Ophthalmology Book

Cataract

  • Cataract

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Cataract

Aka: Cataract, Age-Related Cataract
  1. See Also
    1. Congenital Cataract
  2. Epidemiology
    1. Most common cause of severe Visual Impairment in U.S.
    2. Present in 70% of patients older than 70 years old
  3. 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
  4. 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
  5. 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)
  6. 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
      3. Reduced night vision (with halos in visual fields)
  7. 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
      4. Red Reflex overall appears dull
    3. Consider dilating pupil for exam
      1. Phenylephrine hydrochloride Ophthalmic Solution
        1. Not Cycloplegic
        2. Does not affect close vision
  8. 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. Procedure
        1. Phacoemulsification with intraocular lens replacement
      2. Indications (Refer for impaired function or refractory symptoms)
        1. Impaired vision
        2. Excessive glare
        3. Poor night vision
      3. References
        1. Riaz (2006) Cochrane Database Syst Rev (4):CD001323 +PMID:17054134 [PubMed]
  9. Prevention
    1. Avoid excessive UV Light exposure
    2. Smoking Cessation
  10. References
    1. Pelletier (2016) Am Fam Physician 94(3):219-26 [PubMed]

Age-related cataract (C0036646)

Concepts Acquired Abnormality (T020)
ICD9 366.10, 366.1
ICD10 H25, H25.9
SnomedCT 155127007, 193583005, 193582000, 193594009, 39450006
English Senile cataract, unspecified, Unspecified senile cataract, senile cataract, senile cataract (diagnosis), Senile cataract NOS, cataract senile, Cataract;senile, age related cataracts, age-related cataract, cataracts senile, Age-related cataract (disorder), Senile cataract NOS (disorder), Unspecified senile cataract (disorder), Senile cataract, Age-related cataract, Senile cataract (disorder), Senile cataract, NOS, Age-related cataract [Ambiguous], Senile Cataract
Dutch seniel cataract, seniel cataract, niet-gespecificeerd, Seniel cataract, niet gespecificeerd, Seniel cataract
French Cataracte sénile, Cataracte sénile, non précisée
German seniler Katarakt, seniler Katarakt, unspezifisch, Cataracta senilis, Senile Katarakt, nicht naeher bezeichnet
Italian Cataratta senile, Cataratta senile, non specificata
Portuguese Catarata senil NE, Catarata senil
Spanish Catarata senil, Catarata senil no especificada, catarata senil no especificada, catarata senil, SAI (trastorno), catarata senil, SAI, catarata senil no especificada (trastorno), catarata senil (trastorno), catarata senil
Japanese 老人性白内障, 老年性白内障、詳細不明, ロウネンセイハクナイショウショウサイフメイ, ロウジンセイハクナイショウ
Czech Senilní katarakta, Nespecifikovaná senilní katarakta
Korean 상세불명의 노년 백내장, 노년 백내장
Hungarian Időskori szürkehályog, nem meghatározott, Időskori szürkehályog
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Cataract (C0086543)

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 Americans either have a cataract or have had cataract surgery.

A cataract can occur in either or both eyes. It cannot spread from one eye to the other. Common symptoms are

  • Blurry vision
  • Colors that seem faded
  • Glare - headlights, lamps or sunlight may seem too bright. You may also see a halo around lights.
  • 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 (MSHCZE) Onemocnění čočky oka, při němž dochází ke ztrátě její průzračnosti s postupným zhoršováním zraku. K. se dělí podle různých kritérií. Podle vývoje je k. stacionární (obv. vrozená) nebo progresivní. Podle doby vzniku může být k. vrozená či vznikající v mládí (juvenilní) či ve stáří (senilní). Další dělení je podle oblasti čočky, která je postižena (u senilních katarakt oblast kortikální či nukleární, u vrozených mohou být zákaly postihující celou čočku, či jen některé oblasti, zejm. pouzdra), podle stupně vývoje zákalu (nezralá, zralá, přezrálá k.), podle příčin. K příčinám patří poškození během vývoje plodu (toxicky, infekčně, např. rubeola), vrozené syndromy či metabolické poruchy (galaktosemie), onemocnění či traumata oka (zejm. recidivující, např. uveitidy, glaukom, amotio retinae, silná myopie), celková onemocnění (zejm. diabetes, dále např. kožní choroby, tetanus), působení zevních fyzikálních faktorů (ionizační záření, infračervené záření, sideróza, chalkóza). Obecným příznakem je zhoršení zraku, který však může zůstávat neporušen u některých vrozených a neprogredujících katarakt. Léčbou k. narušující zrak je ve vhodné době provedená extrakce oční čočky s její náhradou (brýle, kontaktní či intraokulární čočka). (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ )
Definition (NCI_CTCAE) 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 (NCI_NCI-GLOSS) 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 (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 (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, 193623003, 155126003, 62795009, 247053007
LNC LP128693-1, MTHU020817, MTHU040525
English Cataracts, Unspecified cataract, Cataract NOS, Cataract, unspecified, Cat. - Cataract, cataract, Cataract (M-54510), cataract (diagnosis), Cataract unspecified, Cataract [Disease/Finding], lens opacity, lenticular opacity, cataracts, Cataract NOS (disorder), CATARACT, Cataract form, Cataract (disorder), Cataract (morphologic abnormality), Cataract form (observable entity), cataract; eye disease, eye disease; cataract, Cataract, NOS, Cataract (disorder) [Ambiguous], Cataract
French CATARACTE, Cataracte non précisée, Cataracte SAI, Cataractes, Cataracte
Portuguese CATARATA, Catarata NE, Pseudoafaquia, Cataratas, Catarata
Spanish CATARATA, Catarata no especificada, Cataratas, Catarata NEOM, catarata, SAI (trastorno), catarata, SAI, Cataract NOS, catarata (anomalía morfológica), catarata (concepto no activo), catarata (trastorno), 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
Czech šedý zákal oční čočky, katarakta, Katarakta, Nespecifikovaná katarakta, Katarakta NOS, Katarakty, cataracta, šedý zákal
Finnish Kaihi
Russian KATARAKTA, KHRUSTALIKA POMUTNENIE, PSEVDOAFAKIIA, КАТАРАКТА, ПСЕВДОАФАКИЯ, ХРУСТАЛИКА ПОМУТНЕНИЕ
Korean 상세불명의 백내장
Croatian KATARAKTA
Polish Zaćma, Zmętnienie soczewki
Hungarian Szürkehályog k.m.n., Cataracták, Szürkehályog, Nem meghatározott szürkehályog
Norwegian Grå stær, Katarakt
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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