The lens of the human eye is a biconvex lens-like transparent structure located inside the eye, whose main role is refraction and regulation of the eye. A cataract occurs when the lens changes from clear to cloudy. Clinically, there are many types of cataracts, mainly including senile, congenital, traumatic, and concurrent cataracts, among which, the most common is senile cataract (internationally known as Age-related Cataract). With the improvement of living standards and health care system, human life expectancy is gradually increasing, and the number of patients with age-related cataracts is also increasing.
Clinically, the main symptom of age-related cataract is blurred vision, which feels like “seeing in a fog”. When they go to the hospital for examination, they will find vision loss and different degrees of clouding of the lens. Currently, cataracts are treated with medication and surgery, but surgery is the main treatment worldwide because the effectiveness of existing anti-cataract medication is not ideal. Improvements in surgical methods and the application of new instruments and equipment have greatly reduced the risk of cataract surgery, and it can be said that cataract surgery is the fastest developing and most technologically mature of modern ophthalmic microsurgery. Especially, the application of cataract ultrasonic emulsification technology, which uses ultrasonic waves to crush the lens nucleus into a celiac state and aspirate it through an incision of about 3mm, and implant an artificial lens at the same time, can generally restore vision on the first day after surgery. Therefore, once patients know they have cataract, the most urgent thing they want to know is whether they should have the surgery or not. When should the surgery be done?
So, how do you determine the timing of surgery in elderly cataract patients? This is both a simple and complex question. It is simple because age-related cataracts inevitably lead to vision loss, and as long as it is clear that the vision loss is due to age-related cataracts and not other reasons, the patient can achieve the goal of vision improvement through surgical treatment. This is because there are many scientific issues involved in determining the timing of geriatric cataract surgery, such as the degree of vision loss, the relationship between lens clouding and vision loss, whether other eye diseases and systemic diseases are combined, and the patient’s lifestyle. Therefore, patients with age-related cataracts must undergo a comprehensive examination and evaluation by an ophthalmologist to determine whether they should undergo surgery.
The lens of the human eye is a biconvex lens-like transparent structure located in the eye, whose main function is refraction and regulation. A cataract occurs when the lens changes from clear to cloudy. Clinically, there are many types of cataracts, mainly including senile, congenital, traumatic, and concurrent cataracts, among which, the most common is senile cataract (internationally known as Age-related Cataract). With the improvement of social living standard and health care system, human can expect to live longer gradually, and the number of elderly cataract patients is increasing. Bao Yongzhen, Ophthalmology Department, Peking University People’s Hospital Clinically, the main symptom of age-related cataract is blurred vision, feeling as if they are seeing things in a fog. When they go to the hospital for examination, they will find vision loss and different degrees of clouding of the lens. Currently, cataracts are treated with medication and surgery, and surgery is the main treatment method worldwide because of the unsatisfactory effect of existing anti-cataract medication. Improvements in surgical methods and the application of new instruments and equipment have greatly reduced the risk of cataract surgery, and it can be said that cataract surgery is the fastest developing and most technologically mature of modern ophthalmic microsurgery. Especially, the application of cataract ultrasonic emulsification technology, which uses ultrasonic waves to crush the lens nucleus into a celiac state and aspirate it through an incision of about 3mm, and implant an artificial lens at the same time, can generally restore vision on the first day after surgery. Therefore, once patients know they have cataract, the most urgent thing they want to know is whether they should have the surgery or not. When should the surgery be done?
So, how do you determine the timing of surgery in elderly cataract patients? This is both a simple and complex question. It is simple because age-related cataracts inevitably lead to vision loss, and as long as it is clear that the vision loss is due to age-related cataracts and not other reasons, the patient can achieve the goal of vision improvement through surgical treatment. This is because there are many scientific issues involved in determining the timing of geriatric cataract surgery, such as the degree of vision loss, the relationship between lens clouding and vision loss, whether other eye diseases and systemic diseases are combined, and the patient’s lifestyle. Therefore, a comprehensive examination and evaluation by an ophthalmologist is necessary to determine whether a patient with senile cataracts should undergo surgery.
The preoperative evaluation of cataract patients includes several aspects: 1) visual function examination, including visual acuity, contrast sensitivity, binocular vision, etc. Cataract patients with visual acuity better than 0.5 do not have significant impact on daily life and generally do not need to undergo surgery urgently. 2) screening for ocular comorbidities, such as glaucoma, age-related macular degeneration and other vitreoretinal pathologies. 3) eye examination related to cataract surgery, including corneal curvature and corneal curvature. Eye examinations, including corneal curvature, corneal endothelium, eye axis length, lens nucleus hardness, etc., and calculate the number of IOLs to be implanted through the above data. 4. Systemic examinations, such as electrocardiogram, chest X-ray, biochemical examination, etc. Especially, the prevalence of diabetes and hypertension is high among the elderly, and such patients need to actively control their blood sugar and blood pressure levels to reduce the risk of surgery.
With the progress of society and the increasing concern for health, the awareness of age-related cataract, the most common blinding eye disease in the elderly, is also increasing. The so-called “cataract is ripe” refers to the complete clouding of the entire lens. At this time, protein denaturation and water increase in the lens, resulting in an increase in lens volume, which can trigger acute glaucoma attacks in some patients and cause lens dissolving glaucoma or allergic uveitis in some patients due to the leakage of lens protein into the atrial water. No matter which of the above conditions occurs, it will bring great pain to the patients and also seriously affect the cataract surgery results, and some patients may even cause irreversible adverse consequences.
The earlier the cataract is done, the better: there are few people who hold this view, which is an inevitable trend for people to meet the requirements of modern technology society for high-quality vision. On the one hand, early cataract has little effect on vision, and some patients may have refractive errors such as myopia, and although their naked eye vision is reduced, they can obtain good vision by wearing glasses; on the other hand, although the development of IOL, a substitute for lens, has reached a fairly high level, and there are many kinds of multifocal, adjustable IOLs used in clinical practice. On the other hand, although the development of IOLs, which are alternatives to the lens, has reached a high level, and there are several multifocal, adjustable IOLs used in clinical practice, they are not yet comparable to the human own lens in terms of adjustment range, adjustment speed and imaging quality. Therefore, it is also undesirable to blindly pursue early surgery while ignoring possible postoperative disadvantages.1. Visual function examination, including visual acuity, contrast sensitivity, binocular vision, etc. Cataract patients with better than 0.5 visual acuity have no significant impact on daily life and generally do not need to be in a hurry to undergo surgery.2. Screening for ocular comorbidities, such as glaucoma, age-related macular degeneration and other vitreoretinal lesions.3. 3.Ocular examination related to cataract surgery, including corneal curvature, corneal endothelium, eye axis length, lens nucleus hardness, etc., and calculate the IOL degree that the patient should implant from the above data. 4.Systemic examination, such as electrocardiogram, chest X-ray, biochemical examination, etc. Especially, the prevalence of diabetes and hypertension is high among the elderly, and such patients need to actively control their blood sugar and blood pressure levels to reduce the risk of surgery.