Case 1: Diagnosis & Conclusions

Diagnosis: Mature cataract

This patient has a mature cataract, referred to as white cataract, due to its opaque appearance which completely blocks the view to the posterior segment.  Prolonged steroid medication use in any form (ie topical, oral, nasal sprays, creams, etc.) may accelerate cataract formation, which is the most likely cause of  a visually significant cataract in this younger patient.

Cataract refers to opacification of the eye’s natural crystalline lens, which is clear at birth. The opacification of this clear structure leads to decrease in vision over time. Cataracts progress slowly and painlessly. In addition to blurred vision, patients may report glare symptoms, and difficulty reading particularly with dim illumination. Cataracts start to develop in the 50s and peak in the 70-80s, with over 50% of the US population having visually significant cataracts by 80 years of age. 

Nuclear sclerotic cataracts (shown below) occur more commonly and are age-related.

NS cataract eyewikiAbove image credit

Cortical cataracts often develop in diabetic patients and have wheel-spoke appearance. 

cortical cataractAbove image credit

Posterior subcapsular can be age-related or steroid induced and often cause significant glare symptoms. 

PSC cat eyewikiAbove image credit

Treatment

iol image

The treatment for cataracts causing decreased vision is cataract surgery. This is typically done under local sedation, and is usually a less than 30 minute outpatient procedure. The cataract is removed and replaced with a clear artificial lens implant (see image on left) which can be customized to the patient’s refractive error, reducing dependency on glasses after surgery.  Patients’ vision typically improve immediately following surgery, if not within a few days of the procedure. After care involves instilling a few eye drops multiple times per days for a few weeks following surgery . (Above left Image credit, license CC BY-SA 3.0)

Patient’s often require medical clearance from their primary care providers so it’s helpful to understand what patients should expect on the day of surgery. 

Check out this video of cataract surgery!

References and Additional Resources:

  1. “Eyewiki: Cataract.” Available at: https://eyewiki.aao.org/Cataract.
  2. “NIH National Eye Institute: Cataract Data and Statistics.” Available at: https://www.nei.nih.gov/learn-about-eye-health/resources-for-health-educators/eye-health-data-and-statistics/cataract-data-and-statistics.
  3. Thompson J & Lakhani N. Cataracts. Prim Care. 2015;42(3):409-23.

Case 1 Index
Case 1 Introduction
Case 1 Physical Exam
Case 1 More Data…