Cataracts

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Cataracts Pathophysiology Opacification of lens, usually due to age-related pigment build-up. Leads to ↓transparency and ↓refractive index of lens, and hence visual impairment. Causes of premature cataracts Steroids, including topical therapy near eyes. Congenital: trisomy, myotonic dystrophy, infection (rubella, HSV). Ocular disease: glaucoma, severe myopia, retinal detachment. Diabetes UV or infrared radiation. Epidemiology Extremely common: 30% prevalence over age 65, and 60% over 80.

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Cataracts
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$Pathophysiology  Opacification of lens, usually due to age-related pigment build-up.  Leads to ↓transparency and ↓refractive index of lens, and hence visual impairment. Causes of premature cataracts  Steroids, including topical therapy near eyes.  Congenital: trisomy, myotonic dystrophy, infection (rubella, HSV).$

Causes of premature cataracts
 Ocular disease: glaucoma, severe myopia, retinal
detachment.
 Diabetes
 UV or infrared radiation.
Epidemiology
 Extremely common: 30% prevalence over age 65,
and 60% over 80.

Symptoms:
 Blurred vision and gradual ↓acuity, with
difficulty reading, watching TV, and
recognising faces.
 Glare from bright lights.
 Monocular diplopia.
 Loss of stereopsis if unilateral.

Signs:
 Reduced red reflex.
 Clouded lens.
Investigations
Clinical diagnosis. Can be supported by slit
lamp with dilated pupil, but not obligatory.

Non-surgical
 Conservative treatment is often appropriate initially,
as cataracts has a highly varied rate of progression,
with significant impairment often taking many years
to develop.
 Advise not to drive and to contact the DVLA if there
is difficulty reading a number plate from 20 metres.

Surgical
Indications:
 When symptoms restrict lifestyle including driving,
reading etc.
Procedure:
 Phacoemulsification: lens broken up with ultrasound
and aspirated from the eye. It is an extracapsular
extraction i.e. lens removed but lens capsule left in
place.

Procedure:
 Intraocular lens implant inserted into remaining
capsule.
 Done under local anaesthetic in around 20 minutes.
Complications:
 Perioperative: haemorrhage, local anaesthetic-
related, vitreous loss.

Complications:
 Early post-op: endophthalmitis, anisometria, eye or
eyelid bruising.
 Late post-op (months later): posterior capsular
opacification causing blurred vision (common), retinal
detachment.
Outcome:
 Improves visual acuity, though reading glasses
usually needed afterwards.

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