I. Concept of the disease
Age-related cataract refers to the clouding and loss of clarity of the lens that occurs with age, also known as “age-related cataract. Some patients develop cataracts in middle age rather than in old age, so the term “age-related cataract” is more appropriate to define the change in the lens. Age-related cataract is the most common type of cataract, mostly seen in middle-aged and elderly people over the age of 50, and its incidence increases with age. In 1982, WHO proposed that the diagnostic criteria for cataract are: visual acuity <0, 7, cloudy lens, and no other eye diseases that cause vision loss.
The mechanism of the disease
The etiology of senile cataract is still not fully understood. It is a degenerative change of the lens after aging and is the result of a combination of factors. Risk factors for its occurrence include: age, occupation, gender, smoking, alcohol consumption, ultraviolet radiation, diabetes, hypertension, positive family history and nutritional status.
You need to understand a few issues
1. Cataracts do not develop only when you are seventy or eighty years old
2. Age-related cataracts are the result of a combination of factors
Common misunderstandings and interpretations
1.How old will I get senile cataract?
Age-related cataract is a manifestation of the aging of the body, and it is a process that develops slowly. 50 years old can start to develop age-related cataract, and the prevalence rate is about 50% for those over 60 years old and 100% for those over 80 years old. As we age, the degree of cataract will gradually increase.
2. If my father/mother has cataracts, will I have cataracts too?
Age-related cataracts have certain genetic factors, but they are mainly age-related. No matter if someone in your family has cataracts or not, cataracts will occur more or less as you grow older.
3. I don’t smoke or drink, and I wear sunglasses when I go out, but why do I have cataracts at the age of 60?
Age-related cataracts are the result of a combination of factors. It is related to age, occupation, gender, smoking, alcohol consumption, ultraviolet radiation, diabetes, hypertension, positive family history and nutritional status. Sometimes there is no way to explain which factor plays the main role.
Common causes of delayed treatment of the disease
Geriatric cataracts mainly manifest as blurred vision, but some also manifest as myopia, astigmatism, diplopia or increasing myopia. You should go to the hospital for examination when you have related symptoms.
A few issues you need to know
1.Suddenly better vision when looking close should alert you to the occurrence of cataracts.
2.Incompetence in seeing is not necessarily presbyopia.
3.Progressive myopia may also be a cataract.
4. One eye has already had cataract surgery and can see, so the other eye will not be treated.
Interpretation of common misconceptions of the public.
1. I used to have presbyopia and needed to wear presbyopic glasses to read books. In the past few years, it is strange that I can read the small print in books without wearing presbyopic glasses.
Myopia acquired by the elderly is a precursor to the development of cataracts, where the hardening of the crystal nucleus leads to an increase in the refractive index of the lens, resulting in age-related pseudomyopia. Therefore when your seeing near vision suddenly becomes better, it is best to go to the hospital eye clinic.
2, older eyes will always be presbyopia, of course, can not see clearly.
It’s not necessarily presbyopia, presbyopia can be corrected with presbyopic glasses to get the best vision, while if you have a cataract, even wearing glasses vision can not be improved.
3. I was only mildly myopic, but now that I’m older, my vision is getting deeper every year and I’ve become deeply myopic.
This is also a manifestation of cataract. Myopic patients are prone to “nuclear cataract”, and as the nuclear cataract continues to worsen, the myopia becomes deeper and deeper, and may turn from mild myopia to high or even super high myopia. In the end, it is so serious that even with deeper glasses, the eyes cannot see clearly.
4. One of my eyes has already had cataract surgery and I can see, so the other eye is left alone.
Cataracts will deteriorate to a certain extent, and cataracts in the over-ripe stage will be easily complicated by “corticolysis glaucoma”, which will cause severe redness and pain in the eye, a sharp increase in eye pressure, and even optic nerve atrophy in serious cases. At that time, even if cataract surgery is done again, the vision cannot be restored.
IV. Performance of the disease
The main symptoms of senile cataract are vision loss and blurred vision, which can cause cataract blindness in serious cases. The degree of vision loss is related to the degree and location of lens clouding. A peripheral clouding of the lens far from the center has no significant effect on vision; while a small clouding of the posterior pole of the lens can seriously affect vision. In cortical age-related cataracts, the clouding usually starts in the peripheral part and gradually progresses to the central part. If there is a transparent part between the central cortical clouding areas, the patient can still have near normal vision; whereas in nuclear cataracts, because the clouding occurs in the central part, significant vision loss can occur even in the early stage of cataract.
Cortical senile cataracts may also manifest as fixed black shadows, which appear as dots or sheets of fixed black shadows in one direction of the visual field, especially against a bright light background. Age-related cataracts may also manifest as monocular double vision, diplopia or hyperopia. Patients often complain of seeing one light into two or more lights. In addition, it may also manifest as nearsightedness. The appearance of myopia in cataract patients is related to the hardening of the lens nucleus. Nucleosclerosis causes a significant increase in the refractive index of the lens, resulting in myopia. The degree of myopia can be relatively mild and varies with cataract development, often resulting in patients with presbyopia not having to wear presbyopic glasses when reading. However, when the nucleus of the lens hardens further and the degree of myopia exceeds that of presbyopia, the patient’s near vision is significantly reduced again.
A few questions you need to know
1. Cataracts are generally invisible to the naked eye, and only a completely white cataract can be seen with a white dot in the center of the pupil.
2. Cataract and vitreous opacity are two different diseases.
Interpretation of common misconceptions of the public.
1.I have a piece of flesh on the white of my eye, is it a cataract?
The flesh that grows from the white of the eye to the black eye is called “pterygium” and is a completely different disease from cataract. Cataracts are usually not visible to the naked eye, but very serious cataracts can be seen as white spots in the center of the pupil.
2.I have a lot of black shadows floating in front of my eyes, is it a cataract?
It is mostly caused by the liquefaction of vitreous humor with age, or it may be the bleeding in the vitreous cavity, or it may be the precursor of retinal detachment, to determine what causes vitreous turbidity, we need to go to the hospital for fundus examination. But it is not the same thing as cataract. The black shadows in front of the eyes caused by cataracts are usually fixed and do not drift around.
V. Diagnosis of the disease
The diagnosis of senile cataract mainly relies on slit lamp and vision examination by doctors. Patients who are suspected of having senile cataracts should go to the ophthalmology department of a hospital and be informed by the ophthalmologist whether they have cataracts, how severe they are, and whether they have other eye pathologies in combination with cataracts.
A few questions you need to know
1. Cataract surgery must be preceded by a thorough physical and eye examination
2. Elderly patients often suffer from senile cataracts combined with other degenerative diseases
Interpretation of common misconceptions among the public.
1. Why do I need to undergo so many tests to open a cataract?
The preoperative cataract examination includes: blood test (fasting), electrocardiogram, blood pressure, intraocular pressure, lacrimal flushing, IOL measurement and calculation, corneal endothelial count, corneal topography, ocular ultrasound, macular OCT, etc. Depending on each patient’s condition, some other tests may also be required. The purpose of the above examinations is to confirm whether the patient can tolerate cataract surgery, to exclude contraindications to surgery, and to evaluate the post-operative results.
2. Poor vision in the elderly does not necessarily mean only senile cataract, but may also be combined with other senile degenerative diseases.
Older patients, especially those over 70 years old, have various reasons for their poor vision: such as senile cataract, age-related macular degeneration, idiopathic macular fissure, idiopathic macular anterior membrane, closed-angle glaucoma, etc. If you do not go to the hospital for this reason, it is likely that the best treatment time for other diseases will be delayed.
VI. Treatment of the disease
The main treatment for senile cataract is surgery. In the past, it was considered that the best time for surgery was when the cataract was mature. With the continuous improvement of ultrasound emulsification surgery technology in recent years, surgery is now possible when the visual acuity is <0.4. In addition, this standard can be adjusted according to the surgical conditions and subjective requirements of patients.
At present, the mainstream cataract surgery method is ultrasonic cataract aspiration combined with folding IOL implantation. The ultrasonic emulsification technique reduces the cataract surgical incision to less than 3mm, which has the advantages of less tissue damage, no suturing of the incision, shorter surgical time, faster recovery of vision, and less corneal astigmatism, and can be completed under surface anesthesia.
The development of artificial lens is also very rapid. Most of the IOLs currently in use are folding (soft) IOLs that can be folded and implanted through small incisions or even microincisions in the eye. There are also some IOLs with special features, such as aspheric IOLs, astigmatism-correcting IOLs, multifocal IOLs, and adjustable IOLs.
A few issues you need to know
1.There is still no effective drug treatment for cataract
2. Cataract surgery is not better as late as possible, but can be performed if it meets the indications for surgery.
3.IOLs may need to be reimplanted in special cases
4.Some patients need time to recover their vision after surgery
5.After cataract surgery, glasses are still needed
6.The choice of IOL is personalized and diversified
Explanation of common misunderstandings among the public:
1. Cataracts can be cured with a few drops and medication.
So far, medication cannot effectively stop or reverse lens clouding, so surgery is still the main treatment for cataracts. We can delay the development and occurrence of cataract by avoiding some high-risk factors, such as consuming more foods with antioxidant effects, avoiding high-intensity ultraviolet radiation, and smoking and drinking less alcohol.
2. Cataracts can only be operated when they are completely invisible.
In the past, cataract surgery was mainly “extracapsular extraction”, that is, the whole nucleus was manually delivered out of the eye, and it was more convenient for surgery if the nucleus was harder (i.e., the mature stage of cataract). The current mainstream procedure is “cataract ultrasound emulsification”, in which the entire nucleus is emulsified into pieces by ultrasound and then aspirated out of the eye through a small incision. The harder the nucleus, the longer the emulsification time and the higher the energy required, thus increasing the tissue trauma and the difficulty of the surgery, and the slower the post-operative recovery.
3.If cataract surgery is done but no IOL is implanted, is the surgery a failure?
In some special cases, the IOL needs to be reimplanted after the second surgery. For example, if a patient’s lens suspensory ligament is loose due to advanced age or other eye diseases, or if the lens is found to be semi-dislocated during surgery and the capsule is not sufficient to support the IOL, it is best not to implant the IOL at this time and wait for the second stage surgery.
4. On the first day of postoperative examination, I still cannot see, and the doctor said that the cornea is edematous, is there a problem with the surgery?
Early postoperative corneal edema is a common phenomenon after ultrasound emulsification. The main reason is that the ultrasound energy used to crush cataracts during surgery will also cause some damage to the cornea. Patients with severe sclerotic cataract and low corneal endothelial cell count are prone to corneal edema. After medication, it can generally return to normal in about 3 days to 1 week after surgery.
5. Although the postoperative vision is good, the eyes always feel uncomfortable and the foreign body sensation is strong.
Post-operative foreign body sensation is also a common symptom after cataract surgery, and many patients complain about the discomfort with their doctors during post-operative visits. Post-operative foreign body sensation is mostly caused by dry eyes. Many older adults have dry eyes before surgery, and this is exacerbated by damage to the corneal limbal stem cells from the surgical incision and the use of postoperative eye drops. Treatment can be done with preservative-free artificial tears to relieve the symptoms, and most patients have dry eye symptoms relieved or disappeared after 1 month.
6.After surgery, it is very clear to see far away, but it is still difficult to see close
The biggest defect of artificial lens is that it can’t be focused like our clear lens to see near and near freely. If designed to let patients see far clearly after surgery, they have to wear presbyopic glasses to see near; if designed to retain myopia after surgery, patients can see near clearly and have to wear myopic glasses to see far. Therefore, correct optometry is needed in January after cataract surgery.
Of course, there are also multifocal IOLs available, which can be used to see far and near clearly, but they are three times more expensive than normal IOLs and have certain indications and limitations. If you have such a need, you can discuss with your surgeon the possibility of implanting such an IOL for individualized selection. In addition, patients with preoperative keratogenic astigmatism can also choose to implant a TORIC lens with astigmatism to obtain better vision after surgery.
VII. Prognosis of the disease
The amount of vision that can be achieved after cataract surgery depends mainly on the eye condition of each patient, especially the macula and optic nerve function. If the macular function of the fundus is good and it is simple age-related cataract, the postoperative result can be very good. If there is also a combination of fundus or optic neuropathy, the post-operative visual outcome will be greatly reduced.
A few issues you need to know
1.Post-operative vision results depend on a variety of factors, it is not true that if you have cataract surgery, your vision must be good.
2. Vision loss may occur again in the distant postoperative period because of “posterior capsule clouding”, which requires YAG laser to cut the posterior capsule clouding area.
Common misunderstandings of the public: 1.
1. After cataract surgery, vision will always improve
Cataract surgery is like replacing a transparent lens on a camera, whether it can take clear pictures depends on whether the negative is good or not. No matter how advanced the lens is, if the negative is bad, you can’t take a good picture. The negative is equivalent to the retina of the human eye. If there are problems with the retina, such as age-related macular degeneration, diabetic retinopathy, optic nerve atrophy, idiopathic macular fissure, idiopathic macular anterior membrane, retinal splitting, etc., the improvement of vision after cataract surgery will be very limited, and even some patients will be advised to give up cataract surgery if the above-mentioned serious lesions are found in the preoperative examination. For patients with diabetic retinopathy, the purpose of cataract surgery is to see the fundus more clearly so as to facilitate better treatment of fundus diseases after surgery.
2. Since my fundus is not good, why did the doctor give me cataract surgery, and as a result, I still can’t see after the cataract is opened.
Due to the obstruction of cataract (especially severe nuclear cataract or total white cataract), some patients cannot fully examine the function of macula and optic nerve in the fundus before surgery, and OCT examination of macular area cannot be done. Although preoperative ultrasound examination will be done, it can only reveal the presence of retinal detachment and other serious fundus diseases, some of which cannot be detected by ultrasound and can only be detected by fundus examination after cataract surgery. Therefore, patients with combined fundus disease should not wait until they are completely blind and then go to the doctor, which will affect the doctor’s judgment of the postoperative effect and increase the difficulty of surgery.
3.It is useless to open the cataract, it will grow out later and you will not be able to see again
After cataract surgery, about 50% of people will have clouding of the posterior capsule, which will lead to vision loss. Generally speaking, it means that the stent of the artificial lens is cloudy, not that “the cataract that was opened will grow back”. For posterior capsule clouding. With YAG laser posterior capsulotomy, vision can be restored. The laser procedure is quick and painless, outpatient treatment, and no hospitalization.
VIII. Follow-up and referral
Cataract surgery is usually followed up on the first day after surgery, the third day after surgery, two weeks after surgery and one month after surgery.
A few questions you need to know
1. Regular follow-ups are needed after cataract surgery
2. If other eye diseases are combined, further treatment is required after cataract surgery
Interpretation of common misunderstandings among the public
1.I can see very well with a good incision, so I don’t need to review
Early post-operative review is very important because doctors need to pay attention to whether the operated eye has infection and other abnormal conditions. If the eye becomes red and painful and vision decreases, it is necessary to seek timely treatment and be alert to the occurrence of postoperative intraocular infection.
2. After cataract surgery, why did the doctor say I need other treatment?
For patients with other combined eye diseases, such as glaucoma before surgery, it is necessary to follow up the IOP frequently after surgery to see if it is necessary to use anti-glaucoma drops at the same time; for some patients with combined diabetic retinopathy before surgery, it is necessary to dilate the pupil in time to check the fundus after surgery and if necessary, laser treatment.
Nine, patients and doctors
Geriatric cataract is a type of disease with high incidence. With the improvement of quality of life, the popularity of cataract surgery increases year by year. Doctors and patients should be on the same page, both aiming to get the disease well. The patient is happy and the doctor is happy when he/she can see clearly with a good operation. For some patients with complicated eye conditions, the post-operative vision may be limited, the patient should be able to understand, and of course, the doctor should fully communicate with the patient to strive for the best post-operative vision on the basis of mutual understanding.