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Ophthalmology > 2: Cataracts > Flashcards

2: Cataracts Flashcards

1
Q

Define cataracts

A

Opacification of the lens

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2
Q

What are immature cataracts

A

Red-reflex still in tact

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3
Q

What are dense cataracts

A

No red-reflex visible

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4
Q

What are nuclear cataracts

A

Change in refractive index - causing dull colours

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5
Q

What are posterior sub capsular cataracts

A

Progress faster. Occur just deep to the lens. Present with dazzling of lights in bright sunlight and when driving at night.

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6
Q

What causes posterior sub capsular cataracts

A

Glucocorticoid use

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7
Q

What increases dot opacities

A

Diabetes and myotonic dystrophy

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8
Q

What is the commonest cause of preventable blindness

A

Cataracts

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9
Q

How does incidence of cataracts change with age

A

Increases with age (75% of over 65’s)

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10
Q

What gender are cataracts more common

A

Female

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11
Q

How should an individual with congenital cataracts be managed and why

A

Urgent referral to surgery before 6W to prevent development of amblyopia

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12
Q

What is amblyopia

A

‘Cortical blindness’ - individual will be unable to see despite glasses or contact lenses

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13
Q

What investigation should be ordered in congenital cataracts

A

TORCH screen

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14
Q

What does a TORCH screen entail

A

Toxoplasmosis

Other: VZV, parvovirus B19, syphillis, listeriosis

Rubella

CMV

HSV

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15
Q

What is a non-modifiable risk factor for cataracts

A

Age

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16
Q

What are 4 co-morbidities associated with acquired cataracts

A
  1. Diabetes
  2. Myotonic dystrophy
  3. HIV
  4. Wilson’s disease
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17
Q

What medication increases risk of posterior sub capsular cataracts

A

Glucocorticoids

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18
Q

What are 3 physical risk factors for cataracts

A
  1. Trauma
  2. Radiation
  3. Sunlight
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19
Q

What 2 lifestyle factors increase risk of cataracts

A

Smoking

Alcohol

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20
Q

Explain onset of symptoms in cataracts

A

Gradual onset of blurred vision

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21
Q

How will unilateral cataracts present

A

May go unnoticed expect loss of depth perception

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22
Q

What is a loss of depth perception called

A

Stereopsis

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23
Q

How may bilateral cataracts present

A

Gradual loss of vision presents as:
- Having to change glasses prescription frequently

  • Dazzling bright lights
  • Monocular diplopia
24
Q

What do patients with cataracts often report

A
  • Halos around streetlights and difficultly driving at night
25
Q

Will near of distance vision be impacted more in cataracts

A

Near and far distance will be impacted equally

26
Q

What will nuclear cataracts present with

A

Loss of colour vision

27
Q

What will posterior sub capsular cataracts present with

A

Dazzle from bright light

28
Q

What are 2 differential diagnosis for cataracts

A

Open-angle glaucoma

Macular degeneration

29
Q

Explain pathology of cataracts

A
  • Normally light enters eye
    through the lens
  • In cataracts there is
    precipitation of protein in the
    lens causing opacification
  • This distorts the light which is refracted and dispersed over the retina
30
Q

What does lens enable

A

Accommodation

31
Q

What are the 3 parts of the lens

A

Nucleus
Cortex
Capsule

32
Q

What is the nucleus of the lens

A

Innermost part of the lens

33
Q

What is the cortex

A

Transparent fibres that surround the lens

34
Q

What happens as we age to the cortex

A

There are more layers of transparent fibres that are added

35
Q

What is the capsule

A

Elastic fibres that holds the nucleus and cortex

36
Q

What connects to the capsule

A

Zonnules

37
Q

What do zonnules connect

A

Connect to ciliary bodies

38
Q

What does changing the shape of the capsule enable

A

Accommodation reflex

39
Q

What investigations are ordered in cataracts

A

Automated perimetry
Ophthalmoscopy
Slit Lamp

40
Q

How will automated perimetry present in cataracts

A

Normal

41
Q

What will be seen on ophthalmoscopy in cataracts

A

Loss of red reflex

42
Q

What is the red reflex

A

Orange discolouration caused by reflection of light from the retina

43
Q

Why is red reflex lost in cataracts

A

As cataract prevents light hitting the retina

44
Q

What are the non-surgical methods of managing cataracts

A

Change glasses prescription

Brighter lights

45
Q

What is the problem with conservative measures for cataracts

A

Optimise vision but do not slow down progression of cataracts

46
Q

What are the indications for surgery in cataracts

A
  • Significant visual impairment
  • Impact QOL
  • Patient choice
47
Q

Explain procedure of cataracts

A

Capsule is cut

Lens is fragmented

Plastic IOL is inserted in its place

Capsule is re-attacged

48
Q

What is the most common complication of cataract surgery

A

1 in 10 will need further laser surgery for opacification behind posterior capsule

49
Q

What is the criteria for Group I license in cataracts

A
  1. Read a number plate more than 20m

2. Visual acuity must be at least 6/12

50
Q

What is the criteria for group II license in cataracts

A
  1. Visual acuity of 6/7.5 in better eye and 6/60 in other eye.
  2. Can’t wear glasses corrective more than +/I 8 diopters
51
Q

Define partial sightedness

A

Visual acuity of <6/60. Or >6/60 with visual field impairment.

52
Q

Define blindness

A

Visual acuity <3/60 or >3/60 with significant visual field loss

53
Q

Who does the decision that someone is ‘blind’ lie with

A

Local authorities. opthalmologists make an application which Is voluntary, not statutory.

54
Q

What is the advantage of claiming blindness

A

Benefits
Reduction TV fees
Trave concession
Tax allowances

55
Q

What are the 3 most common cause of blindness worldwide

A
  1. Cataracts
  2. Glaucoma
  3. Age-related macular degeneration

Ophthalmology (12 decks)

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