Lens Flashcards
More case focused. First part of lens lecture.
Three health factors that contribute to cataracts (especially posterior sub-capsular and cortical cataracts)
BMI - Body mass index HTN - Hypertension DM - Diabetes Mellitus
UV-B exposure increases risk of which types of cataracts?
Nuclear and cortical
Your patient is a 42 y/o Male hyperopic smoker who has begun to complain of glare, especially while driving at night. He also says his vision has actually gotten better recently. Knowing this, you scan the lens and see this. What kind of cataract is this?
Nuclear sclerotic cataract
Why?
- Hyperopic “second sight” due to lense becoming more dense and therefor more plus inducing myopia
- Glare from amino acid buildup due to change in metabolism of the lens
- Smoking and Age major factors in NSC formation
A mother brings her 12 y/o son to see you because he can’t see clearly out of one eye. Before you even seat the patient, knowing it is a unilateral cataract, what do you suspect?
Infantile or Congenital cataract
Why?
- Trauma induced or
- Interuterine infection like measles, syphillis, or rubella (Dirty womb)
Your patient is a 9 y/o male with trisomy 21 (Syndrome of a Down) presenting with an abundance of chromosomes and no visual complaint. You look at the lenses of both eyes and you see this. What are these beautiful blue dots?!
Cerulean (blue dot) cataract
Bilateral non-progressive bluish dots scattered throughout the lens that do not affrect vision
Common causes of this congenital cataract include Hypoglysemia, Trisomy, infectious disease or premature birth are all causative factors for congenital cataracts
A 16 y/o female patient presents to your office for her first “real eye exam”. Aside from the fact that her parents have been remiss in not ever having her eyes examined you work her in as a comprehensive eye exam. She sees 20/20 OU but when you are assessing the lens you see this. You’re thinking, “WTF is it and why isn’t it affecting her visual acuity?!” So, what is it?
Anterior Polar Cataract
It’s not affecting her visual acuity because, though it is on the visual axis, it is not in the nodal point.
It is caused by imperfect seperation, epithelial damage or incomplete vascular reabsorption
The 9 y/o female patient sitting in your chair complaining of trouble seeing. Her mom says that there is a family history of cataracts and you think to yourself “ok… her family must live long. Everyone gets cataracts if they live long enough.” However, you say nothing and on lens evaluation you see this. Aside from how happy you are that you kept your mouth shut, you wonder “what is that?”
Coralliform Cataract
Autosomal Dominant, round/oblong opacities congregated on the suture that look like coral. Variable affect on vision.
Your 10 y/o male patient sitting in front of you keeps telling you about his Star Wars obsession. In the middle of his fanatical rant he realizes you aren’t interested in his ramblings and he gives you “the look”. You want to laugh but catch a glimpse of something in his eyes. You put him behind the slit lamp and see this! No wonder he likes Star Wars! He has galaxies in his eyes!
Lamellar Cataract
Why?
Description: common, bilateral and symmetrical (not always), round grey opacities that surround the nucleus. Often due to metabolic disorder.
A 4 y/o male patient presents to your office, with his parents of course, for a CEE (Comprehensive Eye Exam). The patient won’t sit still and is constantly whining about his desire for “the iPad”. His visual acuity is normal but you see what looks like a ninja star in his eye. Though he does need a good spanking he doesn’t need surgery as he can see fine. Why?
It is a Anterior Sutural Cataract.
It affects vision much more if it is the posterior suture and can affect both or either suture.
It is X linked dominant and is more common for males to have more dense opacification than females.
Bluish dots or a dense chalky band around the suture/s
Your patient is a 7, going on 17, y/o female who is wearing make-up for some pageant she is to attend. You finally get her and her huge frilly dress behind the slit lamp… barely… and notice this on the posterior nasal surface of the lens. You fight the urge to ask the mother why someone would do this to their child but further wonder what was that thing?
Mittendorf’s Dot
(Possibly from the Harry Potter books…)
A remnant of the hyaloid artery on the posterior surface of the lens
And Mittendorf sounds like gryffindor…
What’s the number one factor contributing to the formation of age-related cataracts?
Seriously… do you really need the answer? AGE RELATED cataracts… AGE RELATED
What is the definition of a cataract?
A lens opacity that affects vision either quantitatively or qualitatively
- Quantitatively is acuity
- Qualitatively affects vision, causes symptoms
It could be argued that the suture, lamellar, mittendorf dot, polar, or any other “cataract” that was presented in this powerpoint that didn’t affect vision was not a cataract.
Your 47 y/o male presbyopic pt presents to you clinic complaining that his glasses aren’t working as weel as they were when he got them… 5 years ago. Knowing that both his reading prescription and the number of years he’s been riding this rock we call earth have increased, you have him sit behind the slit lamp as part of his CEE. After dilating, this is what you see. What is it?
Cortical Cataract
- vacules, clefts and wedges are all the start of cortical cataracts but unless it affects vision it is not a cataract according to Dr. Maeda
- Caused by electrolyte imbalance that overhydrates the lens, essentially liquifying it
Your 48 y/o female pt has a Hx of Retinitis Pigmentosa, Uveitis, and Ocular Trauma (she profusely swears it wasn’t from a phallic looking device made for auto-erotic stimulation without even being asked… odd) presents to your clinic c/o problems seeing both at night and during the day. You put her behind the slit lamp and low and behold, the factors above each played a role in this finding. What is it?
Posterior Subcapsular Cataract
- Caused by a loss of lens fiber nuclei and replacement by abbarently migrating epithelial cells
- the clustering cells cause breakdown of adjacent cells
- More symptoms during the day because the cataract is right in the middle of the constricted pupil
- Uveitis, RP and trauma can all contribute to PSC
You’re on a trip to Peru, enjoying yourself because you just finished optometry school, drinking a little much when you stumble out of the bar and into the jungle. You find yourelf outside a hut in the forest staring at a wise old fortune teller. The man asks you to come inside but before he turns away, you notice this and wonder how he can see anything let alone the future with- Wait! What are those called again?!
Mature (Ripe) or Intumescent Cataract
Complete opacification
Your pt is 65 y/o male who hasn’t been able to read a book or even count his own fingers for many years. He finally comes in because he is tired of asking his son to read the articles in the Playboy for him and wants to see if you can help him. After telling him you won’t read them for him either you do a dilated exam on him and find this (note the edge on top). What is it and what kind of timeline are you working with?
Mogagnian Cataract
Get him into surgery ASAP! If this lens capsule starts leaking this patient is in for a world of hurt. Phacolytic Glc, possible lens particle Glc and possible Phacoanaphylaxis both after CE!
Complete liquification of the cortex of the lens leaving the lense to either sink or float
Bad times!
