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OD I > topic 1: cataract > Flashcards

topic 1: cataract Flashcards

1
Q

what are 7 factors that cause earlier onset of cataract?

A
  1. Congenital
  2. Aging>senile
  3. Inflammation, high myopia, RP, etc>complicated
  4. Diabetes
  5. Drugs (steroid)
  6. Trauma
  7. Heat / Irradiation>exfoliation
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2
Q

what are some signs and symptoms of cataract?

A

signs:
Loss of transparency / opacity /cloudy

symptoms:
Myopic/hyperopic shift
Reduced vision (distance/near)
Glare
Desaturation of colours
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3
Q

what is congenital cataract? what are some causes?

A

PX is born with cataract, non-progressive and often does not affect vision

causes:
Maternal infection
Metabolic
Chromosomal
Hereditary
Birth trauma
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4
Q

what should you do if young px has cataract?

A

Refer to ophthalmologist for early surgery (6 wks old) to prevent risk of stimulus deprivation amblyopia and nystagmus

Accurate refractive correction pre- and post- surgery (if applicable)

Patient reassurance:
little impact on vision
most cases not dense and rarely progressive

Patient education:
to monitor opacity and visual function
for dense cases, risk of amblyopia/nystagmus

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5
Q

what are the 3 main types of acquired cataract?

A
  1. senile
  2. complicated
  3. irradation (true exfoliation)
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6
Q

what are the 3 sub types of senile cataract?

A 
Nuclear sclerosis (NS)
Cortical (CC)
Posterior subcapsular (PSCC)
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7
Q

what are the 4 sub types of complicated cataract?

A

Systemic disease
Congenital anomalies
Drugs related
Trauma

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8
Q

what are the 7 risk factors of acquired cataract?

A
  1. Age-related
  2. Primary ocular diseases (eg. chronic uveitis)
  3. Systemic diseases (eg. diabetes mellitus)
  4. Congenital anomalies (eg. Marfan syndrome)
  5. Drugs (eg. Corticosteroids)
  6. Trauma (eg. blunt trauma)
  7. Others (eg. UV exposure, high myopia)
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9
Q

what are 4 ocular conditions that may cause earlier onset of complicated cataract?

A

1.high myopia
2. chronic anterior uveitis
3. retinitis pigmentosa (genetic condition
)
4. retinal detachment

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10
Q

what are the pathogenesis, signs, symptoms and VA of nuclear sclerosis?

A

pathogenesis:
Photo-oxidation of lens protein

signs:
Yellowing of lens nucleus or “lemon drop” appearance
Myopic shift

symptoms:
Reduced distance vision
Glare during bright light
Desaturation of colours

VA:
Affected/reduced

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11
Q

what are the pathogenesis, signs, symptoms and VA of cortical cataract?

A

pathogenesis:
Imbalance of electrolytes causing over hydration of cortex

signs:
Water vacuoles, clefts, spokes and wedges appearance in lens cortex
Hyperopic shift

symptom:
Reduced near vision
Glare during night time
Affects central vision in later stage

VA:
Normally not affected except in late stage

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12
Q

what are the pathogenesis, signs, symptoms and VA of posterior subcapsular cataract?

A

pathogenesis:
Due to migration of epithelial cells toward the posterior pole to replace lens fibre nuclei loss

signs:
Granular opacity just in front of posterior lens capsule
no shift

symptoms:
VA drastically affected for both distance and near
glare in bright light

VA:
Severely impairs central vision, especially in bright light.

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13
Q

how does cataract occur in diabetes?

A 
High level of glucose in aqueous humour
Sorbitol buildup 
Osmotic pressure change causing over hydration of lens substance
Onset in teens
Predispose to senile cataract earlier.
PSCC is common
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14
Q

what kind of cataract is seen in diabetes>

A

snowflake cataract

just behind anterior capsule or in front of posterior capsule

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15
Q

what are the 2 drugs that could cause cataracts? what kind of cataract do they result in?

A
  1. corticosteroids
  2. miotics

Usually bilateral PSCC

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16
Q

what cataract is commonly seen in traumatic cataract?

A

rosette cataract (secondary to blunt trauma)

17
Q

what are 2 kinds of cataract commonly seen in irradiation exposure cataract?

A

1.True exfoliation
Caused by long-term heat exposure (glassblower, welder)
Separation and curling up of anterior lamellae of the capsule

  1. Pseudoexfoliation (DDx)
    Senile lenticular abnormality
    White granular material on anterior pole, AC angle, pupil border, iris, ciliary body
    Risk of glaucoma
18
Q

What are the management options for cataract?

A
  1. UV protection to reduce rate of progression by sunglasses, visors, wide brimmed hat or umbrella, particularly when driving and outdoors.
  2. Patient education on progressive normal aging change.
  3. Avoid driving at night or in dim illumination due to possible glare.
  4. Self-monitoring of vision / regular eye check.
  5. Eating foods with Antioxidant
  6. Referral and surgery to remove cataract if severe
19
Q

when should we refer px for cataract surgery?

A
  1. When corrected VA dropped below 6/12
  2. when blurring of vision is affecting patient’s daily activities
  3. Both the above
  4. f there is a narrow anterior angle and increased risk of angle closure glaucoma.
20
Q

what does immediate, urgent, early and non urgent referral mean? (in terms of time stamp)

A

immediate: attend A&E or eye clinic immediately
urgent: same day
early: within 2 weeks
non urgent: > 2 weeks but preferrably within 1 month

21
Q

what kind of referral if Best corrected VA worse than 6/12 ?

A

Non urgent referral if patient is keen for surgery

22
Q

what kind of referral for PSCC? (patient is symptomatic eg poor reading, glare and photophobia even if distant VA is 6/12 or better)

A

Non urgent referral if patient is keen for surgery

23
Q

what kind of referral if brunescent cataract?

A

Non urgent referral

24
Q

what kind of referral if white cataract in adult?

A

Early referral if cornea is clear, urgent referral if cornea is hazy

25
Q

what kind of referral if subluxated cataract?

A

Early referral

26
Q

what kind of referral if lens induced glaucoma

A

Urgent referral

Advice Sheet for all types of cataract

OD I (5 decks)

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