Cataracts

Question 1

Cataract symptoms

Answer 1

• Asymmetrical
• Slow reduction in vision
• Blurred vision
• Starbursts
• Changes to colour vision

Question 2

Investigation of cataracts

Answer 2

Ophthalmoscopy (post-pupil dilation)
* Normal fundus and optic nerve
* Defect in red reflex
Slit Lamp
* Visible cataracts, cloudy grey pupil
Visual acuity (with a Snellen chart)
Visual Fields (Goldman and Humphrey mapping)

Question 3

Causes of cataract

Answer 3

*Old age
*Smoking
*Alcohol consumption
*Diabetes mellitus
*Steroids

Question 4

Vision for driving

Answer 4

You must be able to read (with glasses or contact lenses) a car number plate made after 1 September 2001 from 20 metres.
You must also have a visual acuity of at least 6/12 on the Snellen scale and an adequate field of vision.

Question 5

Cataract classification

Answer 5

Nuclear - due to change in refractive index (old age)
Cortical - wedge shaped opacities
Posterior Subcapsular - fast progression, glare from bright lights when driving (starburst)

Question 6

Treatment for cataracts

Answer 6

Conservative - observation (if no functional impairment), support groups, driving advice, optimise glasses/contacts (will not solve cataracts)
Cataract extraction under LA with phaecoemulsification, implant of intra-ocular lens

Question 7

Lens replacement procedure

Answer 7

Incision made in cornea
Lens emulsified with ultrasound
Lens aspirated into cannula
Lens capsule left in situ
Folded artifical lens inserted

Question 8

Lens replacement post-op instructions and complications

Answer 8

Use anti-inflammatory and antibiotic eye drops for 4-6 weeks
Wear sunglasses
Most common complication - endophthalmitis 1/1000, also posterior capsular opacification