T UBERÍA DE ACERO HELICOIDAL

Cataract is defined as any opacification of the lens causing deterioration of Visual Acuity of < 6/9 or worse.

Diagnosis of Cataract

There are four (4) basic elements that one would need to consider to be able to formulate a diagnosis.

1. History – a comprehensive history is an important component specially the onset and the nature of the chief complaint

2. Ocular Examination – basic eye examination comprises of the following parts should be done on each patient.

a. Gross eye examination – Biomicroscopic (Slit lamp) examination b. Visual Acuity testing (with and without correction)

c. Intraocular pressure determination d. Movement of Extraocular Muscles e. Funduscopic examination

3. Ancillary examinations – special ophthalmological and laboratory examinations are done as aids in the formulation of the complete diagnosis.

4. Systemic examinations – general systemic examination is done in cases wherein the clinician suspects the lens problem to be part of the presentation of a systemic condition.

1. HISTORY

The patient’s history guides the clinician in arriving at a complete diagnosis, particularly as to the possible etiology of the condition. The following are important questions regarding the patient’s current illness that the clinician should ask.

1. What is the patient’s chief complaint?

The most common presenting complaints of patients with cataract include progressive blurring of vision with no other associated symptoms.

Patient may complain of black spots in the visual field which most of the time are fixed.

Most of the onset of the complaints usually starts during the 5^th decade of life and are usually progressive.

2. How long has the problem been existing?

The duration of the problem should be extracted from the patient. This will help in eliminating the other differential diagnosis.

3. Which eye is involved?

Usually both eyes are involved but one eye might have more blurring of vision that the other one.

4. Are there other associated eye problems?

There are usually no associated eye problems except if the patient presents with complications like glaucoma or uveitis.

5. Does the patient have any prior consultations / surgeries?

It is important to elicit any history of any prior consultations or surgeries. This will help in the determination of the initial onset of the cataract and the medications that may be the cause of the cataract. It is important equally important to know from the patient of any previous eye surgeries that may result in cataract.

6. Other aspects of the patient’s history that should be considered included:

a. Family history. Is there a history of any similar illness in the family? Is there any history of any hereditary illness?

b. Personal history. What is the nature of the work of the patient? Is there any exposure of the patient to intense UV light?

c. Medical history. Has the patient suffered any systemic illness in the past? Has the patient any history of taking oral medications specially steroids for any systemic illness?

2. EYE EXAMINATION

The basic tools that one would require in conducting an examination include the following:

a. Slit lamp biomicroscope – Instrument used in the assessment of lenticular findings in the eye.

b. Visual acuity charts – both for distance and near vision

c. Tonometer – used to determine the patient’s intraocular pressure.

d. Penlight – for gross examination of the eye

e. Direct ophthalmoscope – used for fundus examination

COMMON OCULAR FINDINGS IN CATARACT Typically, the patients with cataract present with the following findings:

1. Gross examination – Patients with cataract present with white pupil (leukocoria). Fig 1 shows a typical picture of leukocoria.

Fig. 1. White pupil (leukocoria)

2. Visual acuity – Most patients with cataract present with reduction of vision even with correction.

3. Intraocular pressure – Most patients present with normal intraocular pressures. However if complications of cataract set in, the intraocular pressure may vary. If there is glaucoma, the intraocular is elevated. If there is uveitis, the intraocular pressure is very soft or hypotonic.

4. Extraocular muscle movement – Since the extraocular muscles are usually not involved, patients exhibit full movement on all directions of gaze.

5. Funduscopic findings – Patients who have relative good visual acuity, the fundus is usually normal.

However, if the patient has a relatively poor vision and the lens is very dense, the fundus can not be appreciated. If the patient has poor vision and the fundus can be appreciated, the fundus findings may vary depending on the posterior segment pathology.

6. Slit lamp findings – Patients with cataract present with varying degrees of lenticular opacifications. It may vary from a slight haziness of the lens to a dense opacification, from water clefts to vacuoles, and from a white to brunescent lens. The opacifications may also vary with location. They may be found in the cortex, nucleus, posterior capsule or a combination of the above. Usually, the anterior is quiet with no signs of inflammation like cells and flare. Fig 2-5 shows the different slit lamp findings in cataract.

Fig. 2 Cortical Cataract

Fig. 3 Posterior Subcapsular Cataract

Fig. 4 Nuclear Cataract

Fig. 5. Intumescent Cataract 3. ANCILLARY EXAMINATIONS

1. Ultrasound of the eye

In most cases of cataract, it is normal. However, this examination is important to determine the status of the posterior segment of the eye which includes the vitreous and retina. This is most useful if patient’s cataract is associated with trauma.

4. SYSTEMIC EXAMINATIONS

Congenital Rubella is associated with development of cataract at birth. Diabetes is associated with cataract formation in the younger age group.