The eye is the window for human to explore the world, suffering from eye disease is like being slowly closed the window, and he, the one who tries hard to open the window again.
What is macular degeneration?
Age-related macular degeneration is considered the leading cause of blindness in the West, and it causes blindness in about 500,000 people worldwide every year, but public awareness is very limited in China. “As a physician, my greatest regret is watching patients lose their sight permanently because they did not seek medical attention in time. Many elderly patients are intellectuals who have the habit of reading books and newspapers, and the loss of vision keeps them away from their beloved habits”, Professor Youxin Chen deplores the fact that many patients delay the opportunity of treatment because they do not pay enough attention to it, or do not know that good treatments are already available.
Macula itself is not a disease, but macular disease is called macular degeneration. The macula is located in the center of the retina and is an important part in determining the function of vision, recognizing most optical signals such as shape, size, color, depth, and distance. If there is an abnormality in it, it will cause low vision. Any lesion in the macula, such as edema or hemorrhage, can affect imaging.
Macular degeneration mostly occurs in middle-aged and older people over 50 years old, and its risk increases with age. Women have a higher risk of the disease than men; smokers have several times more risk than non-smokers; and people with a family history of age-related macular degeneration have a higher risk of the disease.
Let’s take a look at the world that people with eye disease see.
Symptoms in patients with macular degeneration: blurred spots in the center of vision and curved waves in straight lines.
Diabetic retinopathy: blurred vision, shadows, spots and pain.
Both type I and type II diabetes can cause partial loss of vision or even blindness.
Retinitis pigmentosa: Night blindness is the earliest manifestation and worsens progressively. Gradual loss of vision, gradual narrowing of the visual field, and the formation of a tubular visual field in the late stages, eventually leading to blindness.
Cataract: vision becomes blurred and foggy.
Why should I see Chen Youxin?
Why do patients come to see Dr. Youxin Chen by name? There are three reasons: high medical skills, good heart, and the ability to save money.
1, high medical skills: study business, master the latest domestic and foreign treatment technology
Chen Youxin sees more than 100 patients from all over the country every week, and nearly 200 patients at times. On surgery days, he arranges more than 10 surgeries a day, never eats lunch on time, and sometimes does not even go to the bathroom once a day. As you can see from the patients’ votes, Chen Youxin’s treatment satisfaction rate is 98% and his attitude satisfaction rate is 99%.
(The picture is a plaque written by the patient for Chen Youxin himself)
Mr. Lai, a senior citizen in his eighties, was diagnosed with wet macular degeneration after visiting his family in the U.S. He recovered his vision after treatment in the U.S., but his vision declined rapidly after returning to China, and turned to Dr. Youxin Chen. When he took out his treatment in the U.S. and the newspaper information he had collected, he found that one of the Chinese newspapers had published an article by Chen Youxin entitled “There is a way to prevent and treat age-related macular degeneration”. After the treatment, Mr. Lai’s vision has been well restored.
Dr. Chen treated Ms. Meng, who had a macular fissure, in July 2014, and by October, her vision was blurred and she could no longer read numbers or words. The list is endless. This is evidenced by the influx of patients.
2.Good heart: Putting heart to heart, thinking of the patients
When receiving each patient, Chen Youxin asks, “Where are you from?” He said, “This question is very important, by understanding where the patient came from, so as to rationalize the patient’s medical treatment, including the process of follow-up, to understand the priorities.
If a patient is found to be coming from out of town, he will schedule the procedure as soon as possible. There are no laser surgeries scheduled on clinic days, but he will often take the time to schedule a few patients for laser on or after work. “Look, today is Tuesday, if I don’t give him the shot today, it will be next Monday at the earliest, and he will have to wait for days in Beijing. The hotels nearby are expensive and the guesthouses are full, so where should he go?” Chen Youxin said this after he finished laser treatment for a migrant patient who came from Bazhou after work.
(Professor Chen performs laser surgery on a patient who came from Bazhou)
A young male patient, who wore a mask and glasses throughout his visit, said excitedly when he learned that Dr. Chen Youxin was willing to operate on him, “Thank you, I went to five or six hospitals that were unwilling to accept me for surgery.” He was suffering from diabetic retinopathy and was also an AIDS patient.
In fact, to perform eye surgery for AIDS patients, the surgical wipes and sheets used by the patient are disposable, the surgical instruments used are sterilized by high-temperature double steaming, and the surgery is scheduled for the last one of the day in order not to infect other patients. Before this patient was seen, he needed support to walk, but after the surgery on his left eye, his vision has recovered to 0.4, and surgery will be scheduled for his right eye as soon as possible.
(The picture shows Professor Chen Youxin performing surgery on the AIDS patient)
The reporter interviewed several old patients at random outside the clinic, and one of them, a young female patient, nearly choked up after saying a few words: “If it wasn’t for Dr. Chen, I wouldn’t have been able to keep my eye. I lost my eyesight overnight and suffered from uveitis, but the treatment process was delayed and by the time I found Dr. Chen, the structure of my eyes had already undergone irreversible changes. Now Dr. Chen is trying his best to help me keep my eye. I went to Hong Kong to study, and Dr. Chen referred his ophthalmologist friend in Hong Kong to continue treatment for me. I am really grateful to him.”
A patient he cured once said this, “If there really is a legendary ‘No. 8 Pawnshop’ that can pay the equivalent price to reach the heart, I would like to pawn my wasted years for you, so that more patients can come out of the darkness.”
3, can save money: put yourself in the patient’s shoes, as far as possible to reduce patient expenses
Patient Ms. Zuo said, “We spent the whole day in the hospital, but also experienced Dr. Chen’s day of seeing nearly 140 patients. Unlike other doctors we had approached before who prescribed more than a thousand dollars of health care drugs, he did not prescribe a single pill, and when we took the initiative to ask if we needed to take medicine, he said no.”
Patient Mr. Wang, after the initial outpatient examination, Chen Youxin said, “I have to take a closer look at this eye of yours, I don’t have that much time today with so many patients. Come to my special needs clinic tomorrow afternoon and I will give you a good look.” When the patient heard the word “special needs”, he frowned with apprehension because the registration fee for Dr. Chen’s special needs clinic was 300 yuan. The patient cautiously asked, “Do you want to register for a special needs number again?” “No, just come to me directly.”
The toughest problem in treating fundus diseases is the long-term battle. The main treatments are laser, photodynamic, and injections, which are a triple test of patients’ time, energy, and money. Therefore, after diagnosing each patient’s condition, Chen Youxin also has to do the math for each person, tailoring a treatment plan that combines the condition, geography and economic situation in a comprehensive package to save the patient as much money as possible, according to their actual situation. “The anti-neovascular drugs currently used are very expensive and social security cannot pay for them, so the burden on patients is very heavy, and it is important to put yourself in the patient’s shoes and think about the money.” Professor Chen said.
Patients who were misdiagnosed treat him as the last hurdle
Mr. Huang from Chongqing, who had just retired after decades of working in politics and law, noticed a sudden and dramatic loss of vision and went to the hospital for 2 months, nearly losing his sight. He was diagnosed with “macular degeneration hemorrhage”, and the doctor said that he missed the best time for treatment and could only be treated comfortably. He wanted to spend his old age peacefully, but the sudden blindness made him suffer a lot. With a last ray of hope, he found Prof. Chen Youxin, who, after careful examination, gave him photodynamic and anti-angioplasty treatment, and his vision was later fully restored.
Misdiagnosis like Mr. Huang’s happens occasionally in primary hospitals. On one hand, the examination requires expensive machines, such as OCT (optical tomography), and primary hospitals cannot keep up with the equipment. On the other hand, the doctors are not experienced enough. It is important to have a clear understanding not only of the condition but also of the stage of the condition. For example, how to treat the scar stage, how to treat the end stage, and in the case of anti-VEGF therapy, how many injections, how the interval, how long to follow up, all these require a lot of clinical experience. “The drugs currently available for treatment are expensive and not reimbursable, so if doctors make bad decisions, patients suffer losses and treatment is not effective,” said Youxin Chen.
Patient education: Letting patients learn to see a doctor
After work, Professor Chen is a man of leisure when he returns home. He thinks a night back must work, so usually the first thing he does after dinner is open, by answering patient questions to enter the work state. Some patients’ questions are simple and can be solved by answering them online; others have complex conditions and little information, so he will ask them to come to the clinic for an extra number. Of course, Professor Chen also has a lot of research professorial work as well as ophthalmology society and association-related matters that can only be handled at night.
At the airport, at the hotel, or even abroad, he spends whatever scraps of time he has answering questions. But many of the patients’ questions are similar, and Chen Youxin believes that doctors have an obligation to spread knowledge about diseases, so he writes about complex and esoteric diseases in easy-to-understand language. On a morning following Chen Youxin’s clinic, the reporter found that an aunt brought a piece of paper filled with questions to Chen Youxin, saying, “I know you are busy, I searched for your articles and studied for a long time, and I already understand the disease roughly, you just need to help me do the multiple choice questions.”
Life credo: accumulate small virtues to become big virtues
Professor Chen Youxin walks very fast, windy and busy, rushing to the hospital early every day, checking rooms, setting up work, dealing with various issues, and immediately going to the outpatient clinic or into the operating room surgery, a day, out of the hospital, it is often full of stars and moon. When he was asked if he enjoyed this busy state, he thought about it and said, “I don’t enjoy it.
Disease popularization
What are the types of age-related macular degeneration?
Chen Youxin: Age-related macular degeneration is divided into two types: dry and wet.
Which is more common, dry or wet?
Dry age-related macular degeneration is more common. However, in advanced age-related macular degeneration, about two-thirds of them are wet age-related macular degeneration, and almost all vision loss comes from advanced age-related macular degeneration, so wet age-related macular degeneration causes more vision loss than dry age-related macular degeneration.
Can dry age-related macular degeneration develop into wet age-related macular degeneration?
Youxin Chen: Yes. All patients have dry age-related macular degeneration before they develop wet age-related macular degeneration, but there is also a case where dry macular degeneration develops into vision loss but does not turn into wet. There is no way to know if or when dry age-related macular degeneration will turn into wet age-related macular degeneration.
Wet AMD is more likely to cause blindness, so is there a convenient and accurate screening tool?
Youxin Chen: The most advantageous test for wet age-related macular degeneration is OCT, which is a non-invasive test to understand the condition of the macula at various tissue levels, such as edema, hemorrhage, bulge, even abnormal blood vessel entry and pigment epithelial detachment in the macular area of wet age-related macular degeneration. This test is simple and easy to perform, which can improve the accuracy of the diagnosis, while the patient is not subject to any stimulation and is not affected by the systemic condition.
Can macular degeneration be cured?
Macular degeneration is a disease in the process of aging, there is no way to cure it completely, our current treatment method is still treating the symptoms but not the root cause, so there may be one treatment, two treatments, three treatments, in foreign countries the average of five times in the first year, three times in the second year, two times in the third year, but the biggest advantage of foreign countries is that the treatment can be included in medical insurance. Therefore, it is not correct to expect that everything will be fine after one treatment, but it must be reviewed frequently, because the first “enemy” may not be killed, and even if it is killed, a new “enemy” will come out again. Professor Chen called on the government to consider the medical insurance for macular degeneration, so as to reduce the burden of patients and let more macular degeneration patients see the light again!
How to do prevention and early detection of fundus diseases?
Dry age-related macular degeneration has no specific medicine, but it can be prevented by changing living and eating habits and supplementing nutritional supplements. Regular physical examination and self-examination can detect and treat the disease as early as possible. As age increases, the likelihood of disease increases, so regular comprehensive eye examinations are very important, and annual fundus examinations are essential for people over 55 years old. Those aged 40-54 years need an eye exam every 2-4 years; those aged 55-64 years need an eye exam every 1-3 years; those older than 65 years need an eye exam every 1-2 years. For most people who are self-conscious of symptoms, self-examination can be performed using the Amsler form (Amsler).