On the occasion of the Spring Festival of the Year of the Dragon, first of all, I wish readers and friends a happy family and good luck in the Year of the Dragon!
As one of the most important sensory organs of human beings, the eye is an important window for us to experience the world, and 75% and 95% of external information is obtained through vision. In my more than 30 years of medical career, I have witnessed the 102-year-old man go from a state of "dementia" that is silent and indifferent to rekindle his enthusiasm for life, I have felt the joy and excitement of my deaf and dumb father after regaining his sight, and I have experienced the happy ...... of a young mother who is only 29 years old and almost blind to see her child's face clearly for the first timeThe difference between "visible" and "invisible" is self-evident.
Maintaining visual health is not only closely related to daily eye habits, but also depends on the way and attitude we treat eye diseases. At present, there are still people who lack basic visual health knowledge, lack of awareness of the importance and complexity of the eyes, and often only find problems when they cause serious vision defects, and often miss the best prevention or opportunity. Therefore, it is very important to convey correct knowledge of eye diseases to the public and improve national eye health literacy through popular science.
What problems should be watched out for when paying attention to the eye health of middle-aged and elderly people?
With the deepening of the aging of China's society and the continuous improvement of the average life expectancy of the people, the health problems of middle-aged and elderly friends have attracted much attention, especially many eye diseases are closely related to age, if they do not understand and improve in time, it will affect their happy life in the next few decades.
First of all, age-related cataract is still the first blinding eye disease in China, which begins to appear at about the age of 45, and the prevalence gradually increases with age. However, age-related cataract blindness is reversible and vision can be restored with surgery. In addition, age-related macular degeneration and glaucoma, these two eye diseases are irreversible blinding eye diseases, and the loss of vision cannot be reversed, and the existing visual function can only be preserved by timely "interception". At the same time, when we enter middle and old age, we will also encounter different degrees of refractive problems, such as presbyopia, myopia degree changes, etc. It is important to note that many systemic diseases can also have a significant impact on eye health. For example, diabetes can lead to premature cataracts and retinopathy. According to data released by the International Diabetes Federation, as of 2021, the number of diabetic patients in China has reached 1With 4.1 billion people, you can imagine how many patients are troubled. In addition, high blood pressure can lead to occlusion of blood vessels in the eye and retinopathy, and even systemic cancers can lead to eye metastases. Therefore, it is important to have a comprehensive eye examination every year, and early detection can minimize potential risks.
In order to grasp the initiative in health by treating the disease before it is treated, and early prevention and response can we take the initiative in health, so I would like to share some suggestions with you. First of all, the trace elements needed by the eyes can be appropriately supplemented. For example, supplementation with lutein can reduce the risk of age-related macular degeneration. Secondly, we should pay attention to the impact of systemic diseases and control blood pressure, blood sugar, and blood lipids. In addition, we should also be vigilant about external injuries, eye injuries caused by firecrackers during the Spring Festival are not uncommon, and we must not cause lifelong regrets because of the greed for temporary happiness.
Ophthalmology continues to innovate to bring quality medical care to the public.
At present, there is no single drug that is effective** for cataracts, and the only solution is surgery. As an important indicator of the level of eye care in different regions, the annual number of surgeries per million population (CSR) has exceeded 10,000 in some developed countries. However, it is gratifying that with the joint efforts of ophthalmology colleagues, the "14th Five-Year Plan for National Eye Health" issued by the National Health Commission in 2022 mentions that this value in China has increased from nearly 1,000 ten years ago to more than 3,000, and strives to achieve a national CSR of more than 3,500 by 2025, and the coverage rate of effective cataract surgery is constantly improving. At the same time, the continuous development of surgical technology and increasingly high-tech intraocular lenses will further improve the best results, meet the needs of different types of patients, and benefit more people.
A cataract is the clouding of the lens, which functions in the human eye like the lens of a camera, and when the lens is "dirty", it is impossible to take pictures clearly. Cataract surgery works by removing the cloudy lens and implanting a clear intraocular lens, like a new lens for a camera. Therefore, the surgical incision and postoperative effect are closely related to the properties and functions of the intraocular lens. In terms of properties, the early intraocular lens is hard and inelastic, with an optical diameter of about 6 mm, a large incision and 3-5 stitches required at the time of implantation. With the innovation of technology, folding intraocular lenses have gradually appeared, and the surgical incision has gradually shrunk to 3 mm, 22 mm or even 18 mm, which is close to the thickness of a penny coin, not only does there be no need for sutures after surgery, but the operation time is greatly shortened, and the patient recovers faster after surgery. At the same time, the design of the intraocular lens has also been upgraded from spherical to aspherical, and the visual effect presented has correspondingly changed from similar to a "haha mirror" to a normal mirror image. In terms of function, in the past, there was only a monofocal intraocular lens, which was limited to restoring distance vision, and reading glasses were still required for near vision. Nowadays, intraocular lenses with different functions such as bifocal, trifocal, continuous visual range, and astigmatism correction have appeared, which can meet the vision requirements of patients at different distances and achieve far, medium and near vision.
When should I have cataract surgery and how to choose an intraocular lens?
Many patients still have the above misconceptions when considering the timing of cataract surgery. In fact, this was the standard of the period of technological backwardness in the early years. In the stage of vision restoration surgery, it is easier to remove the relevant tissues after the cataract matures, and due to the limited level of diagnosis and treatment at that time, if the patient is operated on when the vision is still acceptable, once complications occur, the patient's life will be greatly affected. However, now the cataract surgery technology is very mature, according to the "APACRS Clinical Practice Guidelines for Cataract Surgery" issued by the Asia-Pacific Society of Cataract and Refractive Surgeons, the visual acuity due to cataract is reduced to 0Surgery is recommended for ages 5 and below**. In fact, there is no fixed standard for the selection of surgery time, and patients can choose the timing of surgery according to their personal work and life needs. For example, some professional drivers need to look at the dashboard, experts and scholars need to do scientific research, and when the writing materials have high visual requirements, they can have early surgery according to the occupational requirements.
Personal needs not only determine the timing of surgery, but also one of the important reference factors for choosing an intraocular lens, and doctors will fully understand their occupation, education level, economic conditions, and eye use scenarios. It is important to emphasize that as multifunctional intraocular lenses are not suitable for all patients, the option needs to be further evaluated after a thorough examination and measurement. In fact, choosing an intraocular lens is like buying shoes, the right one is the best, and you can neither "cut your feet to fit the shoes" nor think "the more expensive the better". In general, intraocular lenses can be used for life after implantation, but some patients with congenital cataracts need to have an intraocular lens replaced if they have severe refractive errors due to growth and development.
Since I started my medical career, I have performed tens of thousands of cataract surgeries with the ideal of dedicating my life to people who desire light. Since 2007, the ophthalmology medical team of the PLA General Hospital, led by me, has completed the international and national blindness prevention and poverty alleviation tasks entrusted by the National Health Commission with high quality and efficiency for 16 consecutive years, spanning 11 provinces and more than 60 counties and cities, and helping more than 10,000 poor patients to regain their sight.
These experiences have made me more passionate about ophthalmology and full of confidence in the future development of ophthalmology. I look forward to the future when intraocular lenses will be infinitely close to or reach the level of the natural lens of the human body, and I also look forward to solving the cataract problems of patients with drugs alone. Ophthalmologist is not only a profession, but also a lifelong career for me, and I believe that with the joint efforts of ophthalmology colleagues and scientific researchers, our imagination of the development of ophthalmic technology will be fulfilled.