Cataracts are not scary

This is the 3029th article of Da Yi Xiao Hu

Cataract is a common curable blindness. Grandma Sun, who is 82 years old this year, comes from the countryside. She has been blind for more than 10 years. She lives in darkness all day long and can hardly distinguish between day and night. She cannot take care of herself. Because the family lives in financial difficulties, they have not been able to take the old lady to see a doctor. Until one day two months ago, her grandson took her from the town to the hospital for examination. After examination by an ophthalmologist, the old lady was diagnosed with cataracts (see Figure 1) and could regain her sight through surgery. Although Grandma Sun is over 70 years old, she has good hearing. When she heard that the hospital could treat her eye disease for free, she was very excited and was full of hope to be hospitalized. The old lady entered the operating room at 9 am, and the operation was successfully completed at 9:30 am. The next morning, when the doctor removed the gauze from the old woman's eyes, she said happily, "I can see clearly, my fingers, and even the words on the wall... Thank you, doctor." The old woman, who had been groping in the dark for more than 10 years, could not hide her joy and told everyone she met, "I can see clearly, it's great." Grandma Sun was agile and after she regained her sight, she returned home to do needlework, cook and basically take care of herself. Similar situations can often be encountered.

Figure 1 Cataract external eye photography examination shows that the lens of both eyes is opaque. After dilation, the left eye is exotropia, the lens cortex is opaque, and the lens nucleus is brown-yellow opaque. The lens nucleus of the right eye is brown-yellow opaque and the nucleus is sunken.

The restoration of vision after cataract is the focus of blindness prevention and treatment. Cataract is the clouding of the lens, which is a slow-developing process. Some cataracts are regional clouding and even form special shapes (see Figures 2 and 3).

Figure 2 Cataract slit lamp microscopic examination shows regional nuclear yellow-white opacity in the lens at 7:30-12:30, with clear boundaries, high density in the periphery, sparse in the center, and slight opacity in the rest of the body. The lesion area has a clear boundary line, fan-shaped, and also like a slice of cut orange.

Figure 3 Cataract slit lamp microscopic examination shows feather-like opacity in the subcapsular cortex of the posterior lens with clear boundaries, which affects vision.

In my country, the incidence of senile cataracts in people over 60 years old is 70%, and in the elderly over 70 years old it reaches 90%. As adults age, the chance of developing cataracts increases. The symptoms of cataracts are relatively obvious, mainly painless blurred vision that gradually worsens, and there are phenomena such as fear of light, seeing objects in darker or yellower colors, and even diplopia (double vision) and deformed objects. However, the initial symptoms of cataracts are not obvious, and the patient hardly feels anything. It was not until the condition became serious and the vision was unclear that cataracts were diagnosed, so cases of delayed diagnosis and treatment were common. When cataracts reach a certain degree, complications such as secondary glaucoma will occur, causing eye pain and discomfort. Overmature cataracts will cause liquefaction of the lens cortex and sinking of the cataract nucleus, making treatment more difficult.

At present, surgical treatment of cataracts is the most effective way at home and abroad. Cataract surgery mainly replaces the ineffective natural lens by implanting an artificial lens. With the continuous advancement of "artificial lens" materials, truly small-incision cataract surgery has become possible. The latest cataract surgery incision has been reduced to 3.2 mm or even smaller, causing minor damage to intraocular tissues. The surgery does not require medication, injections, or bleeding, and has a good prognosis. There are generally no restrictions on the patient's daily life after surgery. Cataract patients are mostly middle-aged and elderly people, and poor vision can easily affect their lives. If surgery is performed until they can no longer see, the best time for treatment will be delayed, and the difficulty of the surgery may increase, thus affecting the effectiveness of the surgery. Therefore, as long as you feel that cataracts have affected your normal daily life, you should consider undergoing surgery.

It should be pointed out that some patients, in addition to cataracts, also suffer from high myopia, uveitis, fundus diseases, especially macular diseases. After cataract surgery, their vision does not improve significantly or even does not improve at all. The cause of the disease is the fundus disease rather than cataracts or cataract surgery.

The successful restoration of sight of a cataract patient can relieve a family and significantly reduce the burden on the family and society, achieving the social effect of "restoring sight for one person, liberating a family, and influencing a generation". Cataracts are not scary. Timely surgical treatment can allow every cataract patient to regain sight and have a good visual experience.

(Excerpted from "Chinese Clinical Diagnostics Atlas" and "Clinical Diagnostics Atlas" edited by Yang Zhiyin et al., published by People's Medical Publishing House, to be published. Contact email: [email protected]).

Author: Jining Medical College Affiliated Hospital

Li Chuanbao, professor of ophthalmology and chief physician