January 14, 2019History of Medicine
Glaucoma has been known in medicine since Antiquity. Hippocrates described glaykoseis as blindness which occurs in the elderly. To the ancient Greeks, glaukos occasionally described diseased eyes, but more typically described healthy irides, which were glaucous (light blue, gray, or green). During the Hippocratic period, a pathologic glaukos pupil indicated a media opacity that was not dark. Although not emphasized by present-day ophthalmologists, the pupil in acute angle closure may appear somewhat green, as the mid-dilated pupil exposes the cataractous lens. The ancient Greeks would probably have described a (normal) green iris or (diseased) green pupil as glaukos.
During the early Common Era, eye pain, a glaucous hue, pupil irregularities, and absence of light perception indicated a poor prognosis with couching (lens depression). Galen associated the glaucous hue with a large, anterior, or hard crystalline lens. Medieval Arabic authors translated glaukos as zarqaa, which also commonly described light irides. Ibn Sina (otherwise known as Avicenna) wrote that the zarqaa hue could occur due to anterior prominence of the lens and could occur in an acquired manner. The disease defined by the glaucous pupil in antiquity is ultimately indeterminate, as the complete syndrome of acute angle closure was not described. Nonetheless, it is intriguing that the glaucous pupil connoted a poor prognosis, and came to be associated with a large, anterior, or hard crystalline lens.
Eye surgery by couching is one of the oldest surgical procedures. The technique involves using a sharp instrument to push the cloudy lens to the bottom of the eye. Perhaps this procedure is that which is mentioned in the articles of the Code of Hammurabi (ca. 1792-1750 BCE). However, Maharshi Sushruta, an ancient Indian surgeon, first described the procedure in Sushruta Samhita, Uttar Tantra, an Indian medical treatise (800 BCE). Since then the procedure was widespread throughout the world. Evidence shows that couching was widely practiced in China, Europe and Africa. After the 19th century CE, with the development of modern cataract surgery (Intra ocular extraction of lens (1748)), couching fell out of fashion, though it is still used in parts of Asia and Africa. In couching, a sharp instrument, such as a thorn or needle, is used to pierce the eye either at the edge of the cornea or the sclera, near the limbus. The opaque lens is pushed downwards, allowing light to enter the eye. Once the patients sees shapes or movement, the procedure is stopped. The patient is left without a lens (aphakic), therefore requiring a powerful positive prescription lens to compensate. However, couching is a largely unsuccessful technique with abysmal outcomes. A minority of patients may regain the ability to sense light and some movement, but over 70% are left totally blind.
The important invention of the ophthalmoscope by von Helmholtz (1850) made it possible to diagnose glaucomatous changes in the fundus. In 1862, Donders discovered that high intraocular pressure caused blindness and called the disease Glaukoma simplex. Further progress in the diagnosis of glaucoma was made by the invention of the tonometer and the perimeter, and the use of cocaine. The first effective surgical treatment of glaucoma, an iridectomy, was carried out by von Graefe in 1856. Drug treatment started in 1875 with the discovery of pilocarpine.
The English ophthalmologist Richard Banister was the first to establish the connection between increased tension of the eyeball and glaucoma. Banister was an English oculist of Stamford, Lincolnshire. He was educated under his relative, John Banister, the surgeon. He devoted himself especially to certain branches of surgery, such as ?the help of hearing by the instrument, the cure of the hare-lip and the wry-neck, and diseases of the eyes.' He studied under various persons eminent in these subjects, among whom were ?Henry Blackborne, Robert Hall of Worcester, Master Velder of Fennie Stanton, Master Surflet of Lynn, and Master Barnabie of Peterborough.' To complete his education he studied the works of authors such as Rhazes, Mesne, Fernelius, and Vesalius.
Banister established himself in Stamford, and acquired considerable reputation as an oculist. He was in demand in all the nearby large towns, and was even asked to go to London. He appears to have performed numerous operations for cataract, and to have cured twenty-four blind persons at Norwich, of which he obtained a certificate from the mayor and aldermen. In 1622 Banister published a second edition of a Treatise of One Hundred and Thirteen Diseases of the Eyes and Eyelids, with some profitable additions of certain principles and experiments, by Richard Banister, oculist and practitioner in physic. It is a translation from the French of Jacques Guillemeau, made by one A. H., and at its first publication dedicated to the elder Banister. Guillemeau was a distinguished surgeon at the courts of Charles IX, Henry III, and Henry IV of France, and his work, Traite des Maladies de l'OEil (Handbook for treatment of ailments of the eye), was published in Paris in 1585, and at Lyon in 1610, and was translated both into Flemish and into German. The English translation by A. H. having become out of print, a second edition was published in 1622 by Richard Banister, together with an ?appendant part' called Cervisia Medicata, Purging Ale, with diverse aphorisms and principles. The work received the name of Banister's Breviary of the Eyes in which the curative properties of Malvern water are also mentioned. In this treatise he names the best oculists for the last fifty or sixty years, not university graduates. Banister was buried at St. Mary's, Stamford, Lincolnshire, 7 April 1626. His wife Anne was buried there 16 April 1624.
The association of elevated intraocular pressure (IOP) and the eye disease glaucoma, first described by Englishman Richard Bannister in 1622:
...that the Eye be grown more solid and hard, then naturally it should be....
Sources: NIH.gov; Research to Prevent Blindness Unrestricted Grant to the University of Miami; Wikipedia