There are some cataracts that are not simply due to age-related degeneration, metabolic disease, congenital anomalies or trauma, but are caused by other diseases of the eye. This type of cataract, which we call concurrent cataract, is a clouding of the lens due to intraocular disease.
1.Symptoms Chapter
Blurred vision (vision loss)
This is the most obvious and important symptom of cataract. Especially the clouding in the central part of the lens can seriously affect the vision even if the scope is small and the degree is mild, because it blocks the light in the visual axis area.
How is blurred vision (vision loss) caused?
Blurred vision can be caused by any lesion located within a person’s visual pathway, including the cornea, lens, retina, and optic nerve. Furthermore, these lesions can co-exist, for example, in patients with concurrent cataracts, whose cataracts occur in conjunction with other eye diseases. Therefore, most of the vision loss in patients with concurrent cataracts is caused by two or more factors.
Common patient misconceptions interpreted.
(1) Is blurred vision (vision loss) necessarily caused by cataract?
No, it is not. Any lesion located in the visual pathway can cause blurred vision, including the cornea, lens, retina, and optic nerve. Furthermore, these lesions can co-exist, for example, in patients with concurrent cataracts, whose cataracts are accompanied by other eye diseases. Therefore, vision loss in patients with concurrent cataract can be caused by a variety of factors, and it cannot be said that all of them are caused by cataract.
(2) Does blurred vision (vision loss) necessarily correlate with the degree of cataract?
No. Because vision loss in patients with coexisting cataracts is the result of a combination of factors, vision loss in many patients is not proportional to the degree of clouding of the cataract itself. For example, patients with severe retinal disease combined with cataract have severe blurred vision even when their lens is minimally clouded.
Corresponding symptoms of coexisting other eye diseases
Complicating cataracts are combined with other diseases in the eye, including: corneal ulcers, glaucoma, uveitis, retinitis pigmentosa, intraocular tumors, and high myopia. Each of these diseases has its own symptoms, and the corresponding symptoms can be seen in patients with comorbid cataracts.
What you need to know.
What are the possible symptoms of other eye diseases that coexist in patients with concurrent cataracts?
Different diseases in the anterior and posterior sections of the eye have their own symptoms. For example, patients with combined glaucoma may have swollen and painful eyes, patients with combined uveitis may have red eyes and eye pain, patients with combined retinitis pigmentosa may have symptoms such as night blindness, etc.
2.Disease
Complicated cataract
(1) Concept of the disease
Complicated cataract is a clouding of the lens caused by intraocular disease. Many diseases in the anterior and posterior segments of the eye can cause changes in the intraocular environment, resulting in disruption of the nutrition or metabolism of the lens and clouding, i.e., complicating cataracts.
(2) Occurrence of the disease
The development of cataracts in patients with different combined eye diseases has its own characteristics. Cataracts caused by posterior segment lesions are the first to appear as subcapsular clouding in the posterior pole of the lens, because the capsule is the thinnest in the posterior pole and has no epithelial protection. In cases caused by glaucoma, the clouding begins in the anterior cortex and nucleus; in cases caused by high myopia, the clouding is mostly nuclear cataract.
What you need to know
What are the characteristics of cataracts caused by different concurrent diseases?
(1) Iridocyclitis: It is the most common cause of concurrent cataract. Typical clouding is commonly found near the posterior iris adhesions and can also occur at the posterior pole of the lens. The lesion progresses slowly, and if the local inflammation is controlled, the clouding may remain stable for a long time without progression. In recurrent chronic cases, in addition to extensive posterior iris adhesions, there is often a combination of thickening or wrinkling of the lens capsule and sometimes pupillary membrane closure in the pupil area.
(2) Fuchs syndrome or Fuchs iris heterochromia iridocyclitis: cataracts occur in 70% of cases, which are caused by inflammation or sympathetic circulatory disorders or degeneration. Lens clouding starts with posterior cortical dots and thin strips in the periphery and gradually spreads to the entire lens, and its development is faster than that of cataracts caused by other iridocyclitis.
(3) Acute glaucoma: The gray spots with clear borders under the anterior capsule are dumbbell-shaped or irregularly rounded and do not progress, like scattered lime pulp on the ground, becoming glaucoma spots. The spots are necrotic lens epithelium.
(4) Glaucoma surgery: It is controversial whether it promotes cataract formation. It is thought that cataract can occur after surgery due to sudden lowering of IOP or nutritional disorders.
(5) Severe corneal ulceration: All concurrent cataracts are cloudy in the anterior pole pupil area with cone-shaped, subcapsular clouding.
(6) Intraocular tumors: Toxic products can cause rapid clouding of the lens or due to compression, such as ciliary body melanoma compressing the lens and clouding in the compressed area.
Explanation of common misconceptions among the public
Since concurrent cataracts are caused by other eye diseases, will the cataracts improve if the other eye diseases are cured?
No. Once a cataract occurs, it is irreversible. At least at the current level of medical care, there are no drugs or other means to effectively treat or reverse the development of cataracts, except for surgery.
3. Common reasons for delayed treatment of this disease
The symptoms are masked by the primary disease, or the patient treats the cataract-induced vision loss as a symptom of the primary disease. Therefore, cataract surgery is not considered as a treatment method, and cataract is allowed to gradually worsen and mature, leading to further vision loss and other complications. At this time, it is much more difficult and risky to perform cataract surgery again.
A few questions you need to know
When should I have cataract surgery?
There is no set time for cataract surgery. The timing of cataract surgery varies individually depending on each patient’s desires, work needs and quality of life requirements. Cataracts that affect the quality of vision, affect the patient’s work and life, or require early cataract surgery for the treatment and prevention of diseases such as glaucoma are all reasonable indications for cataract surgery.
Common misconceptions of the public are explained.
”People say that cataract can only be done when it is ripe and invisible.”
This is a misconception. Nowadays, cataract is not “only when it is ripe” or “only when you cannot see”, but “only when you cannot see clearly”, or even “only when you can see clearly”. “It can be done even when you can see clearly. The former means that the lens has reached a certain degree of clouding, resulting in a decrease in the quality of vision and affecting the normal work and life of the patient, at this time, cataract surgery can be performed; the latter means that if the patient has a shallow anterior chamber, pupillary block, etc., cataract surgery can also be performed early to control intraocular pressure or prevent the occurrence of glaucoma, etc.
4.Disease manifestation
As we have learned earlier, blurred vision is a common symptom of concurrent cataract. However, concurrent cataract is combined with other diseases in the eye, and each of these diseases has its own symptoms, and the corresponding symptoms will also appear in patients with concurrent cataract. Therefore, patients with concurrent cataract cannot be described by one definite symptom: patients with combined glaucoma may have swollen and painful eyes, patients with combined uveitis may have red eyes and eye pain, patients with combined retinitis pigmentosa have symptoms such as night blindness, and so on.
Common patient misconceptions interpreted.
Are all symptoms of concurrent cataracts the same?
You can’t say that. Patients with concurrent cataracts have different diseases in the anterior and posterior segments of the eye, which have their own symptoms and cannot be generalized. Therefore, patients with concurrent cataract cannot be described by one definite symptom. It can be said that cloudiness of the lens is the common denominator of concurrent cataract, but beyond that, patients with concurrent cataract have a variety of “personalities” that stem from a variety of co-morbidities.
5. Diagnosis of the disease
Complicated cataracts are cataracts caused by other diseases of the eye, so the diagnosis consists of two parts: the diagnosis of cataracts and the diagnosis of complications of other eye diseases. Both of them need to be done together according to the patient’s symptoms, signs and auxiliary examinations.
Common misconceptions of the public are explained:
”It’s clear that I have a cataract, why do I need so many other tests?”
The presence of a cataract can be determined by an experienced ophthalmologist at a glance under a slit lamp. However, not all patients have simple cataracts; many have concurrent eye diseases. It is these concurrent diseases that determine a patient’s surgical risk and prognosis for visual function. Therefore, it is essential to detect other eye diseases through a comprehensive ophthalmic physical examination and ancillary tests.
6 , Treatment of the disease
Cataracts themselves can of course be solved by cataract surgery, but it is obviously not the wisest approach to “treat the head when it hurts” alone. Through the diagnostic process described above, other co-morbidities can be identified and treated accordingly, along with cataract surgery, to achieve the best results.
A few things you need to know
(1) Nowadays, what is the effective treatment for cataracts?
It is surgery. Unfortunately, rapidly evolving medicine worldwide still has not found a drug that can effectively treat or reverse the development of cataracts, so for now, surgery remains the only effective treatment for cataracts. However, cataract surgery nowadays mostly adopts ultrasound emulsification technology, which is a small incision, less damage, shorter time, faster recovery and less risk, so it can be said to be an ideal treatment method.
(2) Will treatment methods for other concurrent eye diseases conflict with cataract surgery?
Generally not. For most co-morbidities, cataract surgery has no effect or there is a synergistic beneficial effect. Cataract surgery has been found to have a mildly lowering effect on IOP in long-term observation, thus facilitating the control of glaucoma; cataract removes the obscuration of cloudy lens, which also facilitates the observation and treatment of fundus disease. Of course, for patients with uveitis, cataract surgery may aggravate the inflammation for a period of time after surgery. Therefore, it is generally recommended that patients undergo the surgery after the inflammation has stabilized for six months, and close observation and appropriate increase of glucocorticoid medication are required during the perioperative period, and most patients can smoothly pass the perioperative period.
Common misunderstandings among the public:
(1) Will the symptoms of blurred vision (vision loss) necessarily disappear after cataract surgery?
You cannot say so. Cataract surgery is only one of the factors that can be used to solve the problem of lens clouding. Therefore, it can bring back vision to different degrees, but the effect will be determined by the proportion of cataract in the vision loss.
(2) Can cataract surgery solve all the symptoms of patients with coexisting cataracts?
No. Cataract surgery only removes the lens. Cataract surgery only removes the lens clouding and will result in varying degrees of vision recovery. However, there is no direct treatment for other complicating eye diseases, for example, retinal disease remains after cataract surgery, and glaucoma and uveitis still require further treatment.
7 , Prognosis of the disease
Overall, patients with coexisting cataracts have a worse prognosis than patients with simple age-related cataracts due to the presence of other eye diseases. Moreover, many patients have a higher risk of cataract surgery and relatively more complications due to the presence of unfavorable ocular factors such as shallow anterior chamber, high intraocular pressure, pupillary adhesions, suspensory ligament laxity, and hard nucleus.
A few questions you need to know
What factors determine the prognosis of the disease?
The type and characteristics of the primary disease, its severity, and whether the treatment is timely, reasonable and adequate all affect the prognosis of the disease. It can be said that the prognosis is determined by the disease itself, the patient, and the doctor. Complicated cataract itself is combined with different eye diseases, each with different characteristics and different prognosis; the sensitivity and attention of patients are also different, so the early detection of the disease and the compliance with treatment are also different; the treatment given by doctors is of course an important factor influencing the prognosis of the disease.
Common misconceptions among the general public are explained:
(1) “The old king next door has a cataract and his vision is 0.8, so I must be able to do the same.”
This is a common misconception. Each patient’s basic eye condition is different. The old king may have a simple senile cataract with good fundus retinal optic nerve function and no other factors affecting vision. For example, if the fundus is bad, it is like a camera with a damaged film, and cataract surgery replaces the “lens” with a brand new one, but the image is still not very clear. Patients with coexisting cataracts should fully understand the characteristics and severity of their co-morbidities and lower their expectations of cataract surgery appropriately.
(2) “I was originally highly myopic, and with cataract surgery prescribed, I became low myopic, and my fundus lesions must not progress any further!”
Many patients take it literally and will hold this wrong view. Patients with high myopia are prone to a variety of fundus pathologies. When an IOL is implanted during cataract surgery, high myopia is generally preserved as low myopia after surgery due to the change in lens prescription. However, the various fundus pathologies that result from high myopia due to lengthening of the eye and stretching of the sclera continue to exist and progress and are not discontinued by the change in lens diopters. Therefore, these patients should still pay attention to the monitoring of the fundus, regular follow-up and timely treatment.
8. Follow-up and referral
In patients with coexisting cataracts, follow-up and referral after cataract surgery become especially important due to the presence of other eye diseases. Many patients need to be referred to a fundopathologist, glaucoma surgeon, etc. for further follow-up and treatment after cataract surgery.
Common misconceptions among the general public are interpreted as.
(1) “I’ve had cataract surgery and my treatment is complete.”
This cannot be said. For patients with concurrent cataract, other concurrent eye diseases still exist, so follow-up and treatment are still needed according to the characteristics of their respective disease courses.
(2) “I came to see the fundus and the doctor told me to have cataract surgery first, that’s so irresponsible!”
Cataract is a clouding of the refractive media, which in severe cases can affect the observation of the fundus. When the fundus cannot be seen clearly, laser or surgical treatment is naturally not possible, and the diagnosis of fundus disease cannot even be made. Therefore, sometimes the fundus surgeon will first have the patient undergo cataract surgery, which on the one hand can improve the patient’s vision to a certain extent, and more importantly, can give the fundus surgeon a clear vision to observe and treat the fundus lesions.
(3) “Cataract, fundus, glaucoma, doctors always kick me around!”
Most patients with concurrent cataracts require combined treatment from multiple ophthalmology clinical groups. Especially in large specialty hospitals, ophthalmologists belong to different groups and specialize in their fields of expertise. Referrals to other doctors are made to give patients more specialized and effective treatment.
9. Patients and doctors
Complicated cataract is a combination of multiple eye diseases and therefore requires a combination of treatments and the cooperation of multiple clinical groups. Patients may not understand the need for referral or may not accept the uncertainty of prognosis. The physician should do a good job of explaining to the patient, and the patient should understand that the physician’s referral and a reasonable prediction of prognosis is itself a responsible performance.