6.1.6 Manages patients presenting with cataract.

Nuclear sclerotic

• Older patients

• Slow progression

• Refractive index increases (myopic shift)

• Brunescent colour

• Poor night vision (blocks blue wavelengths)

• High sensitivity to glare

Posterior sub-capsular

• Younger patients

• Rapid progression

• Vision decreases early as cataract on visual axis

• Vision changes with pupil diameter

• Associated with diseases such as Rheumatoid Arthritis, chronic

• Uveitis, renal failure, diabetes

Cortical

• Moderate progression

• Whitish, crystalline appearance

• Growth is best assessed with dilation

• Sometimes associated with radiation therapy

• Can be associated with diabetes

Cataract Referral criteria

VA of 6/12 or worse in one eye

Patients experiencing:

- Significant glare and dazzle

- Difficulties with night vision

- Difficulty reading

- Significant optical imbalance

To improve visual acuity to better than 6/9 where activities vital to daily living would otherwise cease.

Patient must consent

Cataract surgery

Process

Preparation

• Local anaesthesia

• Small incision made at edge of cornea

Lens removal

• Phacoemulsification breaks down cloudy lens

• Fragments are suctioned out

Lens replacement

• IOL inserted into natural lens capsule

Closure

• Incision usually seals without stitches

Recovery

• Protective shield placed on the eye

• Eye drops prescribed to prevent infection and reduce inflammation

Cataract surgery

Risks and complications

Posterior capsule opacification (common)

• Clouding of the lens capsule months / years later

• Quickly treatable with YAG capsulotomy

Endophthalmitis (rare, serious)

• Infection in the eye, sight-threatening Retinal detachment (rare, serious)

• More common in hypermetropic patients

Cystoid macular oedema (rare, serious)

• Post surgical inflammation

• 1-2% patients

• Urgently refer: NSAIDs + corticosteroids

Morgagnian

• End stage / hypermature to cortical cataract

• Nucleus floating in a liquified cortex

• Immediate removal recommended

Zonular / lamellar

• Congenital

• Located in laminar layer around nucleus

• Associated with hyperthyroidism

Congenital cataract

• Congenital

• Can cause minimal affect on vision; severe = amblyopia

• Slow to no progression

Stellast / traumatic

Blunt or penetrating injury

Snowflake

• Rare, rapidly developing

• Grey-white opacities in distinctive pattern

• Often associated with uncontrolled diabetes

• Excess glucose enters lens

LOCS III

LOCS III Grading System

Nuclear Opalescence

Refers to density of lens nucleus

• 0.1 = clear • 6.9 = severely opaque

Nuclear colour

Refers to yellow/browning of nucleus

• 0.1 = almost clear • 6.9 = deep brown

Cortical cataract

Refers to percentage of lens opacity

• 0.1 = almost clear • 6.9 = severely covered

PSC

Refers opacity density / size

• 0.1 = barely noticeable • 6.9 = dens, covers central area