Cataracts

Question 1

Cataract

Answer 1

• opacification or clouding of the lens
• cortical cataracts - radial spokes, caused by diabetes and ageing
• nuclear cataracts - sclerosis of lens nucleus, yellow/brown, old age
• posterior subcapsular cataracts - posterior lens affected, cause glare

Question 2

Cataract risk factors

Answer 2

• diabetes
• steroids
• UV exposure
• smoking
• trauma
• genetics

Question 3

Cataract presentation

Answer 3

• progressive blurred vision
• glare when looking at lights
• colours appear dull
• loss of red reflex
• clouded lens

Question 4

Cataract investigations

Answer 4

• ophthalmoscopy after pupil dilation
• shows defect in red reflex
• slit lamp examination
• shows visible cataract - cloudy grey pupil
• visual acuity with Snellen chart
• Goldmann and Humphrey visual fields

Question 5

Cataract differentials

Answer 5

• primary open-angle glaucoma
• macular degeneration

Question 6

Legal vision for driving

Answer 6

• read a number plate from 20m
• visual acuity of at least 6/12
• adequate visual fields

Question 7

Cataract management

Answer 7

• conservative - patient education, support groups, driving and DVLA, stronger glasses to optimise vision
• phacoemulsification - lidocaine anaesthetic, incision of 2-3mm, lens broken up with ultrasound and aspirated, artificial lens inserted into capsule
• use anti-inflammatory and abx eye drops for 4-6 weeks
• complications - endophthalmitis, posterior capsule opacification, retinal detachment