Cataracts are a common disease in the elderly and are a sign of physiological degeneration, often resulting in vision loss, blurring, and even double vision. However, there are still some misconceptions about when you should have surgery.
Myth 1: Cataracts can be cured by drugs or other non-surgical treatments and surgery can be avoided. Older people often see from various authoritative newspapers or broadcasts all kinds of odd medicines or odd people made from valuable Chinese medicine to treat various eye diseases by tapping into the treasures of Chinese medicine. An important feature of these drugs is that they guarantee rapid improvement of vision after use, often with good feedback from many “users” and recommendations from “bricks and mortar”. As a “non-toxic” herbal medicine, it can rejuvenate the cloudy lens and make it transparent again without the pain of surgery. Therefore, many elderly people will spend a lot of money to buy these “expensive Chinese medicine” made of various “cure for blindness pills”, “restorative medicine”, “bright eye patch The “eye patch” and so on. However, these drugs often fail to improve vision to avoid surgery, and even lead to further vision loss or even blindness due to allergies or other side effects. I once had a patient who was severely allergic after using so-and-so eye patch and had a corneal ulcer that healed with a scar leading to irreversible loss of vision. Therefore, I usually advise my patients not to try these so-called “precious herbs”. The money saved can be used to choose a better quality IOL for cataract surgery, instead of being forced to choose a rigid lens with a large wound and slow recovery due to financial problems.
Myth #2: Cataracts have to be mature before they can be done. This is a very old, and arguably even a bit harmful, statement. As cataract surgery lacked a clear operating microscope 20 or 30 years ago, most ophthalmologists were still relying on magnification to do cataract surgery. If the cataract was immature, the entire clouded crystal cortex could not be seen and removed, so patients were required to have it done only after the cataract had matured. It is actually a sign of medical backwardness. With the popularization of surgical microscope and high-definition surgical microscope, ophthalmologists have been able to clearly see all the cloudy degree of crystal cortex, even the cortex of completely transparent crystal, so there is no longer any need to wait for cataract maturity before doing it technically. And as the standard of living improves, the elderly are becoming more and more conscious of their quality of life. Waiting for cataract to mature will cause the elderly to spend a long period of low vision, which will not only cause inconvenience and quality of life, but also increase the burden on their children.
Myth 3: Cataract surgery requires vision to drop below 0.3 or 0.5. A perfect vision also includes good color vision, contrast sensitivity and aberration. What is contrast sensitivity? Simply put, it is the ability to distinguish between shades of gray. Because our world is not simply black and white, there are many shades of gray between the two, and the ability to distinguish between these different levels of “gray” is our contrast sensitivity. Therefore, many cataract patients have good visual acuity of 0.6-0.8 or even 1.0, but they always feel blurred and live in a serious haze, with plastic film or unclean eye droppings in front of their eyes. In fact, these are all signs of decreased contrast sensitivity. The most obvious effect of decreased contrast sensitivity in daily life is a decrease in the ability to distinguish between steps. This is also a major reason why the elderly often fall, unable to clearly distinguish a small number of steps in a large flat area, which can easily lead to a fall in the air and even lead to fractures. I once had a doctor colleague whose father had poor vision and was ready to see if he needed surgery, but ended up not seeing the steps clearly when going down the stairs and stepping off, resulting in a fracture. The reason is that cataract surgery should not be abandoned just because the vision chart is still good, but we should consider the contrast sensitivity/color vision/parallax and other factors. This is especially true for people who have high requirements for fine vision, such as painters/designers/architects. Therefore, “vision” of 0.8 or even 1.0 is not a contraindication to surgery. However, as a doctor, I would not blindly recommend surgery to all cataract patients, because after all, everyone has different vision needs and the surgery itself has small risks and surprises. So it should be based on the evaluation of the comprehensive visual function, as well as the degree of impact on the patient’s daily life and the patient’s satisfaction with the visual quality.
In addition to the choice of surgery timing, there are also misconceptions about the choice of IOLs in cataract surgery, not that the more expensive the IOLs are, the better the vision recovery. As we all know, in the commodity economy, it is a general rule that you get what you pay for. Most of the expensive things have their own special value, either because of the quality of the goods themselves or the social recognition attached to the goods. We have to admit that price is the standard for measuring the value of many goods. But for a special commodity like IOLs, the most expensive is not the best. In the 21st century, cataract surgery has been upgraded from a simple sight restoration surgery to a refractive surgery, and more patients have higher requirements for post-operative visual quality. IOLs have developed from rigid PMMA to soft folding IOLs of various materials, from spherical IOLs to aspheric IOLs, from monofocal to multifocal, and in recent years, crystals to correct astigmatism have also emerged. The price of IOLs ranges from a hundred dollars to ten thousand dollars, meeting the needs of different levels. However, the choice of IOLs is not simply based on price, but also on the condition of your eyes, your financial situation and your daily needs. Hard crystals are inexpensive and can basically meet the demand for restoration and improvement of vision after cataract surgery, but the disadvantage is the large incision and long recovery time. These IOLs are basically used in large-scale blindness prevention and restoration surgery and can provide basic satisfactory visual quality for most patients. Ordinary folding IOLs are popular in large and medium-sized cities or economically developed areas because of the small incision and quick recovery time, and are generally priced between a thousand and three thousand dollars. Aspheric folding IOLs significantly improve the quality of imaging, especially in the dark/peripheral field at night, and are generally priced between $3,000 and $4,000. The more expensive ones, which we often call high-end IOLs, usually double in price because of some special improvement in them, such as multifocal/corrected astigmatism/corrected astigmatism while multifocal/adjustable IOLs, etc. With prices ranging from about 7,000 to 15,000, the first three types of lenses are basically suitable for all cataract patients and therefore are the most used. With the improvement of economic level and people’s pursuit of high quality of life, the amount of high-end IOLs is gradually increasing. But isn’t it true that the more expensive the lens used, the better the post-operative vision and the more satisfactory the results? The answer is of course no.
One is the patient’s own eye condition, such as the degree of corneal transparency/whether there is corneal astigmatism/vitreous transparency/retinal optic nerve health, and the second is the location of the implanted IOL and whether accidents/complications occur during surgery. The third is whether the preoperative calculation of the IOL degree is consistent with the actual need. Because of the special nature of IOLs, we cannot select the appropriate prescription in a way similar to conventional optometric insertion, but can only arrive at the expected result through a special calculation formula before surgery by biological measurements such as corneal curvature, eye length, anterior chamber depth, etc. Although our calculation formula has advanced a lot with the development of technology, and various third and even fourth generation IOL calculation formulas are beginning to be used in Although our calculation formulas have advanced a lot with the development of technology and various third and even fourth generation IOL calculation formulas are beginning to be used in clinical practice, as an empirical formula, all calculations have a certain deviation, usually within 200 degrees, so whether or not the implanted lens is exactly the desired degree will also affect post-operative vision (this can be improved by post-operative prescription). Therefore, we know that the price of the IOL is not the determining factor for post-operative vision. But more expensive IOLs often mean smaller wounds, less astigmatism after surgery, and better quality of vision. High-end IOLs are very expensive and are often intended to meet specific needs. For example, multifocal/adjustable IOLs are designed to improve the percentage of people who can see near and far without glasses after cataract surgery, toric IOLs are designed to correct corneal astigmatism, and triple IOLs are designed to correct both corneal astigmatism and multifocality. But as high-end crystals for these special purposes, not everyone’s eye condition is suitable. For example, multifocal crystals are not suitable for those who have underlying diseases in their eyes and whose corneal astigmatism exceeds 100 degrees. Therefore, the choice of IOL is usually made by the doctor according to the patient’s eye condition, and the patient will do what he or she can according to his or her needs and financial situation.
Therefore, the choice of IOL is not the more expensive the better, but the best fit.