Cataract - Optometric management, and surgical management + complications

Question 1

What is the most common cataract ?

Answer 1

Nuclear sclerotic cataract

Question 2

What rx shift would someone with a NS cataract have?

Answer 2

More myopic

Question 3

What were the number of cataract cases world wide by 2020?

Answer 3

30 mil

Question 4

What percentage of the population over 65 have cataract ?

Answer 4

30%

Question 5

What are 7 traumatic causes of cataract apart from age?

Answer 5

• Blunt trauma
• Penetrating injuries
• Concussion
• Infrared radiation
• Electric shock
• Ionizing radiation
• Post surgery

Question 6

What type of cataract is this?

Answer 6

Traumatic cataract

Question 7

What are some metabolic causes of cataract ?

Answer 7

• DM
• Hypoglycaemia
• Galactokinase deficiency

Question 8

What are some other causes of cataract?

Answer 8

• Corticosteroids
• Secondary from anterior uveitis
• High myopia
• Rubella
• Down’s syndrome
• Myotonic dystrophy

Question 9

What cataract is this ?

Answer 9

Polychromatic “Christmas tree’” cataract

Question 10

Will a Christmas tree cataract always affect VAs?

Answer 10

No but may cause glare

Question 11

What happens if you do not treat cataract ?

Answer 11

Nucleus becomes dark and cortex becomes soft

Question 12

How would you examine the retina with a cataract that has got to this extent ?

Answer 12

Ultrasound

Question 13

What cataract is this ?

Answer 13

End-stage cataract

Question 14

What is Phacolytic glaucoma ?

Answer 14

End-stage Cataract Begins to breakdown inside the eye, then erodes, pressure goes up

Question 15

What system is used to grade cataract ?

Answer 15

LOCS grading

Question 16

What does the scale go up to for LOCS?

Answer 16

0.1-5.9, in practice we normally can just grade it medium, mild, marked ect

Question 17

What will px with PSC complain of?

Answer 17

Glare when driving at night

Question 18

How did WHO simplify the grading system?

Answer 18

Split it into 3 grade system

Question 19

What is the Oculus Pentacam scanner ?

Answer 19

Scans the anterior pole using densitometry trace

Question 20

What are some sx a px may complain of ?

Answer 20

• Light scatter
• glare
• Struggle driving at night

Question 21

What is back scatter ?

Answer 21

Net curtain effect
(idk how to type it btu ask anisha to explain it because it is interesting)

Question 22

Is there a 6/12 cut off for px to be referred with cataract ?

Answer 22

No- not anymore

Question 23

What is couching?

Answer 23

An older technique involving a long sharp needle through the limbus and the opaque lens is the pushed through into the vitreous cavity

Question 24

What is intra-capsular cryo-extraction?

Answer 24

What was done before Phacoemulsification, pulling out the whole lens using a big incision including the capsule

Question 25

What is extra-capsular lens expression?

Answer 25

Making a gap or hole in the capsule and squeezing the nucleus out

Question 26

What surgery is done now to remove a cataract ?

Answer 26

Phacoemulsification Surgery

Question 27

What size incisions are used in Phacoemulsification Surgery ?

Answer 27

2mm

Question 28

Do you need stitches in Phacoemulsification Surgery ?

Answer 28

No

Question 29

What are five advantages of Phacoemulsification ?

Answer 29

- Minimally invasive - Rapid visual rehabilitation - Single post-op out px visit - No stitches - You can prescribe reading specs are 1month post op

Question 30

How does a Phacoemulsification probe work ?

Answer 30

Uses high frequency oscillations to emulsify particles and sucks it all up

Question 31

What does capsulorphexis mean?

Answer 31

Tearing the capsule, you create a circular gap in anterior capsule

Question 32

Do you know the Phacoemulsification process?

Answer 32

Question 33

What is the main Phacoemulsification Complications during surgery?

Answer 33

Posterior capsular Rupture where they have managed to go through posterior capsule and the vitreous comes forward

Question 34

What is a very common post Phacoemulsification sugary complication ?

Answer 34

Posterior capsular opacification (PCO)

Question 35

How can can posterior capsular opacification be treated?

Answer 35

YAG laser posterior capsulotomy

Question 36

What % of children who have had cataract surgery will get PCO?

Answer 36

100%

Question 37

What is a complication post-cataract surgery regarding the retina ?

Answer 37

Cystic macula oedema, also known as Irvine-Gas syndrome

Question 38

What sx would a px with Irvine-Gass syndrome have?

Answer 38

Reduce VAs

Question 39

How is macula oedema post cataract surgery resolved?

Answer 39

Spontaneously self limiting but can be healed quicker by using steroids

Question 40

What is the name of the infection you can get post cataract surgery?

Answer 40

Endophthalmitis - VERY SERIOUS

Question 41

What is the most common organism that causes endophthalmitis ?

Answer 41

Staphylococcus

Question 42

What is the prevalence of RD post cataract ?

Answer 42

1/300

Question 43

If you cannot see the capsule because the cataract is that bad, what do you stain it with?

Answer 43

Trypan blue

Question 44

Is Phacoemulsification done under general or local anaesthetic?

Answer 44

Local

Question 45

What does phakodonesis mean?

Answer 45

Mobile lens, moves about a lot so cannot do Phacoemulsification

Question 46

As we cannot do Phacoemulsification On a phakodonesis lens, what do we do?

Answer 46

Remove the whole lens

Question 47

What is aniridia ?

Answer 47

Iris damage

Question 48

What are some things they can do to correct astigmatism during Phacoemulsification Surgery?

Answer 48

- Limbal relaxing incisions - lasek or lasik - Astigmatic IOLs - Astigmatic keratotomy

Question 49

What is astigmatic keratotomy ?

Answer 49

Incisions are put in the cornea to try and change to shape of the cornea

Question 50

Which px have a greater chance of getting RD post cataract surgery ? And why?

Answer 50

High myopes because deeper AC, weaker zonules

Question 51

Why are high hypermetropia px difficult to perform Phacoemulsification On?

Answer 51

Smaller eye, shallow AC, bulging eyes

Question 52

Why would a multiple lens implant (piggy back lens) be used?

Answer 52

Increase refractive power of the lens if they require this correction

Question 53

What is photodisruption ?

Answer 53

Modern approach to cataract surgery - uses a laser to cut up tissues & used to for capsulotomy (making an incision in the capsule)

Question 54

What is an advantage of photo disruption?

Answer 54

Very accurate incisions made, time effective, you are left with a perfectly round capsulotomy

Question 55

What laser is used to soften a cataract ?

Answer 55

Femto-laser, will be easier to remove cataract with Phacoemulsification