For the same cataract, why do some people need surgery while others don’t?

Many friends have been to the Aier Eye Hospital affiliated to Wuhan University for cataract examination. After a detailed and professional examination by doctors specializing in cataract and presbyopia, if a friend has cataract, it will be recorded as "cataract" or "cataract can be operated" on the diagnosis sheet.

Some friends may ask, for the same cataract, why do some people need surgery while others do not? What is the standard for judgment?

Today, Zhou Li, PhD, associate chief physician, deputy leader of the Cataract Group of Aier Eye Hospital Group in Hubei Province, and deputy director of the Cataract and Presbyopia Department of Aier Eye Hospital Affiliated to Wuhan University (Aier Eye Hospital Group Hubei General Hospital), is here to share some popular science with our friends.

Cataract is a painless disease in which the lens in the eye becomes cloudy. The cloudy lens blocks the entry of light, causing blurred vision, which may lead to blindness in the long run. Its development process can be divided into four stages: initial stage, expansion stage, mature stage and overmature stage.

1. Initial stage

The characteristic of the initial stage is that the lens begins to become cloudy from the periphery. At first, the central part of the lens is not affected, it is still transparent, and vision is not affected. Therefore, it is generally not easy to be found, and the turbidity can only be seen after the pupil is dilated. However, as time goes by, the lens opacity gradually expands, vision is gradually affected, and the patient will slowly feel a significant decrease in vision. In fact, the "initial stage" is a very long stage.

2. Expansion period

Compared with the initial stage, the risk is greater during the expansion stage. Because the lens expands, some patients may experience increased intraocular pressure, which can easily lead to secondary glaucoma. If secondary glaucoma occurs, it will be more difficult to treat.

"Don't you say that cataracts should be treated only when they are mature?" This statement is actually outdated. Usually, the best time to undergo cataract surgery is when the visual acuity is less than 0.5. The routine cataract surgery performed at the Aier Eye Hospital affiliated to Wuhan University takes only a dozen minutes. The cloudy lens is removed using femtosecond laser or phacoemulsification technology, and then a new transparent artificial lens is implanted. The surgical incision is small and does not need to be sutured after surgery. You can also choose a refractive artificial lens to solve the problem of astigmatism and presbyopia.

3. Maturity

Some patients are lucky enough to survive the "expansion stage" without secondary glaucoma, and then develop to the "mature stage". At this time, the entire lens is diffusely milky white. Patients at this stage have obvious visual impairment and can only recognize index or light perception, and light positioning is good.

4. Overripe period

At this stage, the cloudy lens of the cataract has developed from the mature stage to a reduced water content, and the entire lens nucleus has shrunk and sunk. At this time, some serious complications may occur: phacolytic glaucoma, allergic uveitis, etc. Although the operation of cataracts at this stage is very difficult, they should be treated actively.