Unfortunately, couching is a traditional procedure that is still used today in parts of the world like Northern Nigeria and West Africa due to a multifactorial combination of unfamiliarity of modern procedures, fear of surgery, and preference of relying on traditional methods. Some common complications include secondary glaucoma, hyphema, endophthalmitis, and often results in blindness. However, the lack of aseptic technique and rough nature of the procedure resulted in poor outcomes. One of the earliest surgical interventions for cataracts, dating as early as the 5th century BC, was a technique called couching, which comes from the french word “coucher” meaning “to put to bed.” In this method, a sharp needle is used to pierce the eye near the limbus until the provider can manually dislodge the cataract - typically into the vitreous chamber - and out of the visual axis. Mature cataract Previous Surgical Methods Couching Fortunately, because of advances in technology, cataracts can now be removed and replaced with an intraocular lens (IOL) with a low complication rate. When cataracts cause visual impairment, surgical intervention is currently the only method for treatment. Prior to the 1700s some people thought cataracts were caused by opaque liquid material flowing through the lens hence the etymology of cataract is from the Latin word “cataracta” which means waterfall - or perhaps because sometimes a dense cataract can resemble one to the imaginative viewer. For this reason, it is not surprising that cataracts are a leading cause of blindness worldwide affecting over 20 million in 2010, with the incidence projected to increase. There are many causes and risk factors for developing a cataract, however the most common cause is a senile cataract in which the clouding of the lens is caused by aging. 1.2.3 Intracapsular Cataract ExtractionĪ cataract is a pathologic condition in which the lens of the eye becomes opacified causing changes in vision that may include blurriness, color changes, halos around light, and at its worst blindness.1.2.2 Extracapsular Cataract Extraction.

Pathological fear or needles