This document discusses the investigation and management of senile cataract. It outlines the preoperative evaluation including medical history, ocular examination, visual function tests, slit lamp examination, and systemic investigation. Preoperative complications are also discussed. Surgical management options for cataract extraction are presented including types of surgery. Postoperative care and potential complications are summarized. Low vision management strategies for cataract patients are also provided.

1. INVESTIGATION AND
MANAGEMENT OF
SENILE CATARACT
NISHITA AFRIN
B.OPTOM, 3RD BATCH
INSTITUTE OF COMMUNITY OPHTHALMOLOGY

2. SENILE CATARACT

3. INVESTIGATION

4. INVESTIGATION OF SENILE CATARACT

PREOPERATIVE EVALUATION OF
SENILE CATARACT
HISTORY
General health of the patient Diabetes mellitus, Hypertension,
ischemic heart disease , chronic obstructive
pulmonary disease , bleeding disorders ,
parathyroid tetany, myotonic dystrophy,
galactosaemia , down syndrome, atopic
dermatitis, neurofibromatosis type 2

5. CATARACT IN SYSTEMIC DISEASE
a. Diabetic snowflake cataract
b. advance diabetic catarct
c. stellate posterior
subcapsular cataract in
myotonic dystrophy
d. Advance left cataract in a
patient with myotonic
dystrophy
e. bilateral advance cataract in
atopic dermatitis
f. shield like anterior sub
capsular cataract in atopic
dermatitis

6. CONTINUE……….


Patient ocular history :
Trauma, Inflammation, Amblyopia ,
glaucoma , optic nerve abnormalities , or
retinal disease
social history

7. OCULAR INVESTIGATION…
MEASUREMENTS OF VISUAL
FUNCTION
1. Visual status assessment visual acuity, perception of light ((PL),
perception of rays (PR)
2. Refraction –
3. Brightness acuity
4. Contrast sensitivity
5. Visual field testing

8. VISUAL ACUITY TEST

9. CONTRAST SENSITIVITY…

10. PELLI-ROBSON CONTRAST SENSITIVITY CHART

11. VISUAL FIELD TEST

12. CONTINUE…..

External examination :
a. Extra ocular Motility
b. pupils
c. cover test

13. MOTILITY…

15. PUPILLARY REACTION TEST
a.Swingin
g flash
light
test
b.consen
sual
light
reflex

16. COVER TEST…..

17. CONTINUE……



Special Tests :
Potential acuity estimation
Tests for Macular Function1. Two light discrimination test
2. maddox rod test
3. Color perception
4. Entoptic visualisation
5. Blue Light entoptoscopy
6. Purkinje’s entoptic phenomenon

18. MADDOX ROD TEST…

20. ENTOPTIC VISUALISATION

21. BLUE LIGHT ENTOSCOPY…

22. COLOR PERCEPTION…

23. CONTINUE….

Retinal function test
PR – must be present in all 4
quadrants
Electro-retinogram
Electro-oculogram
Visual evoked potential

24. CONTINUE….

Slit-Lamp Examination :
Eyelids,
Lacrimal apparatus,
sclera
Conjunctiva ,
Anterior chamber ,
Cornea
Iris
Crystalline Lens

25. CONTINUE…….

Fundus Evaluation :
- Ophthalmoscopy
- Optic nerve
- Fundus evaluation with opaque
media

26. OPHTHALMOSCOPY…

27. CONTINUE…..
Measurement of IOP
 conjunctival swab for C/S
 Sac patency test to exclude chronic
dacryocystitis
 Oro-dental check up to exclude septic foci


28. MEASUREMENT OF IOP…

30. CONTINUE……

Preoperative Measurement :
Biometry
1.keratometry
2. A- scan ultrasonography

31. KERATOMETER…..

32. CONTINUE….
B-scan ultrasonography
Corneal Topography
Corneal phachymetry
Specular microscopy

33. B-SCAN ULTRASONOGRAPHY

34. CORNEAL TOPOGRAPHY….

35. SYSTEMIC INVESTIGATION….


Clinical :
- BP
Lab test :
- RBS/FBS
- Urine
- X-Ray chest and ECG – If needed

37. MANAGEMENT……

NON-SURGICAL MEASURES ---1. Treatment of cause of cataract
2. Measures to delay progression
topical preparation containing iodine
salts of calcium and potassium, role of vitamin
E and aspirin
3. Measures to improve in the presence
of incipient and immature cataract----Refraction, Arrangement of illumination,
use of dark goggles, Mydriatics

38. CONTINUE…..

SURGICAL MANAGEMENT ----1. Visual improvement
2. Medical indication
3. cosmetic indication

39. PREOPERATIVE MEDICAL AND PREPARATIONS
Consent
 Srcub bath, care of hair, and marking of the
eye
 Preoperative antibiotics and disinfectants
 IOP lowering
 Mydriasis


40. TYPES OF SURGERY

Intra capsular cataract (ICCE)

Extra capsular cataract (ECCE)

Pseudophakia – SICS , Phacoemulsification

41. COUNSELING AFTER POSTOPERATIVE CATARACT
SURGERY
The post-operative recovery period (the
period after cataract extraction is done) is
usually short. The patient is usually
ambulatory on the day of surgery but is
advised to move cautiously and avoid
straining or heavy lifting for about a month
 The eye is usually patched on the day of
surgery and at night using an eye shield is
often suggested for several days after
surgery


42. 
. Intraocular lenses are usually monofocal,
correcting for either distance or near vision,
however, multifocal lenses may be implanted
to improve near and distance vision
simultaneously, but these lenses may
increase the chance of unsatisfactory vision

43. PREOPERATIVE COMPLICATIONS IN SENILE
CATARACT





Anxiety
Nausea and gastritis
Irritative or allergic conjunctivitis
Corneal abrasion
complications due to local anaesthesia –
- Retrobulbar haemorrhage
- Oculocardiac reflex
- Perforation of globe
- Subconjunctival haemorrhage
- Spontaneous dislocation of lens

44. COMPLICATIONS OF CATARACT SURGERY







Retinal detachment
Endophthalmitis
Corneal edema
Cystoid macular edema
Pseudophakic bullos keratopathy
Epithelial keratopathy
Fibrous downgrowth

45. LOW VISION MANAGEMENT FOR CATARACT
High – add spectacles,
 magnifiers,
 CCTV ,
 Telescopeic loupes for reading and close
work
 Direct lighting when reading or performing
near work
 Glare can be reduce by filter,tints, and
sunlenses


46. CONTINUE….



Large print reading material
Bold line writing paper
and Typoscope

47. REFERRANCES…….
 LENS AND CATARACT –
AMERICAN ACADEMY OF
OPHTHALMOLOGY
 COMPREHENSIVE
OPHTHALMOLOGY – A. K.
KHURANA
 KANSKI CLINICAL
OPHTHALMOLOGY
 PARSON’S DISEASE OF THE EYE