Myth 1: Cataracts can be cured by drugs or other non-surgical treatments and surgery can be avoided.
Older people often read from various authoritative newspapers or broadcasts about all kinds of miracle drugs or miracle people made from valuable Chinese herbs 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.
Myth 2: Cataracts have to be mature before they can be done.
This is a very old-fashioned, and even a bit harmful, statement. As cataract surgery lacked a clear operating microscope 20 or 30 years ago, most ophthalmologists still relied 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 the cataract to mature 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 in the square after leaving the subway and stepping over them, resulting in a fracture. The reason is that cataract surgery should not be abandoned just because the visual acuity table “vision” is still good, but we should consider the contrast sensitivity / color vision / aberration and other factors.
The first is the patient’s own eye condition, such as the degree of corneal transparency/corneal astigmatism/vitreous transparency/retinal optic nerve health, and the second is the location of the implanted IOL and whether there are any intraoperative accidents/complications.
The third is whether the IOL prescription calculated before surgery is consistent with the actual needs. Because of the special nature of IOLs, we cannot select the appropriate prescription by using a method similar to the conventional optometric insertion, but can only obtain the expected result by a special calculation formula through biological measurements such as corneal curvature, eye length and anterior chamber depth before surgery, although our calculation formula has improved a lot with the development of technology. Various third and even fourth generation IOL calculation formulas are beginning to be used in clinical practice, but 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 situation can be improved by post-operative lens prescription).
The price of the IOL is not a determinant of post-operative vision. However, more expensive IOLs often mean smaller wounds, less post-operative astigmatism, and better quality of vision. High-end IOLs are 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.