The Waterfall

The Dutch artist Maurits Escher’s lithograph, Waterfall, is an impossible image. It depicts a waterfall running a mill - the collected water descending only to reach the top of the fall again, and so on ad infinitum. It is an optical illusion. The word cataract is derived from the Latin cataracta, which also means waterfall. The thick, dull, yet translucent curtain of a waterfall resembles the clouding of the eye’s lens. It is not an optical illusion.

In fact, it is part of the ageing process and so was known to ancient man. The Indian surgeon Sushruta introduced a method of cataract surgery called couching. His text, the Sushruta Samhita, which dates from the 6th century BC, describes an operation in which a curved needle was used to push the opaque matter in the eye out of the way of vision and blow it out of the nose. The eye would later be soaked with warm clarified butter and then bandaged. It was only in 1967 that the pioneering US ophthalmologist Charles Kelman introduced a technique that allowed for small incisions to make it a more simple procedure.

At the turn of the 21st century, India was topping global surveys of countries with cases of preventable blindness, and has since been working hard to tackle the issue. The National Blindness and Visual Impairment Survey India 2015-19 suggests that over 66.2% of cases of blindness and 80.7% of severe visual impairment in people over 50 is caused by cataract. Most of these cases are avoidable, with the main barriers to cure being cost and lack of awareness - particularly within rural areas.

These photographs were taken at the Choithram Netralaya eye hospital, in Indore, Madhya Pradesh, during its 70-day “eye camp” that took place early 2020, in which 10,445 free procedures were carried out - restoring vision and allowing people to resume livelihoods that might otherwise have been in jeopardy.