Cataract

Disease Description (Causes and Symptoms)

• Definition: A disease in which the lens becomes cloudy due to protein degeneration in the crystalline lens (lens), causing blurred vision (cataract).
• Main causes: Age-related (most cases), congenital (rubella during early pregnancy, heredity), trauma, diabetes mellitus, uveitis (inflammation), long-term steroid use, excessive ultraviolet exposure, smoking·heavy alcohol consumption, and certain nutritional deficiencies.
• Pathophysiology: Loss of the optical transparency and aggregation of lens proteins cause light scattering and reduced transmission. Depending on the location, cataracts are classified as nuclear, cortical, or posterior subcapsular, with differences in symptom patterns.
• Main symptoms: Gradual vision loss, glare (especially in bright light or when driving at night), reduced contrast and color perception, monocular diplopia (double vision in one eye), temporary improvement in near vision due to a myopic shift (no need for reading glasses), and, in congenital cases, lack of fixation, nystagmus, and a risk of amblyopia in children.
• Prevalence (for reference): Closely associated with increasing age. For example, cataracts are found in many people around age 60, with a high prevalence reported in people aged 70 and older.

Treatment Methods (Standard Treatment · Medication · Surgery · Lifestyle Management · Precautions)

• Nonsurgical management
  • Early·mild symptoms: Adjusting eyeglass prescription, bright lighting·eye protection, and assistive devices such as magnifying glasses·reading glasses.
  • There is no proven medication that reverses cataracts (the current standard is surgical treatment).
• Standard surgery
  • Definitive treatment consists of removing the lens and inserting an intraocular lens (IOL) (usually phacoemulsification + IOL).
  • Types of IOLs: Monofocal, multifocal, toric, etc., selected according to the individual’s lifestyle.
  • Timing of surgery: Consider surgery when vision has declined enough to interfere with daily activities (independent activities, driving, etc.).
• Postoperative care
  • As directed, antibiotic·anti-inflammatory (steroid·nonsteroidal) eye drops are used for 1–4 weeks immediately after surgery, with regular outpatient follow-up (usually at 1 day·1 week·1 month, etc.).
  • Readjustment of the eyeglass prescription is recommended after approximately 4 weeks. Use of an eye shield during sleep may be recommended for several weeks immediately after surgery.
  • Activity restrictions: Avoid strenuous physical labor·lifting heavy objects·swimming·work that makes it easy for foreign matter to enter the eye during the first few weeks.
• Complications and precautions
  • Common complications: Postoperative inflammation, posterior capsule opacification (PCO — treatable with laser YAG posterior capsulotomy), and temporary elevation of intraocular pressure.
  • Serious complications (rare): Infectious endophthalmitis, retinal detachment, persistent vision loss (when coexisting retinal disease·glaucoma is present), and dislocation of the intraocular lens.
  • Prognosis: Vision generally improves well after surgery, but recovery may be limited when coexisting conditions such as diabetic retinopathy·macular lesions·glaucoma·optic nerve lesions are present.

Outpatient Visit Checklist (Preparation · Items to Confirm — Including Example Questions)

• Items to prepare/bring
  • A list of currently used medications (especially including anticoagulants, antiplatelet drugs, and steroids) and the times they are taken
  • Previous ophthalmic examination results (intraocular pressure, visual acuity measurements) and the most recent eyeglass prescription
  • If possible, bring the results of tests related to systemic diseases such as diabetes·hypertension (blood glucose, HbA1c, etc.)
  • Information on any previous eye surgery·trauma and drug allergies
• Symptoms to confirm
  • When symptoms began and how quickly they have progressed (gradual/acute), and whether one or both eyes are affected
  • Night-vision difficulties·glare·double vision, and the impact on daily life (driving·reading)
  • Any recent eye trauma or history of inflammation·infection
• Materials to show the doctor during the outpatient visit
  • Photos/labels of recently used eye drops or oral medications, and eyeglass prescription information
• Example questions (for presenting to the doctor)
  • "When did the symptoms become worse, and which activities are most difficult?"
  • "Do I need to stop my current medications (e.g., aspirin/warfarin) before surgery?"

General Example Questions to Ask the Doctor

• What level of vision can I expect from this surgery (what is the expected outcome)?
• What are the main risks of the surgery, and how likely are complications to occur?
• Are there any medications (such as anticoagulants) that I need to stop before or after surgery? What are the risks of stopping them?
• How long is the postoperative rehabilitation period, and when can I return to daily activities (driving·returning to work, etc.)?
• If I have other eye diseases (diabetic retinopathy·glaucoma, etc.), how will they affect visual recovery?

Examples of Disease-Specific Questions

• I have astigmatism and mainly do near-work activities (reading·computer work). What type of intraocular lens (IOL) do you recommend? (Monofocal·multifocal·toric, etc.)
• I have diabetes and findings suggestive of retinopathy. Will cataract surgery have limitations on my visual recovery? Are additional tests (such as optical coherence tomography) needed before surgery? -(Pediatric) If congenital cataracts are suspected in a child, how will the timing of surgery and additional treatment to prevent amblyopia be managed?