3.1.11-media opacity fundus exam

Question 1

What are the different types of media opacity?

Answer 1

• posterior subcapsular cataract (PSC)
• cortical cataract (CC)
• nuclear sclerotic cataract (NSC)
• posterior capsular opacification (PCO)

Question 2

What does a NSC look like and how do you detect it?

Answer 2

• Brunescence/yellowing of the centre of the lens can be seen
• Use an optic section on slit lamp

Question 3

What does a CC look like and how do you detect it?

Answer 3

• Spokes at the edges, usually starting infero-nasal, may be hidden behind the iris, best seen on dilated pupil
• Retro-illumination from the fundus which can be seen with retinoscopy, direct ophthalmoscope, slitlamp beam (putting beam temporal so that it strikes the ONH for the brightest reflection from the fundus)

Question 4

What does a PSC look like and how do you detect it?

Answer 4

• Vacuoles early on and then PSC seen more centrally
• Retroillumination using retinoscope/direct ophthalmoscope/slitlamp
• Optic section with slit lamp shows a frosted appearance on the posterior portion of the lens

Question 5

What does PCO look like and how do you detect it?

Answer 5

• Looks like PSC in a pseudophakic px with an IOL
• Retroillumination using slitlamp/retinoscope/direct ophthalmoscope
• Optic section with slit lamp shows frosted appearance
• If px has had YAG then will see a clear hole through the PCO

Question 6

How can you examine a fundus with a media opacity?

Answer 6

• If mild or not central then can use direct ophthalmoscope
• BIO lens with slitlamp is best to see through opacity
• Dilated fundus view with BIO lens is most ideal