Do only the elderly get cataracts? Do you have to wait until cataracts are "ripe" before removing them? Don't believe these misconceptions anymore

We often say that eyes are windows to the soul. Through this window, we perceive the colorful world. However, as we age, our eyes may slowly be covered with a veil - our vision gradually declines. In most cases, after a professional examination by a doctor, he will tell us that we have cataracts. Cataracts are one of the major risks that endanger our vision, and there are still many misunderstandings about cataracts, especially cataract surgery, on the Internet. Let's talk about it today.

What are cataracts?

Functionally, our eyes are like a camera, with two lenses, one is the cornea and the other is the lens, and the retina is like the film of the camera. Just as it is difficult to take clear photos if the lens is dirty, the opacity of the lens caused by various reasons will also affect our vision, which is cataract.

Copyrighted images in the gallery, no permission for reproduction. Among them, aging is the most common cause of cataracts. In most cases, cataracts are a manifestation of body aging, just like the graying of elderly people's hair. As we age, each of us is likely to develop cataracts.

What are the symptoms of cataracts?

As mentioned earlier, decreased vision is the main symptom of cataracts. However, for simple age-related cataracts, decreased vision has two characteristics: one is painless and the other is progressive. That is to say, in the process of cataract development, decreased vision is not accompanied by pain and is also very slow. If vision suddenly decreases, or is accompanied by other symptoms such as pain, it means that there are other eye diseases, which requires us to pay more attention and seek medical treatment in time. And decreased contrast sensitivity is another manifestation of cataracts. Decreased contrast sensitivity means that similar or similar colors cannot be distinguished. For example, in poor light conditions, two stair steps with similar colors cannot be distinguished, especially when going down the stairs, which may lead to falls and injuries. This is also one of the hazards caused by cataracts to the lives of the elderly. In addition, as cataracts progress, the following symptoms will also be caused. For example, some elderly people's presbyopia gradually decreases, and even develops into myopia or high myopia; some people will experience monocular diplopia or polyopia, and some people will have changes in photophobia or glare. In addition, most people will have changes in color vision, making the originally bright colors look dull. When these symptoms occur, it is likely that cataracts are sending us a warning. These symptoms may not be obvious at first, but if they persist and gradually worsen, you should seek medical attention in time for early detection.

Do only elderly people get cataracts?

As mentioned above, cataracts are a manifestation of aging, so senile cataracts are the most common type of cataracts. But young people should not take it lightly, because cataracts are not only harmful to the health of the elderly.

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Cataracts can occur at any age. For example, congenital cataracts in some infants and young children may be related to genetics or intrauterine infection. Traumatic cataracts caused by some eye trauma can occur at any age. Some metabolic-related diseases can cause or accelerate the occurrence and development of cataracts, such as type 1 or type 2 diabetes. Some eye diseases or surgeries can also accelerate the progression of cataracts and lead to the occurrence of concurrent cataracts. For example, inflammatory reactions in the eyes, high myopia, vitrectomy, etc., can all accelerate the progression of cataracts. Therefore, cataracts are not a "patent" for the elderly. Now, with the long-term bad eye habits of young people and the trend of younger chronic diseases, the age of onset of cataracts has a tendency to gradually become younger. Therefore, whether you are young or old, you can check the condition of your eyes during a physical examination. If you have symptoms suspected of cataracts as mentioned above, you should also seek medical attention in time.

How many misunderstandings do you know about cataract surgery?

Some people still have some misunderstandings about cataract surgery, especially those around patients who have unsatisfactory postoperative results or surgical complications. Although there are many successful cataract surgery cases around them, the failed cases are often magnified. So, what are the cataract surgery procedures and common complications after surgery? Can vision be restored after cataract surgery? Should cataract surgery be performed only when the cataract is "ripe"? In response to these questions, let's answer them one by one.

1. Does cataract surgery have risks and can it lead to blindness?

Some patients have doubts about eye surgery, thinking that it is okay to just make do with it, that the risks of surgery are too high, and that it would be disastrous if they go blind. This worry is completely understandable, but now there is no need to worry so much. Because with the continuous advancement of medical technology, the risks and complications of cataract surgery have been greatly reduced. Modern cataract surgery procedures usually use phacoemulsification or even the more advanced femtosecond laser-assisted phacoemulsification technology.

During the operation, the patient's own cataract will be crushed and sucked out first, and then a folded artificial lens will be implanted in the lens-shaped capsule. Under the operation of professional ophthalmologists, the safety and effectiveness of the operation can be ensured, meeting the patient's needs for minimal surgical damage, high precision, and fast recovery.

Of course, any surgery has certain risks, but these risks are controllable. Currently, common complications after cataract surgery are postoperative dry eyes and secondary cataracts. Some elderly patients will experience symptoms such as dry eyes and foreign body sensation after cataract surgery, which may even affect the recovery of vision after surgery. In most cases, these patients already have varying degrees of dry eyes before surgery, but the surgical stimulation aggravates the patient's dry eye symptoms. Therefore, cataract patients often have to use artificial tears for a period of time after surgery to relieve dry eye symptoms, and at the same time, physical therapy and other means are used to assist in the later stage according to the recovery of dry eyes. After a period of treatment, the dry eye symptoms of most patients can be recovered.

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Secondary cataract refers to the opacity of the posterior capsule bag that wraps the artificial lens. The occurrence of secondary cataract is related to the patient's age and the proliferation and repair ability of the residual lens epithelial cells. It usually occurs several months or years after cataract surgery, and manifests as a further decrease in vision after cataract surgery. In most cases, laser treatment can be used to restore vision during outpatient follow-up, and secondary cataract will not occur again after one laser treatment.

2. Will vision be restored after surgery?

Some patients have too high expectations for vision recovery after cataract surgery, thinking that cataract surgery is simple and mature, and that vision will definitely be restored after surgery. However, this is not the case. Vision recovery after cataract surgery varies from person to person. Generally speaking, although the vision of most patients will be significantly improved, the degree of vision recovery after surgery is also affected by many factors. Among them, the patient's basic eye condition is the most important factor. In addition, if the patient has other eye diseases before surgery, such as corneal lesions, macular lesions, glaucoma, etc., then the recovery of vision after surgery will be affected to a certain extent.

3. Should cataract surgery be performed only when the cataract is “ripe”?

Now it seems that this is actually a misunderstanding, which is mainly related to the development of cataract surgical technology. Before the implementation of modern cataract phacoemulsification surgery, cataract surgery required the delivery of cataract nuclei under large incisions. At that time, mature cataracts were harder and easier to deliver completely, so this saying came into being. However, with the development of cataract technology to today's era dominated by phacoemulsification, this view is long outdated, and mature cataracts will increase the risk of surgery. Therefore, this view is wrong. When cataracts affect daily life and work, surgical treatment can be considered. If delayed, cataracts may gradually worsen and even cause other eye complications. Earlier surgery can reduce the difficulty and risk of surgery and improve the patient's quality of life as early as possible.

4. Can cataract surgery be performed on both eyes at the same time?

For patients with bilateral cataracts, would it be more efficient to solve the problem of both eyes with one operation? Although it may seem so at first glance, in practice, this is not a good idea. Although with the continuous advancement of medical technology, the risk of infection after cataract surgery has been greatly reduced, there is still a risk of postoperative infection. If both eyes are operated on at the same time, once an infection occurs after the operation, it will have a serious impact on the patient's postoperative vision recovery. In addition, the operated eye needs to be covered on the first day after cataract surgery, and covering both eyes at the same time will also cause inconvenience to the patient's life. Therefore, cataract surgery for both eyes is generally performed separately. Even for patients who undergo surgery on both eyes at the same time (such as congenital cataracts that require surgery under general anesthesia), the surgeon will disinfect the operated eyes separately before performing the operation again in order to reduce the possibility of infection in both eyes.

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Cataract is a common eye disease that blurs our world and affects our quality of life. Therefore, if you have symptoms of suspected cataracts, you should have an eye examination in time to detect cataracts as early as possible, especially for the elderly. Once cataracts are diagnosed, you should choose the right time for treatment under the doctor's advice. When facing cataract surgery, we must correctly understand the risks and effects of the surgery and treat it according to the personalized surgical plan developed by the ophthalmologist, so that our eyes can continue to shine and add more beauty to our lives.

Author: Jia Changkai, deputy chief physician of Xiamen Eye Center affiliated to Xiamen University

Review丨Jin Xiuming, Deputy Director of the Ophthalmology Center, Zhejiang University Second Hospital