[Medical Insight 52nd] The symptoms and treatment of "caucoma" that the ophthalmologist tells us.

□ Broadcast date and time: October 4, 2024 (Fri) 10:20 pm
□ Producer in charge: Lee Siwoo

□ Author in charge: Kim Bae-jeong and Kim Hyun-jeong
□ Cast: Na Kyung-sun (Ophthalmologist at Yeouido St. Mary's Hospital)
□ Broadcast channel
IPTV - GENIE TV No. 159 / BTV No. 243 / LG Uplus No. 145
SkyLife Number 90
Cable - Delive No. 138 / Hyundai HCN No. 341 / LG HelloVision No. 137 / BTV Cable No. 152

* The text below may differ from the actual broadcast content, so please check the broadcast for more accurate information.


◆ Na Kyung-sun: Hello, I'm Na Kyung-sun, an ophthalmologist. The story I prepared today is a symptom that makes your eyes look blurry. It is the symptoms and treatment of cataracts.

◇ Voice actor Park Sang-hoon: Cataract, a disease in which the lens in the eye becomes cloudy and the vision becomes blurred. In 2021, cataract surgery was the number one disease surgery in Korea, with more than 1,400 operations per 100,000 people. The main cause of cataracts is aging, but the number of cataract patients in their 4s and 50s is increasing rapidly due to smartphone usage habits. Among them, looking at a bright cell phone screen in the dark promotes aging of the eyes and can cause cataracts even at a young age. Cataract treatment is more effective than drug treatment. Let's take a closer look at the timing of cataract treatment, surgical methods, and postoperative management methods.

<Understanding the Disease>
◆ Na Kyung-sun: To explain cataracts, I think we need to explain the structure of the eyes first. The eyes are also compared to the camera. As light enters and passes through the cornea once, and then through the transparent organ called the lens, light enters the inside, and the retina is imaged. Then, receiving this information and going through the optic nerve to the brain is the visual path, and cataract refers to a situation in which the lens should be transparent and soft, but as you get older, confusion comes and you can't see it well. Then my optic nerve and retina are healthy, so I can see well outside, but I can't see well afterwards because the lens becomes blurry. Even if you wear glasses, you can't see better because it blocks them from the inside of your eyes. This will now be the reason why your eyesight is failing due to cataracts. So in Korea, cataracts can be treated really well now, so it's very rare to go blind with this. In the world, it is actually the number one disease of blindness that can still be treated, so it would be good to think of it like this. Cataracts are age-related and no one can get away with them as they get older. It is an extremely natural aging phenomenon, as if gray hair and wrinkles are formed. If this cataract becomes too severe, it is hard to see, so it would be good to think that surgery is the only treatment that can overcome. So, as a result of checking the entire sample group in Korea as a large-scale national health and nutrition survey, more than 40% of those in their 40s and older are considered to have cataracts, and more than 90% of those over 65 have cataracts. So, at a certain age, not many people have cataracts, and the probability of developing cataracts is much higher than the probability of not having them.

<∀ and presbyopia>
◆ Na Kyung-sun: The most common misconception among my patients is that the symptoms of presbyopia and cataracts can actually be very confusing, it can be confusing. Usually, people think that aging is hard to see when looking at something close, but in fact, as our eyes lose control, even people who used to see well in the distance have to wear glasses to change into a situation where they can see better. Usually, aging begins in everyone's 40s to 50s. It starts regardless of age and gender, so when I say I can't see as well as before, I might misunderstand that I have developed cataracts. However, cataracts are not related to conditions. As I said earlier, since we see a transparent lens in our eyes, it's not that the lens can be seen and then not seen, so it's not irrelevant to your condition at all, and if your eyesight is good when you wear glasses, there's very little chance that cataracts will cause problems.

<Symptoms of Disease>
◆ Na Kyung-sun: Most of the most common symptoms about cataracts are expressed as blurred. Some say it's too bright. And there are many letters, but not when you open your eyes, but when you look at them one by one. That's why it's called monocular boxy, and even when you look at it with one eye, if the letters just overlap and look like two or three, it could be cataracts. In very extreme cases, you can see it through a mirror. There are not many cataracts that severe in Korea anymore. Of course, only one eye is getting worse, so the eye is bad, so there are cataracts that are not aware of cataracts progressing and turn white when it progresses further, but most of them can think of cataracts as a disease I know.

<Causes of Disease>
◆ Na Kyung-sun: If you know the main cause, you may think that I should do an ophthalmic examination at least once when there are some things. Most appear to be the biggest risk factor. So, as I said earlier, no one can avoid cataracts like gray hair or wrinkles as they get older, but even if this cataract is a cataract from a medical point of view, not all surgery is performed unconditionally. When cataracts progress to some extent and interfere with my daily life, that is the right time for surgery. However, after the age of 60, you need to check if you have cataracts at least once and how much you have progressed. In particular, if cataracts progress only in one eye, the opposite good eye is relatively visible, so there are quite a few cases where you don't know well. So it is important to cover your eyes once in a while and check if you can see your eyes well. UV rays are also considered to be a major cause of cataracts that we are well known for. So in fact, this lens is made up of proteins, which are denatured by age and ultraviolet rays. So, for example, when the egg white is very transparent, doesn't it turn white like this when it's denatured? As such, it is a transparent and regular protein, but when it becomes entangled and deforms, it creates a state in which light cannot pass through cleanly. Therefore, ultraviolet rays are more likely to have cataracts sooner for those who work outside, and even when we look at the whole planet, the prevalence of cataracts is higher in countries with more exposure to sunlight depending on the latitude. As an aside, I did a large-scale epidemiological study with a plastic surgery professor at our university, thinking that if there was a drooping eyelid that blocks ultraviolet rays and corrects other things in the same gender at the same age, it would have a protective effect on cataracts. Contrary to our hypothesis, people with a lot of eyelid sagging also had a higher probability of cataract prevalence, so it seems that certain factors that cause eyelid sagging and cataract have a common denominator. Among them, the most unusual thing is that there are other systemic diseases such as diabetes and high blood pressure. So if you have diabetes and blood pressure, if you are older to some extent, I recommend you to see an ophthalmologist. Trauma is also a major cause, and even when you were very young, even if you were hit by a ball and healed well without any problems, you may have cataracts quickly in your eyes. Therefore, it is recommended to check the traumatic eyes because cataracts can come faster no matter how much time has passed. In addition, steroids are another factor that causes famous cataracts. Steroids that cause cataracts are not just an eye problem, but atopic dermatitis applied to the skin, drugs taken due to various rheumatoid diseases or respiratory asthma, and steroids sprayed on the respiratory system for allergic rhinitis or asthma can cause cataracts a little earlier if used for a long time. Therefore, if you have these diseases and have been administering steroids for a long time in any way, it is important to check if you do not have cataracts even if you are not old yet. I also see a lot of cancer patients. This is because the main cause of cataracts is anticancer drugs or radiation therapy. So, you should treat cancer well and your whole body is very important, so I can tell you that it would be better to come to the ophthalmologist and check for cataracts after your body stabilizes. Another unusual thing is the electrode cataract that often occurs in men in their 40s and 50s in Korea. So, there are cases where you usually miss this with presbyopia, but as I said earlier, presbyopia comes with both eyes, and electrode cataracts usually come with one eye. So all of a sudden, it's too bright and I can't see. If I'm a man in his 40s and 50s, I might have a cataract, so you need to check it out at least once.

<Surgical treatment>
◆ Na Kyung-sun: Patients are always curious about when the right time for surgery is. My long-term patients just ask me if I should get surgery because they want me to decide. In fact, our patients know the timing of surgery best. I make mistakes because I really don't recognize people, or I get uncomfortable because I can't read buses and signs. However, if wearing glasses doesn't help at all, cataract surgery can overcome this daily discomfort. Of course, if there are other diseases in the eye such as glaucoma or retinal diseases, there must be a limit to vision that can be seen well, but glaucoma or retinal surgery has not yet reached the stage where it can completely restore the eyes. You can think of cataract surgery as the only way to restore your eyesight by putting artificial lenses that best resemble my original lens. Now, if you have confirmed your discomfort, the most important thing to note is dryness. When I see patients, most of them have cataracts related to aging, so there are also blurred symptoms of dry eyes, uncomfortable eyes, foreign body, and tears. In this case, cataract surgery is of no help. Sometimes people come to me and say that they will have cataract surgery because their eyes hurt and they are uncomfortable, but this is not the right treatment at all. Cataracts do not give you any feeling of the opacity of the lens in your eyes. It doesn't feel sick or foreign at all, so if I'm feeling uncomfortable, it's very important to treat it first. And there are eyes that are a little difficult to operate. If you have glaucoma or have had retinal surgery before, your eyes are very weak. Then, even with the same operation, the power to withstand the operation may be very low. So, if you have many surgeries other than other cataracts because your eyes are so bad, I can recommend you to have cataract surgery not too late. Now, there are many people who are wondering if there is no medicine in the end. It would be great if the lens turbidity I mentioned earlier could be transparent again with eye drops or medications, but humans have not yet created such technology. But it's a surgery after all. This operation is much easier than it used to be. These days, cataract surgery is very flat, and most of them do not bleed and almost no suture is required. You can return to your daily life very quickly, and it's a surgery that doesn't cause severe pain or long hospitalization, so if it's a really difficult operation, it'll be a big concern when we do this all our lives, but in fact, most of you can restore your eyesight and complete your lifelong homework very easily if you just have the surgery in a safe state. To explain a little bit about the procedure of surgery, you can think of cataracts as grapes piled up in a transparent shell, not just the lens I mentioned earlier. The flesh part in it is gradually denatured and hard to see, but this transparent pouch remains the same. So the procedure is to open this transparent pouch and take out the grapevine from it, and in the past, you had to make a lot of incisions to take out all the big grapevine, but the recent procedure was to cut the grape into small pieces with a very narrow cap and pull the little pieces out through a thin tube. So, compared to the past, many complications have decreased and astigmatism has decreased a lot after drinking. Later, some patients said, 'I'm not going to put an artificial lens. I don't need lenses. There are people who say, 'Oh, just removing that cloudy cataract doesn't end the operation. Then, there is only a transparent pouch, and there is no organ that collects light, so the eyes are invisible. So, artificial lenses and lenses. You have to put in these things, but each person has different types of artificial lenses and different degrees, and each eye measures it and puts in an artificial lens that fits him. <Artificial lens type>
I think they talk about what to put in artificial lenses the most. So the most basic thing is the single focus. So, for example, if we focus far away without glasses, I can see bus signs and things like that, but when I see something close, I need a magnifying glass when looking at the letters. On the contrary, we don't use magnifying glasses when we see something close, but we can't see without glasses when we look far away. This is also a single focus. So, regardless of whether you're far away or close, you can see the best from that distance and you can see it well with glasses on the rest of the distance, and you can think of it as a situation with a single focus prosthetic lens. But these days, modern people have a lot of work to do even if they are old, and they hope to see everything well from various streets. There are also cases where you hate using magnifying glasses. So there are many artificial lenses called multifocal and presbyopia lenses. I don't know which one is the best, but what I'm telling patients is that the artificial lens can never be the same as my young eyes, that is, my good young eyes. So if we try to see the best at some distance, we'll say that if we want to see the rest of the distance with glasses or without glasses at other distances, we'll have to endure a little less vision loss. The most worrisome part about multifocalization is that when you look at streetlights at night, you may complain of symptoms that the light seems to spread like this or the light spreads like this, but some people say that I'm looking at 1.0, but it looks like I put another thin film on it so that the boundary line is not clear. Of course, just removing my cataracts and putting in a transparent prosthetic lens is definitely better than before. It's better not to expect my realistic expectations to go back to my eyes when I was young, but if I want to make a situation where I take off my magnifying glass when I see something close, my vision from afar can be a little more damaged than a regular single-focus lens. You can think of it like this. So, similar to the point of surgery, I think it would be good to think that the prosthetic lens also needs to lose some parts and feel good about others depending on what I want and what my lifestyle focuses on the most.

<Postoperative management>
◆ Na Kyung-sun: Many people are curious about postoperative management. The person I operated on yesterday was from Jeju Island, and he was very worried about whether he could fly. It doesn't matter if you're on a plane right after the surgery. Since this is a surgery, it's most important to clean it up. It doesn't look like there's anything wrong with the tissue because we don't bleed or suture, but in fact, even if we went in for surgery, it causes serious inflammation and there's an incision. So the most important thing is to manage the infection until the incision is healed and prevent inflammation. Personal hygiene is the most important thing, and you should not go to contaminated places or rub your eyes with dirty hands. The timing of putting eye drops varies slightly from person to person, and when you put eye drops for several weeks, be careful not to contaminate the end of the eye drops by touching your eyes, and always put your hands after washing them so that you can safely put the medicine in. And sometimes I think I should save it because it's hard to get eye surgery again. So I'm going to wear sunglasses because I have to block all the sunlight. There are people like this, but all artificial lenses have UV protection. That's why there's already a situation in the eye that blocks ultraviolet rays. So, you don't have to cover up the sun, but you may feel temporarily blinding, so you can wear sunglasses according to your needs. But you don't have to never do what you're looking at, and you don't have to lie still. Since you had surgery to see well, there is no problem with watching if I can watch TV or books on the day of surgery, so you don't have to worry too much about that. But another thing you're curious about is when you can drink or smoke. Drinking or smoking has something to do with inflammation in the end. So, if you drink and smoke before this wound healing is completed, this wound will heal well, so the incision can have a very bad effect on the bite. So in my case, I usually tell you not to smoke for at least three weeks. And then getting a perm and dying your hair. Women are always very curious about that, but I'm telling you not to do that for about three to four weeks. There are many people who are wondering when they can start working out. In particular, you can just start walking right away. If you don't get foreign substances while we're doing well with the protector, you can just walk and live as it is, and especially for people with diabetes, if the sugar level rises, it will have a worse effect on recovery after cataract surgery, so I'm telling you to exercise. It's not good to exercise strength or swim that can be exposed in dirty places, and you should be careful because climbing can be a problem because foreign substances fly in.

<Medical AI Q&A>
◆ Na Kyung-sun: Viewers have sent me a lot of questions about cataract symptoms and treatments. Shall we check it out together?

◇ Y-ON (AI Anchor): It is said that even after my mother has had cataract surgery, she feels hazy symptoms. Is it a side effect of surgery?

◆ Na Kyung-sun: There are actually a number of reasons why you have blurry symptoms after having cataract surgery. Most commonly, it is likely to have been accompanied by dry eyes, and there may have been other problems with the retina or optic nerve. However, when I first performed cataract surgery, it was really visible, but over time, it is mostly called late cataract and posterior cyst confusion. If we leave the transparent shell we mentioned earlier inside and put the artificial lens there, the artificial lens will be transparent forever. However, a situation in which my originally transparent pocket becomes blurry is called a later cataract. The name is cataract, but it's just because the symptoms look equally blurry, and cataracts have already been removed, so they're not back. However, even in such a situation, if the transparent pouch is blurred, it reduces vision just like cataracts, so we irradiate the area with a laser to make a hole. If that happens, the light can enter again well and your eyesight can be restored. Late cataracts tend to come sooner as you are younger, and people with inflammatory diseases can also come sooner. In other situations, in fact, it is caused by degeneration of cells as they grow, so late cataracts can occur in any situation.

◇ Y-GO (AI Anchor): A woman in her early 70s with severe dry eyes. Can I have cataract surgery?

◆ Na Kyung-sun: The symptoms of dry eyes are very vague. Because one of the common symptoms is blurry symptoms, this can lead to severe cataracts and confusion between each other. If you have severe dryness, you may have wounds and pain in your eyes. In that case, cataracts are also short-lived, but since they go deep into the eyes and cause inflammation, dry eyes may become more severe temporarily. And in a state where dry eyes are very severe, there is a wound in the cornea that is most severe in the eyes, so there is a possibility of error during cataract surgery. Therefore, it is better to treat dry eyes as much as possible before cataract surgery and operate in that situation. Of course, dry eyes are not a disease that can be treated yet, so it is not an easy disease to cure that can be operated, so even after cataract surgery, dry eyes must be treated in parallel to maintain good vision.

◇ Y-ON (AI Anchor): I have had 2 LASIK surgeries. Is cataract surgery still possible?

◆ Na Kyung-sun: When we have LASIK surgery, we have the roughest cornea on the eye, not the lens, and when the machine measures it is difficult to determine whether the eye has undergone surgery or not. So, before cataract surgery, when we remove our lens and put in the artificial lens, we go through a lot of measurements, and in the past, errors in the number of artificial lenses could occur a lot. So, I explained that you can make errors unconditionally and re-operate before surgery. These days, with the development of so many diagnostic techniques, the range of errors has decreased a lot. Still, when I get a degree that I really don't want, I may have to change my prosthetic lens or wear glasses. Those who have undergone LASIK surgery really want to take off their glasses. They think it's so sad that I finally took off my glasses because I had a hard LASIK surgery. It's not a way to take off your glasses completely, so I think it's a way to be less disappointed after drinking. Also, young people especially want multifocal prosthetic lenses, but even if they have LASIK surgery, it doesn't mean they can't. However, I told you that the biggest disadvantage of the multifocal prosthetic lens is that it may look a little smudged or less visible from a distance, but it would be good to operate with the knowledge that LASIK's eyes may intensify.

◇ Y-GO (AI Anchor): Diagnosed with retinal interlayer separation during examination ahead of cataract surgery. My doctor wants me to do the surgery after monitoring the progress, so can I do the surgery?

◆ Na Kyung-sun: Retinal hepatic segregation is not this common disease. It usually happens a lot in myopia. So the retina is a completely different part of the eye called the vitreous body, and there's a problem there anyway, but cataract surgery is a surgery that goes into the eye, so it can cause these vitreous changes by applying pressure. So now, even if retinal interlayer separation is not a stage that requires retinal surgery, it may proceed a little more after cataract surgery. This means that all retinal diseases such as retinal vestibule are now changes that occur in the eye, so additional retinal surgery can be performed even after cataract surgery. If you know these things and operate, you won't be in a situation where you can't operate.

<Remember this>
◆ Na Kyung-sun: Many people are confused between presbyopia and cataracts, so many people try to live with cataracts because they are presbyopia. However, cataracts are a disease caused by aging and everyone develops. Please remember that it is a disease that can be treated according to that extent. I hope my story today helped you to live your happy lives. Thank you.