Part 1: Timing of cataract surgery
When is the best time to operate when a cataract is diagnosed?
Prof. Chen Weirong: In the past, it was said that surgery should be done only when the cataract is “mature”. With the advancement of technology, especially with the advent of microscopic surgery, the timing of cataract surgery varies from person to person.
Strictly speaking, as long as the cataract affects the patient’s normal life and work, surgery can be performed. In particular, it is important not to wait until the cataract is “ripe”, because while waiting for the cataract to “ripen”, complications of cataract may occur, such as glaucoma, uveitis or other complications in the overripe stage. There is another situation that patients may not have cataracts but they think they have cataracts and end up going blind while waiting, especially some glaucoma patients or some patients with fundus disease, who think they cannot see well and that is cataracts.
What are the benefits of doing it earlier? Because when the cataract is not too mature, the whole lens and capsule structure is better and the lens is not too hard. Nowadays, surgery is done with ultrasound to crush the crystal, which is not too hard and requires less ultrasound energy, so the surgery is safer and the postoperative result is naturally better.
Can I use any medication in the early stage of cataract that does not affect my life?
Prof. Chen Weirong: Early cataracts can be treated with medications, but it should be emphasized that the first sentence in the worldwide cataract treatment protocol is “The efficacy of current cataract medications is not definite”, which means that these medications may be useful, but they may only be a placebo.
Is there any relationship between when to operate and the degree of vision loss?
Prof. Weirong Chen: There is not much correlation. Some years ago, it was mentioned that it should be done when the vision decreases to 0.3, but now some people have to drive, especially at night, and cataracts can cause diplopia or glare, so that they cannot drive, and at this time, even if the vision is 0.5 or 0.8, they can do the surgery.
Some patients have cataracts in one eye, but the other eye is normal, should this be done?
Prof. Chen Weirong: The surgery has nothing to do with the healthy eye, but depends on the condition of the cataract eye.
Can I have surgery for cataract combined with fundus disease or glaucoma?
Prof. Weirong Chen: Yes. Especially when there is fundus pathology, if you also have cataract, you need surgery. Without cataracts, it is easier to diagnose and treat fundus diseases. The eye is like a camera, the cataract is the lens of the camera, and the fundus is the film of the camera. If the lens is blurred, you cannot see the fundus through the lens, so it is even more important to do it.
In fact, glaucoma and cataract are twins, and they are related to each other. Cataract can cause glaucoma when it is serious, and glaucoma can cause cataract in turn; moreover, some glaucoma can be treated by cataract surgery, such as closed-angle glaucoma, and after cataract surgery, the problem of glaucoma is solved.
When is surgery suitable for traumatic cataract?
Prof. Chen Weirong: Traumatic cataract is divided into blunt contusion and penetrating injury. If the anterior capsule membrane of the lens is penetrated and the lens cortex spills out, it should be done immediately, the sooner the better.
Part 2: How to choose an IOL
How is cataract surgery done?
Prof. Weirong Chen: Nowadays, the main way of surgery is cataract ultrasound emulsification. Femtosecond laser-assisted cataract surgery is also very popular in the past two years internationally. Cataract ultrasound emulsification involves making a small incision of about 1.8~3.2mm on the cornea with a knife (the situation varies from hospital to hospital), then tearing a small opening of about 5mm in diameter in the anterior capsule of the lens, crushing the lens with ultrasound frequency through this capsule tearing opening, then sucking it out, and then putting an artificial lens through this small incision, and the surgery is completed.
What is the difference between femtosecond laser cataract surgery and ultrasound emulsification nowadays? It is that all the current cutting actions with a knife are done by a femtosecond laser instead, achieving accuracy, repeatability and consistency, avoiding errors caused by manual operation.
Do I need to be hospitalized for cataract surgery?
Prof. Chen Weirong: No hospitalization is required, basically you can go home afterwards.
What are the types of IOLs and what is the difference between monofocal and multifocal? How can patients choose according to their needs?
Prof. Weirong Chen: IOLs are broadly divided into two types: rigid and foldable, and according to the implantation location, they are also divided into anterior and posterior chamber types, and more subdivided into monofocal, multifocal, and toric IOLs.
Among them, monofocal IOLs can only meet the requirements of seeing far or near because they only have one focal point; multifocal IOLs can meet the requirements of seeing far and near at the same time, but they are not suitable for all patients, so we should ask the doctor to decide according to the patient’s condition.
The IOLs currently used at Zhongshan Eye Center are all imported and are world-renowned brands. Because we represent the top academic and clinical level of the country, product procurement is strictly controlled. First of all, the products must be approved by the FDA, and then we carefully select some of the best quality and highest end IOLs for patients to use.
How long does an implanted IOL last? What factors are related to its service life?
Prof. Chen Weirong: IOLs can last for a lifetime and generally do not need to be replaced.
Part 3: Hot questions after surgery
I have seen some patients on the internet saying that they feel an aperture after surgery, what is it?
Prof. Chen Weirong: It depends on what kind of IOL it is. Actually, it is a halo, not an aperture. The incidence of halos is relatively low, and individual multifocal crystals may show symptoms of glare and halos after surgery. However, after the nerves adapt through brain learning, these symptoms will usually disappear slowly after 3-6 months; moreover, not too serious halos or glare will not affect the patient’s daily life.
Some patients complain that after cataract surgery, their vision does not improve or even gets worse.
Prof. Chen Weirong: If the vision does not improve or even gets worse after cataract surgery, there may be problems in the fundus of the eye, such as diabetic retinopathy, glaucoma, or other eye diseases; in addition, it is necessary to see if there are any problems with the surgery, and the cause needs to be investigated. Therefore, it is still necessary to have regular follow-ups after surgery.
What is meant by post-operative cataract? Under what circumstances is it usually prone to occur?
Prof. Weirong Chen: During cataract surgery, we will keep the lens capsule to contain the IOL. The proliferation and migration of the epithelial cells left in the capsule can cause posterior capsule clouding, which is called posterior cataract. With the update of surgical techniques, IOLs and surgical instruments, the occurrence of posterior cataracts has been reduced after geriatric cataract surgery. Especially in our hospital, because of the very high standard microscope used during surgery, we can see very fine, and even a little bit of residue will be treated, so that posterior cataracts are greatly reduced. In fact, posterior cataracts are nothing to be afraid of and can be treated with laser incision with little problem.
Can those who have had cataract surgery with poor results have it again?
Prof. Chen Weirong: If the post-operative result is not good, it depends on the situation to see if it is a problem with the IOL or other problems. How does the doctor determine this? First of all, a slit lamp examination will be done to understand the condition of the IOL; secondly, a fundoscopic examination will be done; if the fundus is normal, another optometry will be done to see your refractive status. If the problem is with the IOL’s prescription or position and cannot be adjusted by other means, you can have another surgery for IOL replacement.
Case Study
Complaint.
My father had a cataract ultrasound surgery with a 4100 Yuan American lens, and it has been one month since the surgery. Feeling
Q: My vision has not improved after surgery, but it is worse, but there is no redness, inflammation or other discomfort on the outside of the operated eye. Is it because of the inappropriate choice of crystal?
Prof. Chen Weirong: This should be a rare case, most of them are fundus problems. Because he does not have red eyes or other abnormalities, only photophobia, which is a common symptom after cataract surgery. For example, even a normal person can’t stand to see the sunlight after being locked in a dark room for a long time. Therefore, we generally recommend patients to wear a sunglass after cataract surgery to get used to it for a period of time, and then they will get better.
Q: Is it possible to have another surgery?
Prof. Chen Weirong: If the poor vision is caused by surgery or IOL, you can have surgery again depending on the situation. However, it is important to have a clear examination before surgery.
Conclusion of the interview.
“Cataracts are preventable. Because ultraviolet light is one of the main causes of cataracts, many people in foreign countries wear sunglasses, while Chinese people are a little less aware of protection in this area, even in summer, when the sun is very strong, driving without sunglasses, so that ultraviolet light is very damaging to the eyes. In highland areas such as Tibet, Hainan Island and Yunnan in China, there is more sunshine, so cataracts are high. People should get used to wearing sunglasses, which is the best means of protection.
Secondly, cataracts are also related to vitamin deficiency, mainly related to peroxidation, so you can usually take more vitamin C, but not in excess; eat more fruits rich in vitamin C, which is the safest. There are also some antioxidant substances, such as grapes, hundred fruits, wolfberries, etc., which are all useful in preventing cataracts.”