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19th and 20th century cataract surgery
Sokka looking proud
chordatesrock wrote in little_details
Fandom-specific explanation of the setting: post-Avatar: The Last Airbender, pre-Legend of Korra.

Non-fandom-specific explanation: The setting is non-real-world, based mainly on China, with Japanese and Inuit influences, among others. However, inventions that were, in our world, invented in other countries, occasionally show up in this setting, so don't feel limited by that. I haven't decided exactly how old I want a major character to be, which will affect the time period my fic is set in, but the technological level is probably going to be analogous to our world between the 1850s and the 1920s. I know that's a broad range.

Googled: cataract surgery in 1850s China, history of radio (part of how I pinned down the time period), history of cataract surgery, von Graefe cataract, congenital cataracts in adults surgery, idiopathic congenital cataract. I also looked at a post on atla-annotated (a fandom-specific tumblr), which gave some clues as to the setting (though I don't think I'm going to go with the Qin or Tang dynasty dates; neither would fit with the steamships).

1. What results could you expect from cataract surgery during this period? Would it restore vision?

2. I gather that, if someone is congenitally blind, restoring sight in adulthood will not do much good. Exactly how little good will it do, and, more to the point, what could you find out about the possibility if you were researching it at some point between 1850 and 1920, assuming that you have the money, connections, fame and social standing to gain access to any information that's available?

3. I don't suppose there exist any descriptions of either the surgery or its prognosis that were written during the period, but if there are, and you happen to be able link me to them, that would be great.

4. Why wouldn't a rich family with a blind daughter have tried this already? Would historical surgeries have had serious risks? Would it have hurt the family's reputation to admit to having a blind daughter? (Canonically, her existence isn't widely known until she runs away to help save the world.)

I did a quick search of the surgical manuals on between your timeframes, because I've seen descriptions of cataract operations in the manuals from the 1600s that I like to read. The only one I found that had a description of the surgery was this one published in 1883. It's not China, of course, but I think the process is not going to vary too much (recovery and prep, however, may well). Here is the book and Chapter Five includes the instructions for operating on the eye. It looks like that by this time they have various methods to do it. It also includes a method specifically for use in "congenital cataracts in infants", so they weren't afraid of trying it, of course, and actually recommend it here - so as to why a family didn't have it done early might have to be thought out character-wise (or may be something more specific to a Chinese culture, which I'm afraid I don't know a ton about).

This book came from Project Gutenberg and I didn't see any of the illustrations listed in the PDF version, but there were apparently some listed for cataract operation, and another version might have them?

Hope it helps a bit!

Toph, right?

Well, if you want her getting her sight back as an adult, it might be that she suddenly has access to a fantastic mode of healing that wouldn't have been available to her before: waterbenders. Maybe Katara just learned it? Even if not through Katara, waterbenders have largely been isolated from the rest of the world prior to the end of the war. It might be that a lot of the world's healing knowledge 'vanished' once the Water Tribe cut themselves off (and the Air Nomads, the other nation most likely to have a lot of healing insight, were wiped out), and the Fire Nation and Earth Kingdom healing knowledge just hasn't caught up yet.

Anyway, cataract surgery has actually been around quite a while (there are references to it in writings recovered from ancient Greek, Persian, and Indian societies). The effectiveness of it varies and its safety is generally debatable, but variations of it DID exist in ancient worlds most analogous to the Avatar world.

That said, it probably would be risky enough that Toph's crazy over-protective parents would have decided against it. Or they just thought she was too fragile and weak to handle being able to suddenly see, or if you want to go the creepy route, one or both of her parents liked the idea of her being so dependent on them that they kept her blind intentionally. Even if they wanted to get her eyes fixed, it might be that the only healers they could trust with Toph's care were too far away or too public, somehow, to be able to ensure Toph's existence would continue to remain a secret. (And personally, I wouldn't be surprised if the guy teaching her 'earthbending' at the time - can't remember his name right now - recommended against it, as he figured that if she was blind, her lessons would need to go on a lot longer, and that would mean more money for him.) Toph may also have rejected it because as long as her parents believed her helpless, they wouldn't look closely enough at her life to realize she was sneaking out to compete in underground earthbending tournaments. :)

Later on in life Toph might also refuse fixing her eyes if she believed getting her sight back would be a detriment to her earthbending. So even if she was basically able to get it the moment she ran away as a preteen, that might be why she put it off until adulthood or just decided to never bother fixing it in the first place. She may like the idea of being able to see, but not enough to give up her position as the Greatest Earthbender In The WorldTM. It might also have served as a bit of a political tool in Republic City's shady development period - blind and greatest earthbender can be quite intimidating and gain her a lot of respect, especially since she never treated it as particularly detrimental to her life. But if she were to try and fix it, people might see that as her acknowledging it as a weakness (or at least Toph might assume that was a sincere possibilty and decided not to risk it).

(I know none of this really answers your questions but hopefully these will at least give you a few ideas.)

Yes, it's about Toph. :) I wasn't planning on having her actually gain the ability to see; I was planning to use the failure to get intervention when it could have helped as further evidence that she has the Worst Parents Ever, especially in light of how unlikely it is that it would do any good by the time Toph can choose for herself. Thanks for the ideas for her parents' motives; those are helpful.

Seconding the idea of her parents fearing the risks of cataract surgery--I'm not having much success locating it, now, but before asepsis, there would have been a substantial infection risk. And the quality of vision that was restored was not very good without thick, strong glasses, which created problems of their own. They might even have seen a potential issue with keeping an active young person immobile for the substantial recovery period. (My grandmother had cataract surgery in the late 1940s, and she had to stay in the hospital for a couple of weeks with sandbags on either side of her head.)

So true. Though Toph's parents had no idea that their daughter was an earthbending champion, even they could probably recognize trying to keep her mobile would be an exercise in futility. :) And yikes, your poor grandmother - she really couldn't even more her head to the sides? :(

I imagine they couldn't avoid it altogether--I mean, how would she even use a bedpan while being perfectly immobile?--but they did their best to minimize it. And she was an active, energetic sort of person, by all accounts, so it must have been really stressful.

Good luck with your story--and out of curiosity, do you prefer cephalocordates or tunicates?

Cephalochordates, if I have to pick one; vertebrates, if I'm allowed to take a third option.

Also out of curiosity, how did you come up with your username?

Hehe, it's a long way from amphioxus!

At the time I got my LiveJournal I wanted to be strictly a soils person: orthent is a term from USDA soil technology, for shallow, "skeletal" soils that lack developed horizons either because they're on extremely steep hillslopes, or because they're associated with disturbed sites (like building sites). Back then I thought it sounded cool, but also that if I were a soil, an orthent is what I'd be--shallow and underdeveloped, lol.

Blargh, and that was supposed to be "USDA Soil Taxonomy" not technology...I can type most of the time, I swear.

Charlotte Bronte' father underwent such an operation (I don't know how old he was at the time, but he was considered "old" and he sort of recuperated his eyesight... check out Charlotte's letters and her biographers accounts, maybe you'll find some useful details)

Sorry, now I see you are studing the congenital cataracts... yet the method would be the same, and the memoirs may have some useful details anyway...

See if you can get hold of any books by Richard Gregory. He studied how people reacted to having their sight restored by cataract or corneal operations. There's a paper on-line here to give you a start. I thought I had a copy of his "Eye and Brain" on my shelves but I can't find it.

As I recall patients who had vision restored as adults after no useful vision from birth never achieved full normal depth perception and had great difficulty correlating what they knew from touch with what they could now see. It took many months of practice to be able to use their new sense and always maintained the habit of confirming things by touch.

The first cataract surgery that I know of occurred in the late 15th century in Spain. (Administered to King Juan of Aragon, by a Jewish physician who's name I'm forgetting.) It did completely restore his eyesight and allowed him to continue seeing until his death about a decade later.

Seeing as this would have been centuries before the case you're describing, I'm pretty sure it would be available in China. (Although I could be wrong.)

It would not help the congenitally blind. It was certainly a very risky surgery, and I can't imagine was a lot of fun. (Imagine having someone slice at your eye with a razor without any kind of anestesia/sedation other than perhaps opium...) Of course, there'd be the risk of infection + death. All surgery caries this risk now, and it was far higher in an era without antibiotics. So it's unlikely this would be done *unless* the prognosis was pretty good (i.e. it was cataracts) + the person was a bit of a risk taker. (King Juan certainly was.)

Thank you, that's very helpful, and I think it gives me some idea about why the character's parents didn't have this done.

Yup. Most likely, it was more likely not done than done. (King Juan was known for being an enormous risk taker.) It's hard to overestimate how dangerous surgery was when implements may or may not have been clean and antibiotics didn't exist. (Not to mention pain killers, etc.

Look up "couching." That surgery was done in ancient times, as far back as ancient Egypt.


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