Cataracts

Question 1

Structure of Lens.

Answer 1

Held in place by suspensory ligaments which are attached to the ciliary body.

Question 2

Function of Lens.

Answer 2

Focuses light coming into the eye onto the retina at the back of the eye.

Question 3

Relationship between Ciliary Body and Lens (2).

Answer 3

1. Ciliary Body Contraction - Release Tension on Suspensory Ligaments - Lens Thickens.
2. Ciliary Body Relaxation - Increase Tension on Suspensory Ligaments - Lens Narrows.

Question 4

Nourishment of Lens.

Answer 4

Surrounding fluid - no blood supply. It grows and develops throughout life.

Question 5

Definition of Cataracts.

Answer 5

Clouding and opacification of the lens, reducing visual acuity by reducing light that enters the eye, due to denatured protein.

Question 6

Types of Cataracts (4).

Answer 6

1. Nuclear - commonly age-related.
2. Polar - commonly inherited.
3. Subcapsular - due to steroid use.
4. Dot opacities - seen in diabetes and myotonic dystrophy.

Question 7

Risk Factors of Cataracts (9).

Answer 7

1. Advanced Age.
2. Smoking.
3. Alcohol.
4. Diabetes.
5. Steroids.
6. Hypocalcaemia.
7. Trauma.
8. Radiation Exposure.
9. Myotonic Dystrophy.

Question 8

Epidemiology of Cataracts (3).

Answer 8

1. Leading cause of curable blindness worldwide.
2. Commoner in women.
3. Incidence increases with age.

Question 9

Clinical Features of Cataracts (5).

Answer 9

1. A very slow reduction in vision.
2. Progressive blurring of vision.
3. Change of colour of vision with colours becoming more brown/yellow.
4. ‘Starbursts’ appear around lights (especially at night).
5. Asymmetrical.

Question 10

Differential Diagnoses of Weird Lights (3).

Answer 10

1. Cataracts - Generalised Reduction in Visual Acuity and Starbursts around Lights.
2. Glaucoma - Peripheral Loss of Vision and Halos around Lights.
3. Macular Degeneration - Central Loss of Vision and Crooked/Wavy Appearance to Straight Lines.

Question 11

Key Investigation of Cataracts.

Answer 11

Fundoscopy : Loss of Red Reflex (Lens appears grey/white).

Question 12

Management of Cataracts.

• Manageable Symptoms.
• Early Symptoms.
• Definitive Treatment.

Answer 12

1. Manageable Symptoms - No Intervention.
2. Early Symptoms - Prescribing stronger glasss/contact lens and encourage use of brighter lighting to help optimise vision.
3. Definitive Treatment - Surgery (Pseudophakia).

Question 13

Complications of Cataract Surgery (4).

Answer 13

1. Endophthalmitis (rare) - infection and inflammation of the inner contents of the eye (use intravitreal antibiotic injections) : can cause loss of vision and loss of the eye.
2. Posterior Capsule Opacification (thickening of lens).
3. Retinal Detachment.
4. Posterior Capsule Rupture.

Question 14

Indications of Pseudophakia (Cataract Surgery) (3).

Answer 14

1. Whether a visual impairment is present.
2. Whether there is an impact on quality of life.
3. Patient Choice.

Question 15

Method of Pseudophakia (Cataract Surgery) (4).

Answer 15

Phaecoemulsification :

1. Drilling and breaking lens into smaller fragments with Ultrasound waves.
2. Removal of these fragments by suction.
3. Implantation of artifical lens.
4. Day Case (Local Anaesthetic).

Question 16

Post-Operative Care after Pseudophakia (3).

Answer 16

1. Eye Drops.
2. Eye Wear.
3. Management of Other Ocular Problems.

Question 17

Prognosis of Cataracts (3).

Answer 17

1. They can prevent the detection of other pathologies e.g. macular degeneration, diabetic retinopathy.
2. After cataract surgery, the patient may still have poor visual acuity - these conditions still exists.
3. High Success Rate of Surgery.