Cataracts: Gradual Vision Loss

Question 1

What is cataracts?

Answer 1

Lens of the eye gradually opacifies reducing the ability of light to reach the retina and causing reduced/blurred vision.

Question 2

What is the epidemiology of cataracts?

Answer 2

Leading cause of curable blindness worldwide
Women > Men
Increases with age

Question 3

What is the cause of cataracts?

What are risk factors of cataracts?

Answer 3

Normal ageing process

Smoking
Increased alcohol consumption
Trauma
DIabetes mellitus
Long-term corticosteroids
Radiation exposure
Myotonic dystrophy
Metabolic disorders: hypocalcaemia

Question 4

What is the presentation of cataracts?

Answer 4

Gradual onset reduced vision
Faded colour vision: difficulty distinguishing
Glare: lights appear brighter
Halos around lights

Question 5

What are the investigations of cataracts?

Answer 5

Opthalmoscopy (after pupil dilation)
Defect in red reflex
Normal fundus and optic nerve

Slit-lamp examination: visible cataract

Question 6

What are the classification of cataracts?

Answer 6

Nuclear: change in lens refractive index, common in old age

Polar: localized, commonly inherited, lie in the visual axis

Subcapsular: due to steroid use, just deep to the lens capsule, in the visual axis

Dot opacities: common in normal lenses, also seen in diabetes and myotonic dystrophy

Question 7

What is the management of cataracts?

Answer 7

Non-surgical: early stage - stronger glasses, contact lenses, bright lighting.

Surgical: remove cloudy lens and replace with artificial lens.

Question 8

What are the indications for cataracts surgery?

Answer 8

Visual impairment
Impact on QuALY
Patient Choice

(85-90% success rate)

Question 9

What are potential complications of cataracts surgery?

Answer 9

Posterior capsule opacification: thickening of the lens capsule
Retinal detachment
Posterior capsule rupture
Endopthalmitis: inflammation of aqueous and/or vitreous humour