I. What is cataract
People often describe the eye as a camera. Under normal circumstances, it is transparent and light reaches the retina (equivalent to the negative of a camera) through it and some refractive interstitial, so that people can see external objects clearly. Once the lens becomes cloudy for some reason, it will affect the light entering the eye and reaching the retina, making it difficult for people to see, which is the occurrence of cataract. In other words, a cloudy lens that causes vision loss is a cataract.
Cataract is the most important blindness-causing eye disease in China and internationally, and is mostly found in people over 50 years old. As the population grows and ages, cataracts will cause more and more visual impairment. According to statistics, the incidence of cataract among people aged 60 to 80 years old or above is almost 80%, and the incidence of cataract among the elderly aged 90 years or above is more than 90%, which brings inconvenience to many patients.
Second, the causes of cataract
The causes of cataract are many, except for traumatic cataract, radioactive cataract, congenital cataract and diabetic cataract which have obvious causes, the cataract formation process may have many factors and the situation is quite complicated. The pathogenesis of common senile cataracts has not been fully revealed so far, and may be related to ageing, long-term excessive exposure to ultraviolet light, genetic factors and malnutrition. In China, it has been confirmed by investigation that the incidence of cataracts is relatively higher in highland areas and areas with more sunlight radiation. This is because long-term ultraviolet radiation can affect the oxidation-reduction process of the lens, causing degeneration and clouding of lens proteins to form cataracts. In addition, diabetes, galactosemia and hypothyroidism, which are common in clinical practice, can also cause cataracts. Certain commonly used drugs, especially long-term application of corticosteroids to the eyes or the whole body, can lead to cataracts.
What are the symptoms of cataract?
The general symptoms of cataract are gradual loss of vision and finally blindness, without eye pain during the whole process. The onset of cataract can be sequential in both eyes. In addition to vision loss, some patients can see a fixed black spot against a bright background, and some may have monocular diplopia and increased myopia.
If patients suddenly feel a significant loss of vision without pain, they should consider whether there is a lesion in the fundus, such as fundus hemorrhage, optic nerve papillopathy or retinal detachment, etc. They must see an ophthalmologist immediately and not be mistaken for the cause of cataract.
Clinically, geriatric cataracts are classified into three types: cortical, nuclear and subcapsular.
During the development of cortical cataracts, there is a period called the “swelling phase”. During this period, more water accumulates in the lens, causing the lens to increase in size and the anterior chamber to become shallow. In some patients, this can even lead to secondary glaucoma, where the patient can experience eye redness, eye pain with headache, nausea, vomiting, and a dramatic loss of vision or even light perception. If this kind of glaucoma is not treated in time, it will cause permanent blindness, and even if cataract surgery is performed again, the vision cannot be saved.
What to do if you have cataract
If the vision of early cataract is only mildly reduced and does not affect the daily life, the patient can go to the hospital regularly for examination and wear glasses to improve the vision when he/she wants. When the condition deepens, the patient should discuss with the doctor to decide when to undergo surgery according to the vision needs of daily work or life. It is not necessary for a cataract to be fully mature before receiving surgery. For mature or near-mature cataracts, surgery is needed as soon as possible. Some people think that there is no harm in not having surgery when the cataract is mature, because they just can’t see. This is actually a very wrong and dangerous view. If cataracts are not treated in time, many serious complications will arise, such as glaucoma and uveitis, which mostly occur in the middle and late stages of cataracts, such as the expansion stage and the over-ripe stage. Sometimes it can cause serious inflammation in the eye, which can cause blindness and even lead to atrophy of the eye. Some patients have long-term eye pain due to cataract secondary to glaucoma, which is unbearable, and finally they have to have their eyes removed as a last resort. Therefore, we are reminded that cataracts must be treated surgically when they reach a certain level, and the concept of “cataracts can be operated only when they are ripe” should be abandoned.
V. Cataract medication
Although people have never stopped exploring cataract treatment since ancient times, up to now, there is no real effective drug to stop the development of cataract. In some early stage cataracts, the development of the disease may be slowed down and the vision may be slightly improved after medication, but this is not necessarily the result of medication, because the early progression of cataracts to maturity is a long process, and it may stop at a certain stage of development naturally without seriously affecting the vision. In some patients with intermediate cataracts, neither vision nor lens clouding improves with medication. In near-mature cataracts, drug treatment is even less practical. At present, there are no less than several dozens of drugs commonly used in clinical practice, including eye drops or oral Chinese and Western medicines, but none of them has exact therapeutic effect.
Prevention of cataract
1. Pay attention to mental regulation: be open-minded and broad-minded, keep your emotions comfortable and control your anger. Cultivate interest in raising flowers, birds and goldfish to cultivate sentiment, and talk more with young people, which can distract attention from unpleasant things and stimulate vigorous enthusiasm for life, and can play a role in stopping and delaying the progress of the disease.
2, strengthen eye hygiene, usually do not use hands to rub the eyes, do not use unclean handkerchiefs, towels to wipe the eyes, wash the eyes. After excessive use of the eyes should be properly relaxed, sedentary workers should get up at intervals of 1 to 2 hours for 10 to 15 minutes, raise the eyes and look far away, or do eye exercises. Have enough sleep to recover from fatigue in time.
3, active prevention and treatment of chronic diseases, including eye disorders and systemic diseases. In particular, diabetes is most likely to complicate cataracts, so it is necessary to control blood sugar in a timely and effective manner to prevent further development of the disease.
4, diet should be rich in protein, calcium, trace elements, more food containing vitamin A, B, C, D. Eating more fish can maintain normal vision and slow down the progress of the disease.
5. Smoking has been proven to be prone to cataracts, so you should quit smoking early.
6. Wear dark glasses often. Researchers have found that the greater the intensity and longer the exposure to ultraviolet light from the sun, the higher the chance of cataracts in the elderly. The incidence of cataracts in elderly people aged sixty years old who have been living on the earth’s equator and on the plateau for a long time is more than ninety-five percent, which is nearly two times the global average incidence of elderly people of the same age. Wearing a pair of dark-colored anti-UV glasses when going out can greatly reduce the amount of UV light irradiation to the eye crystal and stop the cloudy degeneration of the lens, thus effectively preventing the occurrence or further aggravation of cataracts.
7, prevent the human body from insufficient water. Adequate water in the body is the most basic condition to ensure the normal metabolism of the human body, which is especially important for the elderly. This is especially important for the elderly, because the body function of the elderly is declining, in the case of dehydration, the normal metabolism in the body is easy to produce disorders, resulting in the accumulation of harmful substances in the body, such as superoxide factor, which will damage the lens cells of the eye and lead to cataracts. For elderly patients with cataracts, dehydration can aggravate the original condition, which is not serious, and this is one of the reasons why many elderly people’s eyesight decreases rapidly after a serious illness. Therefore, when elderly people are dehydrated in general, especially when they encounter diarrhea, vomiting and large amount of sweating caused by various reasons, they should replenish sufficient amount of water in time to meet the metabolic needs.
Seven, what is good for cataract patients to eat
1. Sufficient vitamin intake: Scientists have found that vitamin C has the function of preventing cataract formation, and it can reduce the damage of light and oxygen to the lens. If vitamin C intake is insufficient, it is easy to cause lens degeneration. Therefore, the elderly should usually eat more fresh vegetables such as tomatoes, spinach, onions, cabbage, string beans and fruits such as strawberries, oranges, grapefruit and oranges, which are rich in vitamin C. In addition, scientists point out that low vitamin E levels in the blood can also induce cataracts. This is because lower vitamin E will increase the oxidation reaction, which will easily make the protein of the crystal agglomerate and become cloudy. A recently published study showed that people with the highest dietary intake of beta carotene and other carotenoids had half the risk of developing cataracts compared to those with the lowest intake. Diets rich in vitamin A can reduce the risk of cataracts by 40 percent. beta carotene is mostly found in dark green leafy vegetables. It is also found in orange and red fruits, such as tomatoes, peaches, watermelon and carrots. Animal liver, eggs and milk are the best direct source of vitamin A. The original vitamin A contained in vegetables such as rape, spinach, capers, fennel, pumpkin and tomatoes can also be transformed into vitamin A in the liver.
2, supplemental trace elements: the sharpness of human vision is directly related to selenium, lack of selenium can induce lens clouding and cataracts, which has long been confirmed by scientists. Foods rich in selenium include animal liver, kidney, heart, fish and shrimp, dairy, egg yolk, lean meat, mushroom, fungus, sesame, etc. A study in China found that the serum zinc level is related to the incidence of cataracts, and the lower the serum zinc level in the body, the higher the incidence of cataracts. Among animal foods, oysters, fish, lean meat, animal liver, kidney, eggs and dairy products have high zinc content, among which oysters have the highest zinc content, with 14 mg of zinc per 100 grams.
3, drink more tea: medical doctors in a large number of observations found that the elderly who can drink 5 cups of tea a day, they are much less likely to suffer from cataracts than the elderly who do not drink tea or rarely have the habit of drinking tea, and more or less drink some tea than those who never drink tea, the incidence of cataracts is also lower. Scholars believe that this is related to the large amount of ellagic acid contained in tea. Modern medicine believes that cataract disease is due to the free radicals produced by oxidation reactions in the body acting on the lens of the eye. The large amount of ellagic acid contained in tea can block the occurrence of oxidation reactions that produce free radicals in the body, and tea can play an effective preventive effect on cataracts. Therefore, it is best for the elderly to develop the habit of drinking more tea every day, because this can prevent the occurrence of senile cataracts, and also prevent the deepening of cataracts.
4. In addition, they should drink more water, at least one and a half liters of water a day.
Timing of cataract surgery
Surgery is the only effective method to treat cataract. There are two common misconceptions about the timing of surgery.
1. Cataract should wait until it is mature before doing it
The old view is that cataracts should wait until vision declines to the point of “invisibility” before surgery. This has the following disadvantages. First of all, as cataracts continue to worsen, surgery will increase the damage to several tissues in the eye, such as corneal endothelium, crystal ligament and iris tissue, and increase the chance of postoperative complications. Secondly, during the process of cataract expansion, there is a possibility of acute glaucoma attack. Once the acute attack occurs, there will be changes such as iris atrophy, corneal endothelial damage and post-iris adhesions, which will seriously affect the results of cataract surgery and even lead to permanent loss of vision. Therefore, cataracts should not be operated only when the visual function declines to a very low level.
2. The earlier the cataract is done, the better
Human crystals can see far and near through adjustment. Although artificial crystals have been developed at a rapid pace in recent years, they are far from being comparable to human crystals in terms of adjustment range, adjustment speed and imaging quality. At the same time, in the early stage of cataract, the lens only shows refractive changes due to volume expansion, and simply put, the patient can obtain good vision by wearing glasses. Therefore, it is also undesirable to blindly pursue early surgery while ignoring the possible postoperative disadvantages.
There is no fixed pattern for choosing the timing of cataract surgery. In the past, due to the limitation of medical technology, cataracts had to wait until they were completely “mature” and the affected eye could not see before surgery, and patients had to endure the trouble and pain of low vision for a long time. Patients no longer need to wait until they are completely blind before undergoing surgery, but can receive surgery when cataract medication is ineffective and affects their daily life and work. The risk to experienced surgeons is not increased by early surgery. For different patients, the timing of surgery can vary greatly. At present, it is common in developed countries for patients with visual acuity of 0.5 to undergo surgery, and the quality of vision after surgery is significantly improved, which is also proved in our clinical work. In short, when to receive surgery, we must start from the actual requirements of the patient and discuss with both doctors and patients to determine the timing of surgery.
Cataract surgery methods
At present, there are two types of cataract surgery methods: cataract extracapsular extraction combined with human lens implantation and cataract ultrasound emulsification combined with human lens implantation. The former involves removing the entire nucleus of the lens through a 6-10 mm incision with hand work, while the latter involves a small 2-3 mm incision with an ultrasonic crusher that is extended to crush the nucleus of the lens and then aspirate it. After the cataract cortex is aspirated and cleaned up, an IOL implantation is performed, which has the significant advantages of small surgical incision, quick healing of the incision after surgery, small corneal astigmatism, and satisfactory vision at an early stage.
The advantages of cataract ultrasound emulsification are mainly as follows.
1. Minimally invasive technology without stitches: The ultrasonic emulsification probe can finish emulsifying and sucking out the cataract through tiny incisions of 1.5mm to 3mm. Such tiny incisions have the advantages of no stitches, no increase in astigmatism, good safety and fast recovery for our eyes, etc. It can be said that the incisions cannot be seen the next day after surgery and patients can move around freely after surgery.
2, directional non-invasive technology: the so-called “no” damage is in the surgery ultrasound emulsification needle only on the cloudy lens, but almost no adverse effects on the adjacent tissues such as the cornea, iris, retina, etc.; the surgeon’s delicate operation, supplemented by advanced instruments and equipment, 5-10 minutes to complete the surgery.
3. Surgery is possible without waiting for maturity: In the past, most people thought that surgery is possible only when the cataract has reached the level of blindness, commonly known as “long maturity”, but nowadays, surgery is possible if the visual acuity is around 0.4. This avoids the long and painful process from blurred vision to blindness, and also avoids the possibility of cataract causing glaucoma.
4. Combination of surgical quality and convenience and speed: The application of ultrasonic emulsification has reduced the surgical incision from 10mm to less than 3mm, and no suture is needed, which solves the problem of astigmatism caused by the surgical incision and makes the postoperative vision better.
Ten, painless cataract removal, avoiding the risk of accidents under local anesthesia
It is a common knowledge that anesthesia must be administered for opening surgery. In the past, when playing anesthesia for cataract surgery, a needle must be inserted about 3 cm from the side of the eye to inject anesthesia into the tissue behind the eye in order to achieve the effect of pain relief and stopping the movement of the eye, however, this local anesthesia method also has some disadvantages. In short, there will be certain risks when playing anesthesia medicine if inadvertently easy to cause bleeding in the eye, and in serious cases, it will also lead to blindness of the patient. How can patients achieve the effect of anesthesia before surgery, while avoiding the risks that may occur with needle injection anesthesia? After years of clinical practice, the use of epilepsy anesthesia can completely solve the problem of pain, but the key to surgery is whether the surgeon can achieve a sufficient level of skill. The anesthesia effect of general local anesthesia can last about 2-3 hours, so the surgeon has enough time to perform cataract surgery on the patient. It is required to finish the surgery quickly and accurately.
Skill + experience = the key to successful surgery
The cataract extraction process after anesthesia is the same for cataract surgery under surface anesthesia (painless) and local anesthesia (painful), but painless anesthesia requires high requirements for the surgeon due to the short anesthesia time, and requires the surgeon to accumulate rich clinical experience, be patient and meticulous, and be able to deal with unexpected situations. However, for patients, cataract ultrasound emulsion surgery is short, the incision is small, the postoperative reaction is small, the patient recovers quickly, the postoperative astigmatism is small, only a drop of eye drops of surface anesthesia is needed to eliminate the pain of the surgery, and the accidental risk brought by the anesthetic injection can be avoided, so the safety of the surgery can be guaranteed and the surgery can be completed within ten minutes.
In conclusion, when people grow old, their eyes become dizzy and cataracts come uninvited. Many patients are overwhelmed by this, or they think it is a “natural part of aging” and do not care much about it. Unbeknownst to them, this may lead them to a lifeless world.
Among the cataract patients I see, many of them do not know enough about the disease and put it off again and again, thus delaying the disease. Cataract is a painless vision loss eye disease that mostly occurs in older people over 50 years old. A cataract is a clouding of the lens. The causes of this disease are very complex, diet, age, ultraviolet radiation, emotions, drugs, trauma and other reasons may cause lens clouding.
Reminder.
People can see objects all by the lens, the lens is like the lens of a camera, to see objects clearly, the lens as a lens must remain colorless, transparent and soft. If the lens is cloudy, the original pure black pupil has a whitish area, there will be symptoms such as blurred vision, fear of light, seeing things in double vision, etc. Initially, the symptoms are mild and often mistaken for presbyopia, which does not attract attention, but if not treated in a timely manner, the lens gradually hardens and may cause lens night talk, which can cause complications such as glaucoma, lens dislocation and retinal detachment. Therefore, once you find similar symptoms you should go to the hospital early for examination to avoid aggravation.