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Cataract (Lecture)

PANCE Blueprint EENT (7%)

Patient presents as → a 78-year-old man who complains of slowly progressive vision loss over the last several years. He describes his vision as if he is looking through "dirty glass" and reports seeing a white halo around lights. On physical exam, there is clouding of the lens and no red reflex.

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Cataracts are an opacity of the lens that affects the vision and are the leading cause of blindness worldwide

  • Risk factors for cataracts include age (usually > 60), smoking, ETOH, sunlight exposure, diabetes, metabolic syndrome, prolonged drug use (esp. glucocorticoids), radiation
  • Seen with prolonged systemic or inhaled steroid use and statins

Cataract appears dark against the red reflex on exam

  • Slit lamp to magnify, difficult to see the fundus

Glasses and dilation may improve vision

  • Definitive treatment is with cataract removal

Picmonic
Cataracts

IM_NUR_Cataract_v1.2_

Cataracts are opacities of the lens that develop gradually over time. These are age-related and are typically painless. When examining patients we see a cloudy, opaque lens, which leads to decreased visual acuity. The definitive treatment for cataracts is surgery.

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Question 1
Other than age, which of the following are known risk factors for developing cataracts?
A
Alcohol
B
Tobacco use
C
Metabolic syndrome
D
Sunlight exposure
E
all of the above
Question 1 Explanation: 
Cataracts are the most common cause of vision loss in people over age 40 and is the principal cause of blindness in the world. Cataracts occur with aging. Other risk factors may include the following: Trauma (sometimes causing cataracts years later), Smoking, Alcohol use, Exposure to x-rays, Heat from infrared exposure, Systemic disease (eg, diabetes), Uveitis, Systemic drugs (eg, corticosteroids), Undernutrition, Chronic ultraviolet light exposure.
Question 2
Which of the following findings is most consistent with cataracts?
A
conjunctival injection
Hint:
Conjunctival injection is associated with conjunctivitis and other inflammatory conditions of the eye.
B
poorly visualized optic disc
C
central visual field loss
Hint:
Central field loss is associated with macular degeneration.
D
arcus senilis
Hint:
While arcus senilis may be seen in geriatric patients and is not associated with cataracts.
Question 2 Explanation: 
Cataracts are caused by opacification of the crystalline lens, and this decreases the amount of light that enters the eye. It is difficult to see through the lens from either direction, and thus, the optic disc is poorly visualized on examination.
Question 3
A 66 year-old male presents complaining of 6 month history of progressive blurred vision without associated pain. On examination there is no erythema or injection of the sclera. On funduscopic examination there is an absent red reflex and a cloudy lens. Which of the following is the most likely diagnosis?
A
Retinal detachment
Hint:
In retinal detachment the retina is seen hanging in the vitreous like a gray cloud.
B
Chronic glaucoma
Hint:
In chronic glaucoma there will be slight cupping of the optic disc observed.
C
Age-related macular degeneration
Hint:
Findings in age-related macular degeneration include drusen, degenerative changes in retinal pigmentation, and subretinal neovascular membrane changes.
D
Cataract
Question 3 Explanation: 
Cataracts present with blurred vision that progress over months to years. On examination the red reflex becomes increasingly difficult to visualize until it is finally absent and the pupil is white.
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References: Merck Manual · UpToDate

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