Can a patient undergo couching daily?

Couching Should Not Be Performed Daily or at All—It Is a Dangerous, Obsolete Procedure That Causes Blindness

Couching for cataract is an ancient, discredited procedure that should never be performed in modern medical practice, whether daily or otherwise, as it causes severe vision-threatening complications including glaucoma, retinal detachment, and permanent blindness in the majority of cases. 1, 2

Why Couching Is Contraindicated

Devastating Visual Outcomes

• 70.9% of patients remain blind after couching (visual acuity <3/60), with zero patients achieving good vision, compared to modern cataract surgery where only 17.9% remain blind after aphakic correction 3
• In Nigerian studies, 88.8% of couched eyes presented with visual acuity less than 3/60, and even after subsequent medical/surgical intervention, 33.3% remained permanently blind 1
• A Malaysian study found 76.7% of couched eyes were blind at presentation, and 50% remained blind even after corrective interventions 2

Severe Complications

• Glaucoma is the most common complication (13.3% of cases), with 50% of patients developing intraocular pressures exceeding 40 mmHg—a sight-threatening emergency 2
• Other devastating complications include: corneal opacity, retinal detachment, couching maculopathy, optic atrophy, and panuveitis 1, 2
• These complications are not amenable to simple correction and often result in irreversible vision loss 1

The Only Exception: Highly Specialized Microphthalmic Cases

There is one narrow exception where a modified couching technique may be considered, but this is fundamentally different from traditional couching:

• In microphthalmic eyes with irido-fundal coloboma (corneal diameter <7 mm) where conventional cataract surgery is anatomically impossible, a controlled surgical couching procedure performed by trained ophthalmologists in an operating room may provide ambulatory vision 4
• This modern adaptation involves controlled zonular disruption under sterile conditions with proper surgical instruments—not the traditional needle-based couching performed by untrained practitioners 4
• Even in this specialized context, it is a last-resort procedure when no other surgical option exists 4

Historical Context and Current Status

• Couching originated around 600 BCE and was practiced globally until modern cataract surgery became available 5
• The procedure has been scientifically discredited and abandoned in modern medicine due to poor outcomes and high complication rates 1, 3
• Traditional couching costs approximately US$42-52 (similar to modern surgery) but delivers vastly inferior results, making it both medically and economically unjustifiable 3

Clinical Pitfall to Avoid

Do not confuse patient requests for "traditional treatment" with medically appropriate care. In West African studies, 47.6% of patients who underwent couching did not know modern cataract surgery existed 3. Healthcare providers must:

• Actively educate patients about the dangers of couching and availability of safe, effective modern cataract surgery 3
• Report practitioners performing traditional couching to appropriate authorities, as this constitutes practicing medicine without proper training 1
• Advocate for accessible, affordable modern cataract services to eliminate demand for this dangerous procedure 2, 3