Lens

Question 1

Describe nuclear cataract

Answer 1

Age related, index myopia, yellowing of lens. Browns as matures.

Question 2

Describe cortical cataract

Answer 2

In cortex looks like radial spokes slow progressing. Px complains of glare

Question 3

Describe Posterior subcapsular

Answer 3

Reduces VA more than other types. NV especially. Glare. Worse when small pupils. Seen as rough/ granular on optical section , black on retro

Question 4

Describe congenital cataract

Answer 4

Can be seen as small blue dots in lens, also may be dense at birth will be checked then, prompt removal to avoid amblyopia

Question 5

Describe traumatic cataract

Answer 5

Happens following blunt trauma resembles a star shape

Question 6

Describe Radiation cataract

Answer 6

Happens due to UV exposure or radiation therapy for cancer. Will be seen as spoked from anterior to posterior poles

Question 7

Describe Christmas tree cataract

Answer 7

Rare, cortex needle like appearance. Colourful reflects

Question 8

Describe Secondary Cataract

Answer 8

Following lens replacement surgery, PCO

Question 9

Explain cataract surgery as through to px

Answer 9

The surgery is performed under topical anaesthetic and takes around 10 mins to complete but this will vary by case and surgeon. The operation involves taking out the old lens and replacing it with a new one. This is a day case and has a very high success rate.

Question 10

What complications can arise from cataract surgery

Answer 10

During the operation, scarring can occur at the incision site and may induce astigmatism. The lens may also fall into the vitreous cavity, haemorrhages may also occur
Post op - days after. Wound leaks, raised iop
Post op - months. Retinal detachment, PVD, inflammation, infection, PCO

Question 11

Why refer for cataract surgery

Answer 11

If reduced vision is now affecting day to day life, eg no longer meeting driving standards. The px must be happy to go ahead with surgery

Question 12

Describe phacoemulsification

Answer 12

Modern cataract surgery. The surgeon creates one or more incisions in the cornea to insert instruments, then they remove the front surface of the lens capsule ,the lens is emulsified by an ultrasonic hand piece and a pump removes the lens particles, the eye is then filled with a salt solution to replace aspirated fluids and once all particles are removed a new lens is inserted into the remaining capsule

Question 13

What post op care is given after cataract surgery

Answer 13

Topical antibiotics and steroids

Question 14

Describe the different types of IOL available

Answer 14

Monofocal - NHS corrects distance vision. Px will require near rx
Multi focal - expensive, has rings of different refractive powers to allow px to see at different distances removing requirement for specs. Glare is often experienced
Toric - corrects astigmatism, nhs if cyl greater than 2.00 D

Question 15

Discuss LASIK and LASEK

Answer 15

LASIK involves an epithelial corneal flap being created and the use of two lasers to reshape the other layers to correct refractive error, the flap is smoothed back down reducing the need for stitches and speeding up recovery time.
LASEK involves the removal of the epithelial layer of the cornea with the use of alcohol, a laser is then used to reshape the cornea to correct refractive error, recovery time is 1-2 weeks.
LASIK is not for everyone so LASEK will be used in cases with thin corneas, high myopia and pre-existing medical conditions