When we see how technologically forward and advanced modern-day medicine is, we forget that it is also an age-old, ancient profession with a rich, intriguing history that we remain unaware of.
Ophthalmology in particular has always been at the forefront of medical innovation, but its archaic history is so drastically different from present day practices that some concepts, while ingenious at the time, seem almost bizarre to think about now. Here are my top five moments in ophthalmology that revolutionised the field and changed the way we approach eyecare.
Ancient couching in India (~6th Century BCE)
My curiosity began when I was watching a show from the 1900s in which one of the characters was in hospital for a week for recovery following cataract surgery. It got me thinking how we went from that scenario to having patients go home within hours of having the same procedure. Delving deeper into history, I came across the fascinating story of how the first ever cataract surgery was conducted back in 6th Century BCE.
Sushruta, the father of Indian surgery, describes in his compendium, the Sushruta Samhita, how he would use a curved needle to dislodge an opaque lens into the vitreous cavity, which resulted in the restoration of vision to a certain degree. This excerpt not only marks the earliest documentation of ophthalmic surgical instruments, but also showcases how even thousands of years ago, people believed in the concept of sight being restorable. By modern standards, the procedure, termed as couching, was neither safe nor precise, with no pain relief, sedation or sterility, but this only makes us admire how far innovation has brought us.
The invention of the ophthalmoscope (1851)
The ophthalmoscope, an ophthalmologist’s second in command during every consultation, is a device that looks simple and yet is vital to formulate diagnoses, and it was not always around. Before Hermann von Helmholtz, a young 29-year-old physiology professor, people had only speculated about what lay behind the pupil of the human eye. Helmholtz’s invention of the ‘eye mirror’ in 1851 seemed like a straightforward creation. All he used was a source of light, a reflective surface and an optical system to sharpen the image of the fundus – three elements that hold firm even today. He himself did not realise its diagnostic potential at first and simply wanted to demonstrate to his students why the pupil sometimes appeared darker or lighter in certain conditions. Over the years, the ophthalmoscope went through several ‘makeovers’, with the light source being changed from candlelight to modern-day built-in LEDs and went from looking like a magnifying glass hammer to the sleek handheld device we see in clinics today.
Contact lenses: innovation through centuries
There are 150 million contact lens users in the world at present. Hypothetically, if we reinstated the first ever design of contact lenses, this number would probably be next to zero. In 1649, René Descartes suggested that a fluid-filled glass tube placed directly in contact with cornea was the key to vision correction. This, as one can imagine, was not a successful idea as it prevented patients from blinking at all. The thought however was not forgotten, and in the late 1880s the first see-through and well-tolerated eye coverings were made in Germany. These lenses, called Fick’s lenses, were made of heavy blown glass and had a diameter of about 20mm. While they managed to correct myopia, they proved to be cumbersome, uncomfortable and had a longevity of only two hours.
Fast forward to World War II; air force pilots found themselves encountering a recurring problem: conditions were dusty and gruesome to begin with, and wearing clunky glasses only added to their list of things to worry about. They needed safer, more efficient vision correction, that did not go foggy or get immediately crushed on impact. Thus, out of pure desperation and necessity, better contact lenses were born. Wartime surgeons, whilst managing devastating ocular trauma, were also pushing forward techniques for corneal repair and artificial eyes as their contribution towards battlefield intervention. In 1944, Norman Bier finally introduced his fenestrated lens that allowed overnight wear by relieving corneal hypoxia. This story serves as a great example of how medical innovation can be driven by urgency, and sometimes even by something as destructive as war.
The first corneal transplant: the eye that saw twice
In 1905, Eduard Zirm, a surgeon from Olomouc decided to attempt something that had not been achieved in the medical world before: restoring sight in a blind eye. His patient, a farm labourer called Alois Glogar, had lost vision in both eyes after a devastating lime burn. As fate would have it, at the very same time he was presented with another young patient who had to have his eye removed due to ocular trauma. Zirm realised that the boy’s cornea was still healthy and decided to transplant it onto Glogar’s eyes. With the young boy’s consent, Zirm meticulously extracted small discs of tissue from the donor eye and using fine sutures (which would be considered primitive by today’s standards) carried out the first ever corneal graft transplant. The infection risk was high, the procedure was arduous, and the people were skeptical, but much to everyone’s surprise one of the grafts took. Zirm had executed the miracle no one thought possible and for the first time in history, a blind man could see again. His pioneering surgery laid the foundation for modern keratoplasties, and what seemed like a science fiction story back then is now considered common practice.
Intraocular lenses: learning from wartime injuries (1949)
The list of the medical innovations during WWII does not end at contact lenses, Harold Ridley, an English ophthalmologist, observed something curious during wartime: pilots with Perspex shrapnel lodged in their eyes did not have an immune reaction to their injuries. Shortly after the war, in 1949, Ridley developed an intraocular lens (IOLs) using Transpex, a modification of Perspex, which he already knew was well tolerated by soldiers. He decided to test his newest creation in an extracapsular cataract extraction that he performed on a 45-year-old female patient. Unfortunately, Ridley was not convinced that his lens was adequately stable and was concerned that his sterilisation technique using cetrimide could cause uveitis. As a result, he immediately removed the lens and spent more time modifying the IOL. Ridley faced immense criticism and resistance from his peers, but his beliefs did not falter. In 1950, he successfully implanted an improved version of the IOL on the very same patient. Ridley’s innovation turned cataract surgery from reductive to restorative, and today 28 million people undergo cataract surgery every year, benefitting from his breakthrough. The IOL technology has gone through extensive changes through the years, but even at present day, 80–90% of patients use the contemporary monofocal design – a direct descendant of Ridley’s original model, with others using more advanced versions used to correct problems like presbyopia and astigmatism, to mention a couple.
Conclusion
All these are not just facts or tales, they are windows into how far innovation, science and human curiosity have brought us. From experiments that no one believed in, to the simple skill of observation and patience – progress can come from different sources. Who knows? The next big discovery in eyecare (or any other field) could be taking shape this very moment.
References
1. Güell JL, El Husseiny MA, Manero F, et al. Historical review and update of surgical treatment for corneal endothelial diseases. Ophthalmol Ther 2014;3(1–2):1–15.
2. www.selectspecs.com/blog/history-of-contacts/
srsltid=AfmBOoqtukfBIr5jwNq0RqEbx8FY6BvTn
NJRlOJqY_nGCTIwEYK89xr
[Link last accessed March 2025]
3. Leffler C. The History of Ophthalmology – The Monographs volume 17: A New History Of Cataract Surgery: Part 2 From 1751 through the Modern Era. Amsterdam, Netherlands; Wayenborgh Publishing; 2024.
4. Shah S. Ophthalmology in ancient time – the Sushruta Samhita. J Clin Ophthalmol Res 2018;6(3):117.
Declaration of competing interests: None declared.
