Why do you get cataracts?
Age is the most important factor. I have always believed that cataracts are a bug in biological evolution, a deliberate flaw left by God. The human lens keeps growing throughout life. But the lens grows inside the lens capsule and is suspended inside the eye by the suspensory ligament, so the new growth of lens cells on the surface has no other place to go but to accumulate inside, whereupon the inside becomes more and more dense and impervious to light.
A cataract is a clouding of the lens inside the eye from transparent to opaque, which prevents light from entering the eye and thus affects vision. The initial clouding has little effect on vision, but later it gradually worsens, significantly affecting vision or even blindness. It can be said that as people get older, they all have cataracts to a greater or lesser extent, only the degree of difference. With the increase of life expectancy in the world, the number of cataract patients will continue to increase.
At present, medications for cataracts do not remove cataracts, but at best can only delay their development. The cataract itself develops very slowly, and whether or not medication is used does not make much difference to the patient. I generally do not recommend that patients use eye medications for cataracts. It is a waste of money. It is also uncomfortable to order more eye medication. The preferred treatment for cataracts is surgery.
What is the level of cataract for surgery? Is it necessary to wait until it is mature?
As long as the patient feels that the vision loss caused by the cataract has affected his or her normal life, surgery can be performed. With today’s surgical techniques, there is no need to wait until maturity. Maturity is when the lens is completely clouded, and by that time there is usually little vision left. A long, long time ago, probably more than 20 years ago, cataract surgery required removal of the capsule and the lens together, so you had to wait for maturation so they were attached as one.
Now that type of surgery has long since been eliminated. The conventional approach now is ultrasound emulsification combined with IOL implantation. This can be done with anything from a clear lens to a nearly mature one, so the condition of the lens is no longer the deciding factor for the procedure, but the patient’s own perception. If one feels that the vision has declined to the point that it affects one’s life one can have the surgery. If one feels that the vision is okay, or that better vision can be achieved with glasses, then one can continue to wait.
Oddly enough, many doctors in other specialties are not aware that cataract surgery does not require waiting for maturation. For eye surgery consult your ophthalmologist.
Is it dangerous to have a cataract, stay and not have surgery?
Cataracts generally progress very slowly and will not change much in the short term without treatment. Cataracts that mature may cause inflammation inside the eye or may cause an attack of acute angle-closure glaucoma, which is a sudden swelling and painful eye disease that requires immediate treatment. Patients who are more concerned about themselves in areas with slightly better medical care generally do not allow themselves to progress to this extent.
Are there risks associated with cataract surgery? Is it complicated? Is it major surgery?
There are risks associated with any surgery!!! Attention! Any surgery has risks!
The human eye is not designed and produced by a doctor and the doctor is not responsible for the warranty! No, note that no, no surgery can guarantee a return to health or be free of danger. Only, note that only, only if the patient is willing to take the risk of the procedure, can the doctor help the patient. This is no different than giving your hard-earned money to a fund manager.
People are going to get sick, people are going to get sick and die, and one day you are going to die at the hands of a doctor. Sadly, this is true, without exception. Unless you do not go to the hospital.
For cataract surgery, or any surgery that goes inside the eye, the most serious thing that happens is called a “choroidal hemorrhage”, also known as an “expulsion hemorrhage”, where everything inside the eye may be “expelled” once it happens. Once this hemorrhage occurs, everything inside the eye may be “expelled”, and it is good to save the shell of the eye after resuscitation.
The good thing is that the possibility of this complication is so small that I have only heard of it and never seen it, but I hope I will not encounter it either. One such hemorrhage is enough to destroy the spirit of an ordinary surgeon and make it difficult for him to sit in front of the operating microscope again.
In general, cataract surgery is a moderate surgery in ophthalmology, right? In a tertiary care hospital, it can be done by a senior resident or attending physician or above. Some of the smaller hospitals cannot even afford to perform ultrasound emulsification surgery.
Cataract surgery, also known as ultrasound emulsion surgery, is now very well developed. It can be done in about half an hour or less. A cataract specialist typically performs dozens of cataract surgeries a day.
There are many different types of IOLs, and there are currently the following.
1. Rigid IOLs. The incision is about 6mm, such a wound requires sutures, then the sutures will cause a certain amount of astigmatism, a bigger reaction in the short term after the surgery, and a longer recovery time. The price of a rigid lens is about less than $1000. A part of patients with slightly difficult family will choose it, and there are also patients whose cataract has nearly matured and the surgery has been unable to use ultrasound emulsification, and they have to do ECCE surgery because the incision itself already needs 5-6mm.
2. Folding IOL. In Beijing, most (over 95%) of patients in tertiary hospitals will choose this type of IOL, which is first folded, placed inside a special implant and then pushed into the eye to unfold it, so the incision is usually 3.2-3.5mm, this kind of incision does not need to be sutured, and the astigmatism is smaller and the recovery time is faster. The approximate price is between 1500 and 2999. Please note that not all of the expenses are reimbursed by the medical insurance, but only 600-700 RMB, and you need to pay the excess amount yourself.
3. Specially treated IOLs. For some patients with specific eye diseases, they may need this type of IOL, such as heparin surface treated IOL, which has much less inflammatory reaction after surgery. The price is probably close to or over $3,000.
4. Bifocal/adjustable IOLs. This type of IOL is designed to meet both distance and near vision requirements. The first few IOLs cannot do this, they only have one focal point, so you have to wear presbyopic glasses to see clearly at a distance, or the other way around, you have to wear nearsighted glasses to see clearly at a distance.