My name is Brain Little. I’m a consultant ophthalmologist based at Moorfields Eye Hospital.
我是布莱恩·利托，在英国摩菲眼科医院（欧洲最大的眼科医院）担任主任医师。
My special interest is particularly cataract surgery, and particularly complex cataract surgery.
我的专业兴趣主要集中在白内障手术治疗，尤其是复杂性白内障手术。
I also deal with implantation of multifocal intraocular lens as well as a particular interest.
另一方面我开展并有专业兴趣的领域，是多焦点人工晶体植入术。
I have about 25 years of experience doing this.
我在这个领域有长达25年的经验。
I’m currently president of the United Kingdom and North Ireland Society of Cataract and Refractive Surgery.
我目前在任英国和北爱尔兰白内障及屈光手术学会主席。
And I’m the director of training at the Cataract Service of Moorfields.
我是（欧洲最大的眼科专科医院）Moorfields眼科医院白内障专科的教学培训主任
There are many options of cataract surgery that really didn’t exist a few years ago.
有很多白内障手术的术式选择是最近几年才诞生的。
And that’s particularly in the area of the availability of different types of implant.
尤其是各种不同类型的新型眼内植入物。
The standard lens, which is monofocal lens, is perfectly adequate for everyday needs but is limited for near vision.
标准的人工晶体是单焦点的，对于日常生活完全足够，但无法满足近距离视力需求。
And there are a couple of options for near vision, one is to put a monofocal lens in each eye: one for distance, one for near, and they work together.
用于改善近距离视力的方法也有几种可供选择。一种是在每只眼内各植入一枚单焦点人工晶体：一枚用于远视力，一枚用于近视力，两边共同发挥作用。
But the better way of getting monofocal vision without glasses is to put multifocal lens in.
但另一种更好的方法可以使患者无需戴镜而（在不同距离）获得与单焦点人工晶体相仿的视力效果，这就是多焦点人工晶体。
And again within this area of lens implant, there are different types of multifocal lens implant so they can actually be tailored to this specific needs of an individual depending on what their visual demands and their life style is.
在这类的晶体植入物中，也有不同类型的多焦点人工晶体，可以根据患者在视力和生活方式上的特定需求，来个性化地加以选择。
So somebody who is very much working at computer distance you maybe put into a different type of lens implant, than somebody who wants particularly high resolution close vision.
例如相比于需要很高分辨率近距离视力的人士而言，对于基本在电脑前工作的人士，植入的人工晶体类型就应有所不同。
Those choices are available and there are solutions for virtually everybody.
对于上述这些患者，都有相应类型的人工晶体可供选择。事实上，对于每位患者，都可以制订出相应的解决方案。
If one could be honest, we don’t really have the perfect substitute for our own lens when we were 15 years old.
实实在在的说，没有什么植入物可以完美到能够替代我们自己在15岁时的晶体。
So one has to accept there are limitations in the optics that one can develop in a small plastic implant that is going to substitute for the infinite focusing power of our natural lens that age.
因而我们必须接受的是，在一枚小小的塑料植入物上能够开发出的光学性能是有限的。植入物替代的，是我们自身虽然有极大聚焦能力但却会老化的天然晶状体。
But they have evolved and improved significantly since it was available.
（尽管有局限性），人工晶体自从问世以来已经得到了显著的发展和改良。
The first one was available about 20 years back.
第一枚（多焦点人工晶体）的问世大约在20年前。
And that has limitation and side effect: what is called dysphotopsia where you get optical phenomenon like halos and rings around lights, and poor contract at night.
当时的产品有局限性和副作用，称为眩光，具体表现为一些光学现象，如光线周围的光晕和光圈，以及夜间视物对比度下降等。
And the optics of these implants have been improved significantly and steadily over that time.
这类植入物的光学性能随着时间已经得到显著和平稳的改善。
So that now the levels of dysphtopsia and side effects are significantly less.
因此，现在的（多焦点人工晶体）所带来的眩光症状和副作用都明显减少。
And the quality of vision with contrast sensitivity is much much better.
视觉质量和对比敏感度也较过去有了大幅改善。
It’s always been an objective in cataract surgery to try and minimize the size of incision.
尽力缩小手术切口，一直是白内障手术的一个目标。
Simply because it allows the eye to heal quicker and recover quicker.
原因很简单，手术切口越小，眼部的伤口愈合就越快，恢复时间也越短。
The smaller the incision the less corneal distortion there is.
此外，切口越小，角膜受变形程度也越小。
So the incision’s got progressively smaller over the years.
也正因为这些原因，近年来手术的切口越做越小。
So that now, so the sub-two-and-half-millimetre incision surgery is commonplace.
目前，切口长度不足2.5毫米的白内障手术很常见。
And those of us who have been around during its development have seen the advantages of this small incision.
作为这一手术技术发展过程的亲身经历者，我们已经看到了小切口所带来的优势。
And it makes a significant difference in those areas I mentioned about, the recovery time, and the amount of induced astigmatism or distortion of the cornea.
正如刚才所提到的，小切口技术在手术恢复时间，以及手术导致的角膜变形和散光程度等方面都带来了很大的不同。
And so that’s a significant improvement in that type of surgery.
这是白内障手术领域的重要发展。
But that had to go hand in hand with the evolution of technology of the instruments that you use.
但这些（手术方式的）发展，都必须与手术设备器械的技术革新相同步。
That has to fit through smaller incision.
手术器械必须能通过缩小的手术切口（施行手术）。
So it’s been a parallel development but with very tangible benefits.
（手术设备器械的发展）是与手术方式的发展相伴随产生的，而这些发展带来的益处却是显而易见的。
Unfortunately not every cataract is straightforward.
遗憾的是，并非所有白内障病例都很容易处理。
So that patients that have had other eye diseases that can affect the lens as well, the cataract surgery itself is necessarily more challenging and complex.
患者的其他眼部疾病可能对晶状体产生影响，白内障手术也会相应更具挑战性、更为复杂。
And I have a lot of experience in dealing with those of the cases.
在处理这类病例上，我的经验非常丰富。
So for example in cases where the cataract, the whole lens is loose for example, that can be very challenging, very difficult surgery.
例如，在白内障手术中，如果整个晶状体都很松垮，手术的挑战性会很大，技术难度会很高。
And those are areas that I’ve actually developed an expertise in over the years.
我多年来的技术专长就是处理这类复杂的白内障病例。
And also with cataract operations that haven’t gone so well first time around. And the lens needs positioning or it may need exchanging, is another area that I get involved in as well.
还有些情况下，第一轮白内障手术不顺利，对人工晶体需要调整位置或加以更换，这也是我擅长的技术领域。
So that my expertise over the years has been concentrated very much on those types of cases. They are very challenging cases to deal with.
我多年的临床专业工作主要集中于处理这类对技术难度要求很高的复杂手术。
And you can’t always get a satisfactory result every time of course, depending on really what problems they’ve had with the original surgery.
当然，处理这类第一次手术失败的复杂情况，并不是每次都能获得满意的效果。（修补工作的）效果与初次手术之后出现的问题有关。
So the first step in that is just a careful evaluation of exactly what has happened.
因而在处理这类病例时，首先要做的就是分析清楚到底发生了什么情况。
And what is wrong with the current situation.
这些情况导致目前出现了什么问题。
And what you can do about it.
我们能针对这些问题采取什么措施。
So you have to address it in a step-wise approach.
在处理方式上，我们需要采用分步实施的方法。
And you cannot often be absolutely certain of the result.
对手术的预期效果，（手术医生们）不能采用绝对肯定的态度。
So you go into it with a full and informed consent.
（手术医生）应当与患者充分探讨并获得患者的知情同意。
And you may not be possible to get the exact result that one is hoping for, the patient is hoping for.So I think it’s managing expectations in those situations.
手术的效果有可能不一定完全达到患者的预期，因此，应当（帮助患者）合理调整期望值。
But fortunately, most, most operations you can actually rectify things that have gone wrong and get a satisfactory result in the majority of cases.
有幸在多数情况下，（既往手术带来的）问题都是可以纠正并取得满意疗效的。
The evolution of lens implantation is an intriguing one.
人工晶体植入物的发展是非常有趣的。
Cause it started only just over 65 years ago when the first lens implant was put in the eye.
从第一台人工晶体植入手术至今，已有超过65年的时间。
And it was made out of solid acrylic plastic, hard acrylic plastic. And it was Perspex as it was known then.
当时的人工晶体是用一种称为Perspex的硬质丙烯酸塑料制成的。
And it was the reason that material was chosen is that there were fighter pilots in the second world war that have fragments of Perspex from the sidescreens in their eye.
选择这种材质的原因是，在第二次世界大战期间，有战斗飞行员不幸遭受飞机侧窗的Perpex碎片射入眼内。
Which have been noted to be inert. And there was very little reaction in the eye to that.
由此发现，Perpex在眼内具有惰性，在眼内引发的反应很轻微。
And then a medical student observed that, that was the case. And asked why we couldn’t make a lens out of it.
这个现象被一位医学生观察到，因而想到是否可以用这种材质制作人工晶体。
Because it’s clear, you can mould it, you can shape it, why can’t you put it in the eye.
材质是透明的，可以拿来铸模塑形，为什么不能植入到眼睛里呢。
So he did so.
于是乎这位医学生便将这个想法付诸了行动。
And then a surgeon Harold Ridley implanted the first one in about 1950 (29 November 1949).
然后一位手术医师赫洛德•莱德利便在大约1950年的时候（实际的日期是1949年11月29日）开展了第一例人工晶体植入术。
And it got mixed reception.
之后，这种手术获得了褒贬不一的评价。
Because many people thought you shouldn’t put foreign materials in the eye.
因为很多人认为，不应当在眼内放进异物。
And so he was ostracized from the main society of ophthalmology and turned into a heretic, because they thought he was doing more damage than good, more harm than good.
之后这位手术医师遭到了主流眼科界的排挤，被视为是“异教徒”。大家认为他（给患者）带来损伤和伤害大于好处。
And in fact, so the, but the concept was a sound one. And it did work.
而实质上，这种手术理念是正确的，是行之有效的。
And the question was refining it to a degree that the lenses were optically satisfactory and didn’t pose any threat to the inside of the eye, which if they weren’t properly sized and fitted, they could do.
而具体要解决的问题则是，如何制造在光学上能产生满意效果并且不会在眼内造成任何危害的人工晶体。而尺寸和植入位置不合适人工晶体则有可能会造成危害。
So very slowly and against much opposition, they evolved into more superior forms of implants that got more reliable optical results and were less hazardous.
慢慢的，在诸多阻力下，人工晶体逐渐发展成更为精密高级的植入物，光学效果更好，危险性也更小。
But that took a good few decades and in fact ironically he was aged about 90 when he was then heralded as the most significant ophthalmologist of the 20th century which was a turnaround that took about 40 years to happen.
但这个发展过程经历了数十年。颇具讽刺性的是，这位手术医生在90岁高龄时被选为20世纪最卓越的眼科医生，而这个翻身，花了40年的时间。
But in that time, a lot did happen.
而在那些年间，的确发生了很多进展。
And the technique of current surgery where ultrasound is used through a small incision, that came in about 1969, but then there weren’t lenses that were small enough to fit through those incisions.
现在通过小切口使用超声实施手术的技术，是在1969年发明的，而在那个年代，还没有能够通过小切口植入眼内的人工晶体。
So this day, the lenses that could fit through those incisions have to actually be flexible lenses and foldable lenses, so that they could be folded, implanted and then unfold in the eye.
而现如今能够通过小切口植入眼内的人工晶体都必须是柔软可折叠的，植入时处于折叠状态，植入眼内后再伸展开来。
And the first one of those came into, became available in 1985.
这样的人工晶体在1985年才出现。
And they were very expensive, unaffordable, and so they were very slowly adopted.
当时这样的人工晶体价格昂贵，很少有人能支付得起，因而历时很久才得到应用。
So really, the lens technology that we use today has always been around for around 30 years.
所以其实我们今天使用的这种人工晶体问世已经有30年之久了。
It hasn’t been, has only been in common usage really over the last 20 years.
但这种人工晶体真正得到广泛应用，才刚刚20年时间。
So it’s been a gradual process over that time.
这是一个逐渐得到接受的过程。
But over the last 15 years or so, the availability of multi-focal lenses has made a significant difference to the way we perform cataract surgery.
而在过去约15年间，多焦点人工晶体的诞生则对白内障手术的方式带来了重大影响。
Because it offers a chance of being relatively spectacle-independent.
这项技术可以真正使患者手术后不用戴眼镜。
And these lenses are made of the same basic acrylic material although they are very flexible so that they can be rolled up and injected into the eye through an injector that has a nozzle that is only about 1, 1 and a half millimetre in diameter.
这类人工晶体的基础材质也是丙烯酸材料，不同的是，材质柔软、可卷曲折叠并放进植入器。这种植入器头端的排出通道管径只有1至1.5毫米。
And then they unfold perfectly inside the eye to the same shape as they were originally.
（通过植入器注射进入眼内的）人工晶体可以展开恢复到原有形态。
Which as you could imagine is a very high-demand thing to make on any material. But they do so very reliably.
可以想象，这对于任何材质而言都是很高的要求。但目前的人工晶体材质可以很可靠的做到这一点。
So that evolution combined with the development of the optics that allowed multifocal lenses to be used has brought us to where we are today.
这些发展，与光学发展相结合，便产生了我们如今使用的多焦点人工晶体。
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