Cataracts: Difference between revisions
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==Background==
==Background==
* A cataract is opacification in the lens of one or both eyes which can lead to decreased visual acuity and visual distortions
[[File:Schematic diagram of the human eye en.png|thumb|Eye anatomy.]]
* Cataracts are most commonly due to normal age related changes, however they can also be caused by eye trauma, exposure to sunlight or radiation, malnutrition, corticosteroid use, and other pathologic processes
*Opacification of the lens of one or both eyes, which can lead to decreased visual acuity and visual distortions
* By age 80, approximately 50% of Americans have been diagnosed with one or more cataracts<sup>[1]</sup>
*Most commonly due to normal age related changes, however they can also be caused by [[eye trauma]], exposure to sunlight or radiation, malnutrition, corticosteroid use, and other pathologic processes
* Additional risk factors for cataract include Diabetes, smoking, prolonged exposure to sunlight, and alcohol use<sup>[1]</sup><sup>[2]</sup>  
*By age 80, approximately 50% of Americans have been diagnosed with one or more cataracts<ref>National Eye Institute, "Cataracts" <https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/cataracts>, accessed 16 Dec 2020</ref>
* A cataract is typically a non-emergent pathology which can be managed with outpatient ophthalmologic surgery on a routine basis.
*Additional risk factors for cataract include diabetes, smoking, prolonged exposure to sunlight, and alcohol use<ref>National Eye Institute, "Cataracts" <https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/cataracts>, accessed 16 Dec 2020</ref><ref>West SK, and Valmadrid CT, "Epidemiology of risk factors for age-related cataract," Surv Ophthalmol. 1995;39(4):323.</ref>
* With the exception of traumatic cataract, vision loss for cataract is typically not acute, and will develop over the course of months to years.
*Typically a non-emergent pathology and can be managed with outpatient ophthalmologic surgery on a routine basis.
**With the exception of traumatic cataract, [[vision loss]] from cataract is typically ''not'' acute; rather, develops over the course of months to years.


==Clinical Features==
==Clinical Features==
[[File:Dense white mature cataract.jpg|thumb|right|The appearance of a dense, white cataract in a 60 year-old male. ]]
[[File:Dense white mature cataract.jpg|thumb|right|The appearance of a dense, white cataract in a 60 year-old male. ]]
*Vision loss typically not acute but develops over months to years (unless traumatic cataract)
=== History ===
=== History ===
* Cloudy or blurry vision
* Cloudy or blurry vision
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* Colors appear faded
* Colors appear faded
* Appearance of a halo around bright lights
* Appearance of a halo around bright lights
* Recent trauma to the eye
* +/- Recent trauma to the eye
=== Exam Findings ===
=== Exam Findings ===
* Lens opacity on ophthalmic examination
* Lens opacity
* Darkening of the red reflex
* Darkening of red reflex
* Decreased visual acuity
* Decreased visual acuity


==Differential Diagnosis==
==Differential Diagnosis==
===[[Acute Vision Loss (Noninflamed)]]===
{{Acute vision loss noninflamed DDX}}
*Arteritic anterior ischemic optic neuropathy
*[[Amaurosis fugax]]
*[[Central retinal artery occlusion]] (CRAO)<sup>†</sup>
*[[Central retinal vein occlusion]] (CRVO)<sup>†</sup>
*[[High altitude retinopathy]]
*[[Open-angle glaucoma]]
*[[Optic neuritis]]
*[[Posterior Reversible Encephalopathy Syndrome (PRES)]]
*[[Retinal detachment]]<sup>†</sup>
*[[Temporal arteritis]]<sup>†</sup>
*[[Traumatic optic neuropathy]]
*[[Vitreous hemorrhage]]
*[[Stroke]]<sup>†</sup>


''<sup>†</sup>Emergent Diagnosis''
===Subacute Vision Loss (Noninflamed)===
* Cataracts
* Congenital blindness
* Diabetic retinopathy


===[[Unilateral red eye]]===
{{Eye trauma}}
*Nontraumatic
{{Unilateral red eye DDX}}
**[[Acute angle-closure glaucoma]]^
**[[Uveitis|Anterior uveitis]]
**[[Conjunctivitis]]
**Corneal erosion
**[[Corneal ulcer]]^
**[[Endophthalmitis]]^
**[[Episcleritis]]
**[[Herpes zoster ophthalmicus]]
** Inflamed [[pinguecula]]
** Inflamed [[pterygium]]
** [[Keratoconjunctivitis]]
** Keratoconus
**Nontraumatic [[iritis]]
**[[Scleritis]]^
**[[Subconjunctival hemorrhage]]
*[[Orbital trauma]]
**[[Caustic keratoconjunctivitis]]^^
**[[Corneal abrasion]], [[Corneal laceration]]
**[[Conjunctival hemorrhage]]
**[[Conjunctival laceration]]
**[[Globe rupture]]^
**[[Lens dislocation]]
**[[Ocular foreign body]]
**[[Posterior vitreous detachment]]
**[[Retinal detachment]]
**[[Retrobulbar hemorrhage]]
***[[Ocular compartment syndrome]]
**[[Traumatic hyphema]]
**[[Traumatic iritis]]
**[[Traumatic mydriasis]]
**[[Traumatic optic neuropathy]]
**[[Vitreous detachment]]
**[[Vitreous hemorrhage]]
**[[Ultraviolet keratitis]]
 
^Emergent diagnoses
^^Critical diagnoses


==Evaluation==
==Evaluation==
===Workup===
*Typically diagnosed clinically by the finding of lens opacity on direct ophthalmic exam
Eye Examination<sup>[3]</sup>
**Precise classification (nuclear, cortical, posterior sub-capsular) may be done by ophthalmologist
* Visual Acuity
*If the patient has risk factors for diabetes or HIV/AIDS, consider appropriate diagnostic tests
* Pupillary Examination
* Intra-ocular Pressures
* Extra-ocular motility and alignment
* Confrontation Visual Fields
* External Examination
* Slit lamp examination
* Fundoscopic examination
 
An ophthalmologist will be capable of doing a dilated eye examination, which can aid in the diagnosis and classification of cataract.
 
Note: If a cataract is suspected to be secondary to trauma, a full neurologic examination and traumatic survey should be done.
 
===Diagnosis===
* The diagnosis of cataract is based on the findings of lens opacity on direct ophthalmic examination.
* Cataracts are typically classified using the lens opacities classification system.
* Cataracts can be classified as nuclear, cortical, or posterior sub-capsular, however characterization of cataract is typically done by an ophthalmologist.


==Management==
==Management==
* The definitive treatment for a cataract is outpatient surgical management with an Ophthalmologist
*Definitive treatment is (typically outpatient, non-emergent) surgery, wherein clouded lens is removed and replaced with clear, artificial lens
* During a cataract surgery, the patient's clouded lens is removed, and it is replaced with a clear, artificial lens for the eye.
*Other supportive care modalities that help with visual symptoms include:<ref>National Eye Institute, "Cataracts" <https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/cataracts>, accessed 16 Dec 2020</ref>
 
Other supportive care modalities that help with visual symptoms include:<sup>[1]</sup>
* Using brighter lights while at work or at home
* Using brighter lights while at work or at home
* A trial of anti-glare suncglasses for outdoor activities
* A trial of anti-glare sunglasses for outdoor activities
* Using magnifying lens glasses for reading and other daily
* Using magnifying lens glasses for reading and other daily


==Disposition==
==Disposition==
If the diagnosis of cataract is made, the usual disposition is outpatient followup with an ophthalmologist within 1-2 weeks to discuss the potential for surgical management.
*Discharge with optho follow up


==See Also==
==See Also==
*[[Acute Vision Loss (Noninflamed)]]
*[[Orbital trauma]]
*[[Unilateral red eye]]
==External Links==
==External Links==
*https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/cataracts
*https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/cataracts
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==References==
==References==
<references/>
<references/>
#National Eye Institute, "Cataracts" <https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/cataracts>, accessed 16 Dec 2020
#West SK, and Valmadrid CT, "Epidemiology of risk factors for age-related cataract," Surv Ophthalmol. 1995;39(4):323.
#American Academy of Ophtalmology, "The 8-Point Eye Exam" <https://www.aao.org/young-ophthalmologists/yo-info/article/how-to-conduct-eight-point-ophthalmology-exam>, accessed 16 Dec 2020


[[Category:Ophthalmology]]
[[Category:Ophthalmology]]

Latest revision as of 15:57, 8 February 2021

Background

Eye anatomy.
  • Opacification of the lens of one or both eyes, which can lead to decreased visual acuity and visual distortions
  • Most commonly due to normal age related changes, however they can also be caused by eye trauma, exposure to sunlight or radiation, malnutrition, corticosteroid use, and other pathologic processes
  • By age 80, approximately 50% of Americans have been diagnosed with one or more cataracts[1]
  • Additional risk factors for cataract include diabetes, smoking, prolonged exposure to sunlight, and alcohol use[2][3]
  • Typically a non-emergent pathology and can be managed with outpatient ophthalmologic surgery on a routine basis.
    • With the exception of traumatic cataract, vision loss from cataract is typically not acute; rather, develops over the course of months to years.

Clinical Features

The appearance of a dense, white cataract in a 60 year-old male.
  • Vision loss typically not acute but develops over months to years (unless traumatic cataract)

History

  • Cloudy or blurry vision
  • Difficulty with night time vision
  • Colors appear faded
  • Appearance of a halo around bright lights
  • +/- Recent trauma to the eye

Exam Findings

  • Lens opacity
  • Darkening of red reflex
  • Decreased visual acuity

Differential Diagnosis

Acute Vision Loss (Noninflamed)

†Emergent Diagnosis

Subacute Vision Loss (Noninflamed)

  • Cataracts
  • Congenital blindness
  • Diabetic retinopathy

Orbital trauma

Acute

Subacute/Delayed

Unilateral red eye

^Emergent diagnoses ^^Critical diagnoses

Evaluation

  • Typically diagnosed clinically by the finding of lens opacity on direct ophthalmic exam
    • Precise classification (nuclear, cortical, posterior sub-capsular) may be done by ophthalmologist
  • If the patient has risk factors for diabetes or HIV/AIDS, consider appropriate diagnostic tests

Management

  • Definitive treatment is (typically outpatient, non-emergent) surgery, wherein clouded lens is removed and replaced with clear, artificial lens
  • Other supportive care modalities that help with visual symptoms include:[4]
  • Using brighter lights while at work or at home
  • A trial of anti-glare sunglasses for outdoor activities
  • Using magnifying lens glasses for reading and other daily

Disposition

  • Discharge with optho follow up

See Also

External Links

References

  1. ↑ National Eye Institute, "Cataracts" <https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/cataracts>, accessed 16 Dec 2020
  2. ↑ National Eye Institute, "Cataracts" <https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/cataracts>, accessed 16 Dec 2020
  3. ↑ West SK, and Valmadrid CT, "Epidemiology of risk factors for age-related cataract," Surv Ophthalmol. 1995;39(4):323.
  4. ↑ National Eye Institute, "Cataracts" <https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/cataracts>, accessed 16 Dec 2020
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