Age-related cataract, also known as age-related cataract, is one of the most common eye diseases affecting the vision of the elderly and the leading cause of blindness. According to statistics, half of the blind people in China are caused by cataract. Due to the increase in population and aging, its incidence is increasing year by year. Therefore, prevention and treatment of cataract is one of the priorities of public health work and blindness prevention and treatment in China at present. In recent years, with the progress of medical science and technology, many breakthroughs have been made in the treatment of senile cataracts. The surgical treatment of senile cataracts has changed from the pure purpose of preventing blindness to improving the quality of life of the elderly. However, many people still have many misconceptions about the diagnosis and treatment of senile cataract. A case in point: patient Wang xx, female, 95 years old, visited the ophthalmology clinic in 2014 and reported that her vision had been declining for more than 20 years. She was in good general condition, but her vision was extremely poor and she could not take care of herself and needed family care. At the time of presentation, the patient had photopic vision in both eyes and poor mental status. Examination revealed a grade 5 nuclear cataract (the most severe grade 1) with normal intraocular pressure and fundus examination. The surgery went very smoothly, and after the surgery, the vision was restored to 0.5. Not only did he not need family members to take care of him, but he could also read books, newspapers and TV easily. After surgery, doctors found that patients and their families had more misconceptions about cataract surgery and were afraid to operate. Diagnosis Myth 1: Cataracts are only for the elderly Elderly cataracts account for more than 80% of the total number of cataracts, so it is true that the elderly account for the majority of cataracts, but this disease is not always the patent of the elderly. There are congenital cataracts in infants, developmental cataracts in young people, and traumatic cataracts, concurrent cataracts, and metabolic cataracts (such as common diabetic cataracts) in patients of all ages, so cataracts are not exclusive to the elderly. Myth 2: Elderly people have blurred vision and no eye pain is cataract The refractive system of the eye is composed of cornea, lens and vitreous body. Light is imaged on the retina and then transmitted to the cortical visual center of the brain through the optic nerve, and any abnormality in any one place will lead to blurred vision. “In the clinic we commonly see patients who can’t see in both eyes go to the hospital and ask the doctor to do cataract surgery, and through examination it is found that the optic nerve in both eyes has atrophied, and further examination diagnoses them as advanced glaucoma.” It is also found that some patients suffering from blurred vision caused by retinal detachment and macular degeneration are delayed in diagnosis and treatment by patients who think they are cataracts. The reason for this is that some fundus diseases such as age-related macular degeneration and hemorrhage, and some glaucoma such as open-angle glaucoma can cause no discomfort to the eyes except for blurred vision. Therefore, after elderly people find blurred vision, they must go to the hospital ophthalmology examination once to exclude other causes of blurred vision so as not to delay the treatment. Treatment Myth 1: Cataract is a normal manifestation of old age, and it does not matter whether it is treated or not Cataract is indeed a common eye disease, and it is the main eye disease causing blindness. Under normal circumstances, the crystal behind the pupil is transparent. When it becomes cloudy, it is known as a cataract. Many people think that cataract is a normal manifestation of old age and it is unnecessary to cure it or not, this idea is wrong. The initial cloudiness of cataract does not affect vision much, but if it is not treated early, it will gradually aggravate and cause complications such as secondary glaucoma in the late stage, which can obviously affect vision or even blindness, and also increase the difficulty of surgery and post-operative complications. Therefore, once cataract occurs, please consult a cataract doctor and follow his or her instructions. Myth 2: Excessive belief in medication Many people hope to treat cataracts through medication to avoid the pain of surgery. In fact, cataract patients’ lens protein denaturation is an irreversible process, just like egg white after being heated, no matter what drugs are used, the denatured protein cannot be restored to its original clear and transparent state. At present, there is no specific drug for cataract, but for early stage patients, drugs can be used to slow down the development process. Many elderly people believe in medication for a long time and do not seek medical treatment in time even when their vision decreases, sometimes even delaying the best time to treat the eye disease. Even if the cataract is too advanced, it may not be able to return to the best visual quality even if it is treated by surgery. Therefore, one should not be overly superstitious about the effect of drugs on senile cataract. At present, there are many drugs for cataract treatment in pharmacies and hospital pharmacies, both domestic and imported. Some outpatient doctors also prescribe them to patients, and even indiscriminately prescribe expensive imported or domestic cataract treatment drugs. Other patients blindly believe in the propaganda of some false drugs, thinking that the drugs can cure cataract. This is really a misconception. Therefore, once the vision loss is serious, you should consult a doctor in time and choose surgery treatment earlier. A special point to emphasize is that the only effective treatment for cataracts is surgery. Myth 3: The elderly cannot have surgery Some people think that surgery is not necessary for the elderly or that surgery is too dangerous. In fact, the current advanced cataract surgery has basically broken through the age restriction. Moreover, some elderly people who suffer from hypertension, diabetes and heart disease can undergo surgery as long as their blood pressure, heart function and blood sugar are controlled by internal medicine within a relatively normal range. Nowadays, cataract surgery is relatively mature, and only a drop of eye drops is needed for anesthesia (surface anesthesia) during surgery. The pain during surgery is minimal, and most patients can tolerate the surgery, so there is no need to let the elderly spend their later years in the dark. Myth 4: Cataract surgery is very scary and painful Due to the progress of surgical equipment and methods, the current ultrasonic cataract extraction combined with IOL implantation has developed into a real minimally invasive surgery, with small incisions and injuries, and combined with highly effective anesthetic eye medication, the whole process is usually completed in just ten minutes, and most patients feel nothing at all that the surgery is over, so patients have little pain. Myth 5: Cataract surgery can only be done when the cataract is mature and invisible Some people think that surgery can only be done when the cataract is mature, i.e., when it is completely invisible, which is an outdated view. With the application of small incision ultrasound technology and foldable IOLs, surgery can be performed as long as the vision is lower than normal and affects work and life, and at this time, the surgical incision is small, less painful, less complications, faster postoperative recovery and better vision quality. In addition, overripe cataracts can cause serious complications such as secondary glaucoma and uveitis. It has been a long-held view that cataracts should wait until they are mature before surgery. In the past, cataract surgery methods used extracapsular extraction of cataract or intracapsular extraction of cataract, and the surgery was required to be done at the mature or near-mature stage of cataract. This has many disadvantages. First, the cataract will continue to worsen, and damage to several tissues in the eye, such as the corneal endothelium, the suspension ligament of the lens, and the iris tissue, will increase, and the chance of postoperative complications will increase. Secondly, for patients with narrow atrial angle and closed-angle glaucoma, there is a possibility of acute glaucoma attack during the cataract expansion phase, and 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 outcome of cataract surgery. Therefore, the choice of surgery time depends on the development of cataract. After the 1980s, cataract surgery has been significantly improved by performing surgery under a microscope and using microsurgical instruments, and the surgical techniques and methods are completely different. Especially with the maturity of ultrasonic emulsion surgery, surgery can be considered whenever the visual function is affected by lens clouding, daily life and study and work are no longer convenient, or corrected visual acuity is below 0.5. Some eye diseases where the lens is transparent can also be operated on, such as crystal dislocation, high myopia, and metal foreign bodies within the lens. Myth 6: Cataract surgery in hot weather is not good In the past, due to the relatively poor conditions in hospitals and homes, such as the lack of air conditioning, there were many inconveniences or infections in hot weather surgery. Nowadays, the sterilization and isolation measures in hospitals are very good, and the conditions at home are also better, so the inconvenience of bathing and sweating in the heat is also well solved. Therefore, cataract surgery is no longer restricted by time. It is proved that the safety of surgery in summer when the temperature is high is the same as that in autumn and winter when the temperature is low, so there is no need to worry that cataract surgery will not recover well in the heat. Myth 7: All cataract surgeries must be able to improve vision. The eye is like a precision camera, and cataract is like a camera lens that has a problem and can be replaced through surgery. However, the imaging of a camera is not only related to the lens, but also related to the film and so on. Some elderly people have cataracts, glaucoma, fundus disease and other eye diseases, just like the film of a camera has problems. For such patients, even if they simply change the lens (have cataract surgery), their vision may not necessarily be improved after surgery because of the film problem (fundus problem). Myth 8: Cataract will grow again after cataract surgery The cloudy lens has been completely removed after cataract surgery and will not grow again, but the common clinical “posterior cataract” is a clouding of the capsule behind the IOL that plays a supporting role. About 5-20% of patients will experience vision loss for a period of time after surgery, but this is not a recurrence of the cataract. In case of “posterior cataract”, it can be solved by YAG laser, which can be done in a few minutes without pain and surgery, so there is no need to worry. Myth 9: The more expensive the IOL is, the better. No, IOLs should be chosen according to your personal situation. Artificial lens, that is, a special lens made of synthetic materials, its composition includes silicone, polyformaldehyde acrylic nail finger, hydrogel, etc.. The shape and function of the artificial lens is similar to the lens of the human eye. After cataract surgery, the cloudy lens is removed and the artificial lens is implanted into the eye to replace the original lens, so that external objects can be focused and imaged on the retina, and the surrounding scenery can be seen clearly. Cataract patients want to choose the “best” IOL before surgery, and even believe that the most expensive IOL is the best, lest the wrong one affect their post-operative vision. At present, the IOLs commonly used in clinical practice are all folded soft IOLs, and there are about 4 types of IOLs according to their functions: ordinary optical IOLs, aspheric IOLs, multifocal IOLs and astigmatism correction IOLs. Aspheric IOLs are more suitable for young patients, especially for night vision improvement; multifocal IOLs are more suitable for patients who often work at close distances and can automatically complete the focus transformation between seeing far and seeing near; while patients with more serious astigmatism will have the best visual effect after choosing astigmatism correction lens. Therefore, you should choose the right lens according to your personal situation, not necessarily the most expensive one is the best one, please follow the advice of your surgeon. In a word, if you find that your vision is blurred, you should go to the hospital for an eye examination to confirm whether it is an age-related cataract.