Historically, Apple didn't have cursor customization built into the OS-- cursor color customization was new in Monterey (macOS 12) and cursor size customization is only a few releases older (I can't find exactly when it was added). Classic Mac OS didn't do it, either, AFAIK (although I'm sure there were third-party options).
Windows (as of 11) still has the same custom cursor capabilities it's had since Windows 95, plus some bits (it can generate cursors with custom colors on the fly now). Applying custom cursors is pretty easy, and the 95-era properties sheet is still readily accessible (besides cursor schemes, there are other options there that haven't migrated to the modern Settings app).
You can also do like me and just make your cursor gigantic. I keep it at about 75% of max size. My co-workers may make fun of me but using huge text and a giant cursor has actually caused my eyesight to improve in the last 2 years or so. n=1 so entirely anecdotally of course. :)
I don't know if they've fixed this, but it used to be that the pointer target was inside the black border, not at the actual tip of the pointer. That's not really a problem if the pointer is at the default tiny size, but when you make it bigger suddenly everything you point at is offset by the thickness of the border, which makes it borderline unusable.
I think cursor customizations died with memory safety.