Ophthalmology Book

Cataract

  • Cataract

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Cataract

Aka: Cataract
  1. Epidemiology
    1. Most common cause of severe Visual Impairment in U.S.
    2. Present in 70% of patients older than 70 years old
  2. Pathophysiology
    1. Opacification of the crystalline lens of the eye
    2. Stages of development
      1. Immature Cataract
        1. Opacities separated by areas of clear lens
      2. Mature Cataract
        1. Complete lens opacification
      3. Hypermature Cataract
        1. Lens cortex is liquefied
        2. Lens capsule looses fluid
          1. Risk of Inflammatory reaction
          2. Risk of secondary Glaucoma
  3. Locations
    1. Nuclear Cataracts
      1. Central lens (nucleus) becomes dense and sclerotic
      2. Discolored by yellow, brown or gray hue
    2. Cortical Cataracts
      1. Peripheral opacities
      2. Radiating spokes appearance on slit lamp exam
    3. Posterior Subcapsular Cataracts
      1. Most rapidly progressive
      2. Seen in younger patients and those on Corticosteroid
  4. Risk factors
    1. Normal Aging (90% of cases)
    2. Tobacco Abuse
    3. Ocular UV-B light exposure
    4. Traumatic injury to lens or capsule
    5. Comorbid conditions
      1. Diabetes Mellitus
      2. Hypoparathyroidism
      3. Myotonic dystrophy
      4. Atopic Dermatitis
      5. Congenital Cataract
    6. Medication related
      1. Systemic Corticosteroid
      2. Topical echothiophate iodide (Glaucoma treatment)
  5. Symptoms
    1. Progressive reduced vision (usually bilateral)
      1. Patients report Clouding or fogging of vision
      2. Nuclear Cataracts may improve site temporarily
        1. Cataract sclerosis changes shape of Lens nucleus
        2. Myopia may result and may correct Farsightedness
    2. Skewed Color perception
      1. Lens becomes pigmented in nuclear sclerotic Cataracts
      2. Blues filtered out
      3. Color is shifted to yellow and red part of spectrum
    3. Diminished vision in bright light
      1. Central opacities block light when pupil constricts
      2. Glare may also occur
  6. Signs
    1. Lenticular opacities of various shapes and degree
    2. Technique
      1. Set ophthalmoscope to +10
      2. View lens from 12 inches from patient's face
      3. Cataracts appear as dark areas against red pupil
    3. Consider dilating pupil for exam
      1. Phenylephrine hydrochloride Ophthalmic Solution
        1. Not Cycloplegic
        2. Does not affect close vision
  7. Management
    1. Assessment of concurrent eye disorder
      1. Glaucoma
      2. Retinal Detachment
      3. Macular Degeneration
      4. Retinal vascular occlusive disease
      5. Retinopathy of Diabetes
      6. Hypertension
      7. Arteriosclerosis
    2. Maximize Refractive Error correction with glasses
    3. Consider dilating drops to improve vision
    4. Ophthalmology referral for Cataract Extraction
      1. Refer for impaired function or refractory symptoms (e.g. excessive glare)

Cataract (C0086543)

Definition (NCI) Partial or complete opacity of the crystalline lens of one or both eyes that decreases visual acuity and eventually results in blindness. Some cataracts appear in infancy or in childhood, but most develop in older individuals. (Sternberg Diagnostic Surgical Pathology, 3rd ed.)
Definition (NCI) A disorder characterized by partial or complete opacity of the crystalline lens of one or both eyes. This results in a decrease in visual acuity and eventual blindness if untreated.
Definition (MEDLINEPLUS)

A cataract is a clouding of the lens in your eye. It affects your vision. Cataracts are very common in older people. By age 80, more than half of all people in the United States either have a cataract or have had cataract surgery.

Common symptoms are

  • Blurry vision
  • Colors that seem faded
  • Glare
  • Not being able to see well at night
  • Double vision
  • Frequent prescription changes in your eye wear

Cataracts usually develop slowly. New glasses, brighter lighting, anti-glare sunglasses or magnifying lenses can help at first. Surgery is also an option. It involves removing the cloudy lens and replacing it with an artificial lens. Wearing sunglasses and a hat with a brim to block ultraviolet sunlight may help to delay cataracts.

NIH: National Eye Institute

Definition (NCI) A condition in which the lens of the eye becomes cloudy. Symptoms include blurred, cloudy, or double vision; sensitivity to light; and difficulty seeing at night. Without treatment, cataracts can cause blindness. There are many different types and causes of cataracts. They may occur in people of all ages, but are most common in the elderly.
Definition (MSH) Partial or complete opacity on or in the lens or capsule of one or both eyes, impairing vision or causing blindness. The many kinds of cataract are classified by their morphology (size, shape, location) or etiology (cause and time of occurrence). (Dorland, 27th ed)
Definition (CSP) opacity or cloudiness of the crystalline lens, which may prevent a clear image from forming on the retina; may be congenital or caused by trauma, disease, or age.
Concepts Anatomical Abnormality (T190)
MSH D002386
ICD9 366.9, 366
ICD10 H26.9
SnomedCT 193570009, 128306009, 155130000, 62795009, 155126003, 193623003, 247053007
English Cataracts, Unspecified cataract, CATARACT NOS, CATARACT, CATARACTS, Cataract, NOS, Cataract NOS, CATARACT UNSPECIFIED, Cataract, unspecified, Cat. - Cataract, cataract, Cataract (M-54510), A-735-739 CATARACTS, cataract (diagnosis), Cataract NOS (disorder), Cataract unspecified, Cataract [Disease/Finding], lens opacity, lenticular opacity, cataracts, Cataract form, Cataract (disorder), Cataract (morphologic abnormality), Cataract form (observable entity), cataract; eye disease, eye disease; cataract, Cataract (disorder) [Ambiguous], Cataract
French CATARACTE, Cataracte non précisée, Cataracte SAI, Cataractes, Cataracte
Portuguese CATARATA, Catarata NE, Cataratas, Catarata, Pseudoafaquia
Spanish CATARATA, Catarata no especificada, Cataratas, Catarata NEOM, Cataract, Cataract NOS, catarata (anomalía morfológica), catarata (concepto no activo), catarata (trastorno), catarata, SAI (trastorno), catarata, SAI, catarata, forma de la catarata (entidad observable), forma de la catarata, Catarata
German KATARAKT, Katarakt NNB, unspezifischer Katarakt, Katarakt unspezifisch, Katarakte, Katarakt, nicht naeher bezeichnet, Katarakt, Star, grauer
Dutch niet-gespecificeerd cataract, cataract NAO, cataracten, cataract niet-gespecificeerd, cataract; oogziekte, oogziekte; cataract, Cataract, niet gespecificeerd, cataract, Cataract
Italian Cataratte, Cataratta non specificata, Cataratta NAS, Cataratta
Japanese 白内障NOS, 詳細不明の白内障, ハクナイショウNOS, ショウサイフメイノハクナイショウ, ハクナイショウ, 水晶体混濁, 白そこひ, 白内障
Swedish Grå starr, GRA STARR
Czech šedý zákal oční čočky, katarakta, Katarakta, Nespecifikovaná katarakta, Katarakta NOS, Katarakty
Finnish Kaihi, HARMAAKAIHI
Russian KATARAKTA, KHRUSTALIKA POMUTNENIE, PSEVDOAFAKIIA, КАТАРАКТА, ПСЕВДОАФАКИЯ, ХРУСТАЛИКА ПОМУТНЕНИЕ
Norwegian GRA STAER/KATARAKT
Danish Katarakt
Hungarian szurkehalyog, Szürkehályog k.m.n., Cataracták, Szürkehályog, Nem meghatározott szürkehályog
Korean 상세불명의 백내장
Croatian KATARAKTA
Basque KATARATA
Hebrew katarakt CATARACT
Polish Zaćma, Zmętnienie soczewki
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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