6.1.6. Manages patients presenting with cataract. Flashcards
Symptomatic Cataract Questions (these are the MAIN questions):
- Regarding your eyesight in the past month or so, how are you finding your vision overall when wearing your glasses (both eyes open)?
- How much has your eyesight been interfering with your life in general or with things you like to do?
- How has your eyesight been affecting your reading ability?
- Any issues with glare? Night vision?
- How has this been making you feel?
- DO PINHOLE MONOCULARLY
6.1.6 - Cataract, NO Referral
Advise:
“12/12 recall sooner if any problems/vision worsens & impacts lifestyle, new Rx, vision degrading due to cataracts but normal due to age, if px feels vision affecting daily life/out of driving standards, px has option to be referred. Px declined today, happy for now. Aware of waiting list, risks & benefits of surgery. Advised UV protection to slow cataract onset, reduced smoking, better lighting when reading etc, larger & bolder text. CoO cataract leaflet given”
what type of people are likely to have PSC;
pxs taking steroids. Therefore, pxs with atopic history i.e. taking steroid creams & inhalers will have higher risk!
Nuclear:
- Nuclear: yellowing and hardening of the central portion of the crystalline lens and it occurs slowly over years
- General haziness of distance & near
- Increased myopia
- Lowered ability to discern colour - reduced CS
- Glare & difficulty night driving
- Monocular diplopia
Cortical:
- Cortical: when the portion of lens fibers surrounding the nucleus become opacified. The impact on vision is related to how close the opacities are to the center of the visual axis
- Glare!!
- Decreased vision & CS - relates to how close it is to the central axis
Posterior subcapsular:
- opacities located in the most posterior cortical layer, directly under the lens capsule.
- Very close to central axis so great impact on vision
- Glare
Cataract severity ranges from
- Lamellar separation - demarcation of cortical fibres due to fluid
- Incipient - wedge shaped opacities going toward centre in both ant & post cortex
- Immature - greyish white
- Intumescent -
- Mature - complete cortex involvement, quite ripe, milkier due to calcium formation
- Hypermature -
- Morganian -
Anterior subcapsular
Can be from trauma, iatrogenic, idiopathic
Posterior polar
- Typically congenital and autosomal dominantly inherited.
- Not many sxs but if PSC forms around it, can cause lots of sxs!
Traumatic
- Rosette or Stellate
- Following both blunt and penetrating eye injuries as well as after electrocution, chemical burns, and exposure to radiation
Glassblower’s
IR radiation, cortical changes
Blue dot
Genetic - Discrete punctuate bluish opacities throughout the cortex
Lamellar
Lamellar fibres separated
Criteria (generally speaking): for referral
Px wants to proceed, needs noting on referral letter AND
Their vision worse than 6/12 OR
If vision better than 6/12 but px having sig synmtoms releated to visual problems
Done at time or referral, not on assumption may be worse at further time
Record Keeping & Questioning:
Symptomatic Cataract Questions (these are the MAIN questions):
- Regarding your eyesight in the past month or so, how are you finding your vision overall when wearing your glasses (both eyes open)?
- How much has your eyesight been interfering with your life in general or with things you like to do?
- How has your eyesight been affecting your reading ability?
- Any issues with glare? Night vision?
- How has this been making you feel?
