knowledge has come a long way over the course of our species’ relatively recent history.

But there is at least one form of treatment that was fairly advanced even in ancient times. Back then, eye problems were especially common. As a result, ancient peoples developed fine instruments and various ways to treat common ailments. A good example are cataracts. Cataracts develop in the lens near the front of the eye and eventually cloud one’s vision. A person with cataracts develops a greyish sheen to the eyes and eventually may go completely blind.

Today, cataracts are fairly easy to treat, for example by having the lens sonically disintegrated, sucked out, and then replaced by an artificial lens that is inserted into the eye after making a tiny hole. An operation like that is fairly routine nowadays. My own mother had cataracts in both eyes and after treatment – one eye one day, the other the next – she was even able to see again without even needing to use the spectacles she had otherwise used her entire life.

Such advanced techniques were beyond the capabilities of ancient peoples, but they still had a pretty sophisticated method of dealing with cataracts. The medical texts written by Cornelius Celsus, who lived during the reign of the Emperor Tiberius (r. AD 14–37), include a detailed description of a cataract operation (7.7.13–14; transl. Greive):

I have elsewhere already mentioned cataract […] when of long standing, it requires a manual operation, which may be ranked among the most delicate in surgery. […] The left eye must be couched with the right hand, and the right with the left. Then either a needle with a cutting edge, or at all events one not too fine, is to be pushed directly through the two outer coats [of the eye], at the part which is mediate between the black of the eye and the temporal angle [= the angle adjacent to the temple], opposite to the middle of the cataract, so as not to wound a vein. Nor should it be introduced with timidity; for it enters a space that is void. […] When it has arrived there, the needle is to be directed towards the cataract [= lens], and gently rotated there; [cut and then] press it somewhat more strongly, in order that it may settle at the bottom. If it remain there, the cure is complete: it it repeatedly return to its former position, it must be broken up and cut into pieces with the same needles.

The technique advocated here is called ‘couching’. It involves inserting a needle and cutting loose the clouded lens at one end and then pushing it down further towards the bottom of the eye ball. While eye sight will never be perfect, this has been shown to restore a measure of eye sight to those afflicted and will be seen as a vast improvement over the earlier situation, especially if the patient was virtually blind before. Needles of the kind mentioned in Celsus’ text have indeed been found archaeologically.

Here’s a diagram that clarifies better how the procedure worked:

Celsus’s text is the earliest western text that mentions the treatment of cataracts. The Romans could conceivably have acquired the knowledge from further east. The Hindu text Sushruta Samhita has a long section on eye diseases and also includes a detailed discussion of cataracts, but the date of the text’s compilation is a source of contention: some claim it’s as early as 600 BC, while others believe it dates to the Christian era.