Age Related Cataracts

What are examples of acquired cataracts?

age-related cataracts

secondary cataracts

systemic disease induced cataract

traumatic cataracts

What is a cataract?

lenticular opacification

What are risk factors for developing a cataract?

UV light exposure

steroid use

diabetes

smoking

What is the treatment for cataracts?

cataract surgery

Which cataract grading system is primarily used in research?

Lens Opacities Classification System (LOCs)

Lens Opacities Classification System (LOCs) uses what illumination to grade cataracts?

nuclear: direct illumination

cortical + PSC: retroillumination

What is present in a grade 1 nuclear cataract?

can still see Y sutures

minimal VA changes

What is present in a grade 2 nuclear cataract?

may see Y suture

moderate VA changes (20/30-20/60)

What is present in a grade 3 nuclear cataract?

No Y suture seen

20/70-20/200

What is characteristic of a grade 4 nuclear cataract?

20/400 or worse

What is characteristic of a grade 1 cortical cataract?

≤25% of dilated pupil obscured

What is characteristic of a grade 2 cortical cataract?

50% of dilated pupil obscured

What is characteristic of a grade 3 cortical cataract?

75% of dilated pupil obscured

What is characteristic of a grade 4 cortical cataract?

≥90% of dilated pupil obscured

What is characteristic of a grade 1 PSC cataract?

3% of dilated pupil obscured

What is characteristic of a grade 2 PSC cataract?

30% of dilated pupil obscured

What is characteristic of a grade 3 PSC cataract?

50% of dilated pupil obscured

What is characteristic of a grade 4 PSC cataract?

>50% of dilated pupil obscured

What is the most common type of cataract?

age related

What is the onset of age related cataracts?

gradual onset of symptoms and gradual development

What is a nuclear sclerotic cataract?

hardening of nuclear fibers by age

What are the unique symptoms of a nuclear sclerotic cataract?

blurred distance vision

color distortion

monocular diplopia

glare later in disease process

What is the presentation of a nuclear sclerotic cataract?

yellow coloration of the lens that turns brown with disease progression

myopic shift (pts can read at near without specs)

dense nucleus

What are causes of a cortical cataract?

aging

neurofibromatosis

What is a cortical cataract?

opacification of lens fibers surrounding nucleus

What are the unique symptoms of a cortical cataract?

Glare, esp at night

decreased vision at all distances if cataract is over fixation

What is the presentation of a cortical cataract?

starts as vacuoles and clefts (spokes)

wedge shaped and radial spoke opacities develop later

opacities usually start inferior nasal then migrate central

What are causes of PSC?

long term steroid use

diabetes

atopic dermatitis

neurofibromatosis

What is a PSC?

swollen migratory lens epi cells

What is unique about PSC?

patients tend to get this at a younger age and develop faster than the other age-related cataracts?

What is the main symptom of PSC?

difficulty seeing in bright light and at near (pupil constriction)

What is the presentation of a PSC?

granular or plaque like appearance on direct illumination

vacuolated appearance on retroillumination

What is a hyper mature cataract?

advanced cataract

What is the presentation of a hyper mature cataract?

white pupil

wrinkled anterior capsule

thinned nucleus, still in place

liquified cortex

What are the complications of a hypermature cataract?

phacomorphic glaucoma

lens induced uveitis

difficult cataract sx

What is a morgangian cataract?

further advancement of a hyper mature cataract

What is the presentation of a morganian cataract?

white pupil

cortex liquifies

nucleus is free floating and sinks inferior

coalesced protein globules

What are the complications of a morganian cataract?

phacomorphic glaucoma

lens induced uveitis

difficult cataract sx