Cataracts

Question 1

How do you manage a suspected cataract?

Answer 1

Refer to an optometrist for examination and visual acuity assessment

Counselling on how will affect vision + QoL + what surgery involves/risks/benefits

Surgery indications:

• Person wants to keep driving but does not meet DVLA minimum sight requirements
• Significant impact on QoL/ADLs

Question 2

Why would you suspect and how do you manage a suspected cataract in paediatrics?

Answer 2

Urgent same day call to ophthalmology if:

• Opacity or absence of red reflex
• White pupillary reflex (Leukocoria)

Urgent written referral to ophthalmologist if:

• Inequality in colour, clarity or reflection
• No detectable abnormality but parent describes Hx suspicious of leukocoria e.g. in a photo (though this often a reflection of the optic disc in flash photography when off axis to camera)

Question 3

How do cataracts present?

Answer 3

Gradual, painless reduction in visual acuity

Blurred vision

Difficulty seeing at night and reading text

Sensitivity to light/glare - esp. at night

‘Halos’ around lights and double vision in a single eye

Gradual reduction in perception of colour intensity (esp. blues)

Often in the elderly but can be congenital

Question 4

How do you assess for cataracts in the elderly?

Answer 4

Clinical features, onset, duration; impact on daily life; ocular Hx, risk factors etc

Assess:

• Visual acuity - Snellen’s
• Ocular alignment and motility
• Pupillary function
• Ophthalmoscopy = opacity of the lens may appear as deficits in the red reflex; slit lamp for more detail