9 questions and answers about cataracts

The elderly are the most susceptible to cataracts. Among the elderly aged 60 to 89, the incidence of cataracts is 80%, and the incidence of people over 90 years old can reach more than 90%. The population base of cataract patients in my country is large, but the surgery rate is low. The annual compound growth rate of cataract surgery in my country is currently 16.3%. This figure is very amazing. Regarding cataracts, I have sorted out 9 commonly asked questions here, hoping to be of some help to everyone.

The above figure is an estimate of the number of cataract patients in China from 2002 to 2016. The data comes from the "2017-2023 China Cataract Drug Industry Market Operation Trend and Development Prospect Forecast Report"

1. What is cataract?

If the human eye is compared to a camera, the lens is composed of the cornea and the lens, and the retina is equivalent to the film. A transparent lens and a good film are the basis for clear imaging. As we age, the lens gradually changes from transparent to opaque, which forms cataracts. Traditional Chinese medicine calls it "round cataracts", which is the number one cause of blindness in the elderly.

2. What causes cataracts?

Traditional Chinese medicine believes that cataracts are mostly caused by aging and physical weakness, liver, spleen and kidney deficiency, inability of qi and blood to nourish the eyes, malnutrition of the lens, and gradual turbidity.

Modern medicine also believes that aging is the main cause of cataracts. In addition, heredity, local nutritional disorders, immune and metabolic abnormalities, trauma, poisoning, radiation, etc. can all cause lens metabolism disorders, leading to lens protein denaturation and turbidity, and forming cataracts.

This disease is more common in people over 40 years old, and the incidence rate increases with age.

3. What are the symptoms of cataracts?

The most common symptom of this disease is painless, slow vision loss in one or both eyes. The course of the disease is usually long, and most patients have adapted to the blurred vision before it affects their daily life. Some patients also have rapid and intense illness, and their vision decreases significantly in a short period of time. There may be glare, monocular diplopia, and increased myopia. If elderly people experience similar symptoms, most of them may be cataracts.

4. How to treat cataracts?

As for its drug treatment, both at home and abroad, it is currently in the exploratory research stage. Most Chinese medicine treatments start with its cause, regulating the liver, spleen and kidney, and replenishing qi and blood. There are also some local medications, mainly eliminating cataracts and improving eyesight. Acupuncture treatment can dredge the meridians and activate the collaterals, which is beneficial to improving blurred symptoms and systemic accompanying symptoms. Modern medicine also believes that early cataracts can be treated with oral vitamin C, vitamin B2, vitamin E and other drugs to delay the progression of the disease. For some patients with mid-term cataracts, vision and lens opacity can also be improved to a certain extent after taking the medicine. However, for mature cataracts, both Chinese and Western medicine tend to prefer surgical treatment.

5. Surgical treatment of cataracts?

The principle of the operation is to remove the original cloudy lens and implant an artificial lens with the same function, thereby restoring transparency and completing the rehabilitation of vision. The specific procedures are:

(1) Phacoemulsification is a new type of cataract surgery that has been developed in recent years both at home and abroad. It uses ultrasound to crush the lens nucleus into a milky state, and then sucks it out together with the cortex. After the operation, the posterior capsule of the lens is retained and a posterior chamber intraocular lens can be implanted at the same time. Its advantages are small incision, less tissue damage, short operation time, and rapid visual recovery.

(2) Extracapsular cataract extraction. The incision is larger than that of phacoemulsification. The cloudy lens nucleus is expelled and the cortex is aspirated, leaving the posterior lens capsule. A posterior chamber intraocular lens is implanted at the same time.

6. How to prevent cataracts?

1. Wear sunglasses when going out, especially in summer or at the seaside or other places with strong ultraviolet rays. Wearing sunglasses can reduce the damage caused by ultraviolet rays to the eyes;

2. Drinking water appropriately and preventing dehydration can prevent the condition from getting worse;

3. It is recommended to take 100-200 mg of vitamin C every day to effectively prevent cataracts;

4. Eat less spicy, greasy, and difficult-to-digest food;

5. Taking aspirin appropriately can effectively delay the occurrence of cataracts;

6. Try to quit smoking to reduce the incidence of cataracts;

7. Use drugs with caution in early pregnancy, as some drugs can cause congenital cataracts in the fetus;

8. Control blood sugar.

7. Precautions before surgery

1. Patients with hypertension, diabetes and cough should be examined by an internal medicine physician and surgery should be performed only after the conditions are under control and stabilized.

2. If you are taking internal medicine such as high blood pressure, diabetes or cough suppressants, you should continue to take them before, during and on the day of surgery.

3. If you take anticoagulants for a long time, you generally need to stop taking the drugs 3 to 5 days before surgery.

4. Be sure to use antibiotic eye drops as prescribed by your doctor three days before surgery.

5. Take a shower and wash your hair the day before surgery.

6. Wash your face thoroughly on the day of surgery and do not use any cosmetics.

7. You can eat a small amount before surgery.

8. Things to note on the day of surgery

1. A family member must be present on the day of surgery.

2. Arrive at the ophthalmology clinic on time as required by the doctor and make preoperative preparations.

3. Go to the toilet before surgery to prevent the urge to go to the toilet during surgery.

4. Surgery generally uses surface anesthesia or local anesthesia, and general anesthesia in special circumstances.

5. Please do not move your head during the operation and do not speak unless necessary.

6. Do not cough or hold your breath during the operation, as it will increase intraocular pressure and hinder the operation.

9. Postoperative precautions

1. A slight foreign body sensation in the wound on the day of surgery is a normal reaction and these symptoms will gradually disappear after one day.

2. On the day of surgery, please do not open the dressing on the operated eye and try to lie down in bed and rest.

3. Return to the ophthalmology clinic on the second day after surgery to change the dressing and bring the prescribed eye drops.

4. If you feel any of the following conditions, please contact the surgeon immediately:

(1) Severe eye pain accompanied by headache.

(ii) There is a lot of eye secretion.

(3) Continuous tears.

(iv)Sudden loss of vision.

5. Try to avoid flying one week after surgery.

6. When going out, be sure to protect the operated eye, move slowly, and be accompanied by someone.

7. Take eye drops seriously:

(a) Wash your hands with soap and water and dry them first.

(ii) The best position for the patient is lying down (sitting is also acceptable).

(iii) Tilt your head back slightly and use your index finger to pull down your lower eyelid.

(IV) Determine the name of the eye drops and avoid using the wrong eye drops

(V) Look up and use your other hand to apply eye drops or eye ointment. Leave 5 to 10 minutes between applying the two eye drops.

(vi) Release your lower eyelid, gently close your eyes, and rest for 3 to 5 minutes.

8. Please avoid the following actions without the doctor's permission to avoid increased intraocular pressure and affect wound healing:

(1) Heavy work such as carrying children or lifting heavy objects.

(2) Bend down to pick up something or wash your hair.

(3) Rub your eyes vigorously with your hands or a handkerchief.

(iv) Sleep facing the side of the eye on which surgery was performed.

(5) Eating hard things, such as melon seeds and broad beans.

(6) Eating spicy foods, such as chili peppers and cigarettes.

(VII) Severe cough.

(8) If you have constipation, do not exert yourself too much and eat more papaya and bananas.

9. The following things can be done:

(1) Keep a happy mood.

(2) Don’t watch TV for too long.

(3) Eat more vegetables, fruits and drink more water.

(IV) Please go to the barber shop and lie down while washing your hair. If your eyes are splashed with water, please go home and get some medicine immediately.

(5) You can do some light household chores, such as watering the flowers and folding clothes.

(VI) Please try to lie flat when sleeping. If you need to sleep on your side, sleep on the side that has not undergone surgery.

Expert Recommendation:

Wang Zhiqiang: Doctor of Medicine, Associate Chief Physician, Director of Ophthalmology.

He is good at combining traditional Chinese and western medicine to treat myopia, amblyopia, pediatric blepharospasm, dry eyes, age-related macular degeneration, optic atrophy, glaucoma, menopausal eye diseases and other ophthalmic diseases. He is good at cataract, glaucoma, vitreous cavity injection, tear duct, pterygium, eyelid plastic surgery and other surgeries. He advocates the combination of traditional Chinese and western medicine in the treatment of eye diseases, giving full play to the advantages of both traditional Chinese and western medicine, in order to help patients to the greatest extent. In clinical practice, he comprehensively uses traditional Chinese and western medicine treatment methods, harmonizes internal and external treatments, and treats both the symptoms and the root causes. He has rich experience in the treatment of many common and difficult ophthalmic diseases such as juvenile myopia, blepharospasm, diabetic retinopathy, age-related macular degeneration, ischemic optic neuropathy, optic atrophy, retinitis pigmentosa, high myopia retinal diseases, thyroid-related eye diseases, orbital inflammatory pseudotumor, etc. He has edited and participated in 3 professional books, undertaken and participated in more than 10 national, provincial and ministerial projects, and published more than 20 papers in professional core journals. He is an expert in setting questions for the National Administration of Traditional Chinese Medicine's regular training examination and professional title examination. He has served as a teacher in the Neijing Teaching and Research Section of the Western Medicine and Chinese Medicine Class of Xiyuan Hospital of the China Academy of Chinese Medical Sciences, a teacher of clinical students at Beijing University of Chinese Medicine and Binzhou Medical College, a teacher of Beijing and district-level continuing education projects, and also teaches ophthalmology graduate students and international students. He is keen on popularizing ophthalmology knowledge and has been invited to participate in the recording of TV and radio popular science programs and publish various popular science articles many times. He won the third prize in the 2017 National Popular Science Competition on behalf of the State Administration of Traditional Chinese Medicine.