As the saying goes, “old age comes before old eyes”. When Mr. Zhang was in his 40s, he suddenly found one day that his eyes were not as clear as before, and he had to take things far away to see them clearly, and the ophthalmologist told him that his eyes had become blurry. After going to the hospital and examining his eyes with a slit lamp magnifier, he was diagnosed with senile cataracts, and the hospital was so busy with patients that the doctor didn’t have much time to tell him what the cataracts were about. Today, in our spare time, we will tell Mr. Zhang, Auntie Li, Grandma Wang and other old people who have cataracts about the causes and consequences of cataracts and answer all their doubts.
I. What is cataract?
Cataract is one of the most common diseases of the elderly, and it is very common among them, almost all of them will have it, just like white hair, which will happen to everyone sooner or later. Under normal circumstances, our eyes are like a camera, which can see clearly objects in the distance or in front of us, mainly because of several necessary conditions. It becomes white, yellow or black. The normal lens is a transparent biconvex lens through which light is clearly imaged on the retina. When the lens is cloudy, the transmission of light is affected, and you cannot see clearly.
What is the performance of early cataract?
The development of cataract is slow, and in the early stage, it is only a wedge-shaped clouding around the lens, which often does not show obvious symptoms. Therefore, the early stage of cataract will not have much effect on vision, but when the lens has a large “white cloud”-like cataract, obvious symptoms will appear.
How is cataract caused?
The intensity of eye use is basically irrelevant to the development of cataracts. In addition to bright light and ultraviolet radiation, genetic predisposition is another major factor leading to cataract development. Long-term exposure to bright light or ultraviolet light will increase the incidence of cataracts.
What are the treatments for cataracts?
There are two main treatments for cataracts: conservative treatment (i.e. medication) and surgery.
1.Drugs: So far, no drug has been proven to treat cataract, which is like white hair, no drug can make white hair black, and hair dye does not count. There are only a few drugs that can slow down the progression of cataracts. Here, it is impossible not to mention Salprace eye drops, which are too well advertised, but they are no more effective than Cataract Stop or Carlin-U, are more expensive than the latter two, and are not included in the health insurance list. The medication only serves to delay the development of cataracts, and eventually, surgery is needed to solve cataracts.
2.Surgery: Nowadays, the most commonly used procedure is ultrasonic emulsion lens aspiration combined with IOL implantation. At present, it is generally believed that surgery can be performed when vision loss affects daily work and life, for example, when watching TV or road signs are blurred and reading is inconvenient, except for other reasons. In particular, patients with bilateral senile cataracts should not wait until they are completely blind before performing surgery.
Cataract surgery is not age-specific. As long as the patient is in good health, surgery can be performed on people over 90 years old, and it is not uncommon for centenarians to have surgery. However, elderly people with systemic diseases such as hypertension, coronary heart disease or diabetes must be effectively controlled and their blood pressure and blood sugar must be stabilized at or near normal levels, and the surgery must be done under cardiac monitoring if necessary.
V. Do I have to implant an IOL for cataract surgery?
Yes. At present, cataract ultrasound emulsion surgery is the most advanced surgical method commonly used in the world to treat cataract and is also a very mature surgery. Through an incision of only 3.2mm or even smaller, the cloudy lens nucleus is crushed into a chylous form and aspirated, and then an IOL is implanted. It is very popular among patients because of the small incision and quick recovery of vision after surgery. Implanting an IOL during cataract surgery can avoid the trouble and inconvenience of wearing highly farsighted glasses after surgery, and can also obtain more satisfactory vision at an early stage. However, for some special cases, such as: phase I surgery for traumatic cataract, congenital cataract patients younger than 2 years old should choose the appropriate time to implant IOLs in phase II according to the specific situation.
VI. What kind of IOL should be selected?
There are many kinds of IOLs, including hard IOLs and soft IOLs that can be folded. Hard IOLs are mostly used for cataract surgery with large incisions, but with the continuous improvement of crystal technology and techniques, there are now soft folding IOLs, which are basically not needed by doctors and patients; folding IOLs are suitable for mainstream ultrasound emulsification surgery, which can be pushed into the crystal capsule through a small incision and then stretched out.
There are also many types of folding IOLs, mainly including monofocal IOLs (spherical IOLs and aspheric IOLs), multifocal IOLs, and some other functions such as Toric astigmatism correction IOLs and yellow IOLs.
The materials of folding IOLs are basically the same and can be used for life. The difference between IOLs mainly lies in whether to see one focal point (distant or near) or two focal points (distant and near) after surgery. The specific type of IOL that is suitable for use needs to be considered based on the patient’s requirements and eye condition.
Monofocal IOLs allow patients to see at a distance and require presbyopic lenses for near vision, and are suitable for patients who are not originally myopic or have very low myopia. Monofocal IOLs also allow patients to see near and require nearsighted glasses to see far, which is suitable for patients who are originally myopic and have not worn fancy glasses.
Multifocal IOLs are more convenient because they can solve the problem of seeing both near and far at the same time. However, patients with large astigmatism should not use them, otherwise they will be uncomfortable to see after the surgery. Patients with large astigmatism can use Toric toric IOLs. Patients with fundus disease should not use multifocal IOLs, otherwise it is inconvenient to treat the fundus in the future, and it is not necessary to implant multifocal IOLs.
VII. Guidance for daily life of cataract surgery patients.
1. Diet: It is appropriate to have a light, easily digestible, nutritious and less stimulating diet, eat more fresh vegetables and fruits and coarse fiber foods, avoid chewing hard foods (e.g. nuts), keep bowel movements smooth, avoid forceful bowel movements, and prohibit smoking and alcohol. If you have diabetes, hypertension and other chronic diseases, please follow the doctor’s instructions to consume a therapeutic diet, and at the same time, you should take your medication on time and monitor it regularly.
2, pay attention to the combination of work and rest, avoid doing strenuous sports within 3 months, especially sports that have an impact on the eyes, and do not swim. You can do walking, slow walking, tai chi and other sports.
3, pay attention to safety, try to avoid collision surgery eye.
4, pay attention to eye hygiene, do not splash dirty water into the eye, wash your face with eyes closed, scrub your cheeks with water or wet towel, avoid dirty water and facial cleanser into the eye, do not use dirty hands to wipe the eye, pay attention to the prevention of infection; should not watch TV, reading, reading computers, etc. for a long time, pay attention to eye rest.
5. Follow the doctor’s instructions to order eye medicine and take oral medicine on time. Generally speaking, it takes about one month to order eye medicine after cataract surgery, and in some special cases, it may take a long time. For example, patients with dry eyes may feel dry and uncomfortable six months after surgery and need to order some high quality artificial tears for a long time.
6. In the early postoperative period, you may not be very comfortable with strong light, so you can wear sunglasses to block the light, and at the same time, you can avoid discomfort caused by wind and sand entering your eyes. After the vision stabilizes in 3 months after surgery, refractive examination should be done at the time of review, and glasses should be prescribed to adjust the vision of seeing far or near if necessary, in order to achieve the best vision effect.
7. Review on time, bring your medical card, registration card and medical record to the ophthalmology clinic for follow-up, and ask the doctor about the medication. The routine follow-up time after cataract surgery is 1 day, 1 week, 1 month and 3 months after surgery.
8. If abnormalities such as eye redness, swelling, pain, increased secretion and vision loss suddenly appear after surgery, you must go to the hospital in time.
In conclusion, cataract is the most common eye disease in the elderly. If it has affected normal life, watching TV and reading is affected, it can be treated by surgery. There is no need to be afraid of surgery, let alone worry about pain. The current cataract ultrasound emulsification combined with IOL implantation is very mature, and the surgery takes a short time, and there is no need to inject anesthetic during the surgery. Always try to rely on medication. Medication cannot make the cataract disappear and restore the patient’s vision to normal, it only plays a part in delaying the development. If you wait until you can’t see, the crystal will be ripe and may break when you touch it, and the nucleus of the lens will be very hard, which will not only increase the difficulty of surgery but also increase the risk of complications. This not only makes surgery more difficult but also increases the risk of complications.
Cataracts are just like wrinkles and gray hair on the face of the elderly, and will happen to everyone at a certain age. Actively prevent and treat them, and don’t be misled by false advertisements.