Acquired Lens Opacities

Question 1

what part of the lens is a permeable, elastic membrane that is constantly reproduced?

Answer 1

capsule

Question 2

where is the lens capsule the thickest?

Answer 2

near the equator

Question 3

what part of the lens is made of densely packed secondary fibers?

Answer 3

lens cortex

Question 4

what part of the lens has very little extracellular space?

Answer 4

lens cortex

Question 5

is the lens vascular or avascular? does it have high or low oxygen pressure?

Answer 5

avascular with low oxygen pressure

Question 6

what physiological factors impact the energy needed for protein synthesis & protection from oxidative damage?

Answer 6

highly anaerobic & lower energy production

Question 7

damage or rupture of cell membranes in the lens results in what?

Answer 7

protein aggregation & enzyme inactivation

Question 8

oxidative (free radical) damage causes an increase in what?

Answer 8

• increase in soluble proteins

- increase in lens hydration

Question 9

when new cells envelope old cells, what occurs?

Answer 9

growth in diameter & axial length

Question 10

when new cells envelope old cells, what does it impact?

Answer 10

refractive gradient & accommodation

Question 11

what makes diffusion difficult? what happens?

Answer 11

compact spaces of inner lens fibers → metabolites accumulate over time

Question 12

where are the oldest cells located?

Answer 12

nuclear & inner cortical

Question 13

what are oldest cells devoid of?

Answer 13

organelles & access to oxygen

Question 14

what are the most common causes of complicated (secondary) cataracts?

Answer 14

• uveitis
• retinal detachment
• retinitis pigmentosa

Question 15

acquired cataracts can be associated with what skin disease?

Answer 15

atopic dermatitis

Question 16

what metabolic etiologies most commonly cause acquired cataracts?

Answer 16

• diabetes
• Wilson’s disease
• myotonic dystrophy

Question 17

what drugs commonly cause acquired cataracts?

Answer 17

• corticosteroids

- chlorpromazine

Question 18

what are the 3 morphological classifications of acquired cataracts?

Answer 18

• nuclear
• subcapsular (anterior & posterior)
• cortical

Question 19

what are the 3 types of cortical cataracts?

Answer 19

• polar
• cuneiform: cortical spoking
• vacuoles

Question 20

what are the consequences of aging lens?

Answer 20

• VA decrease → #1 cause of blindness in the world
• refractive error change
• increased glare
• shallower anterior chamber

Question 21

what do you use to measure the impact of a cataract by projecting the Snellen chart onto the retina?

Answer 21

potential acuity meter (PAM)

Question 22

what is an alternative to the potential acuity meter?

Answer 22

potential acuity pinhole

Question 23

what is used to assess the impact of glare on visual acuity?

Answer 23

brightness acuity test

Question 24

nuclear cataracts are best graded with the slit lamp beam at what angle? & focused on which structure?

Answer 24

30-45 degrees to the lens

Question 25

what grade is a nuclear sclerotic cataract that appears Brunescent?

Answer 25

grade 4

Question 26

what grade is a nuclear sclerotic cataract that appears yellow-orange?

Answer 26

grade 3

Question 27

when a nuclear sclerotic cataract is graded as "trace", what color is it?

Answer 27

slight yellow

Question 28

cortical spoking is best graded with what slit lamp technique?

Answer 28

retroillumination of the lens

Question 29

posterior subcapsular cataracts are best graded with what slit lamp technique?

Answer 29

retroillumination of the lens

Question 30

what would you grade a PSC that is > 3mm?

Answer 30

grade 3+

Question 31

what size is a PSC when it is graded as PSC 2+?

Answer 31

2-3mm

Question 32

what would you grade a PSC that is 1-2mm?

Answer 32

PSC 1+

Question 33

what causes steady gradual changes in the lens after age 40?

Answer 33

oxidative stress

Question 34

a homogenous increase in insoluble proteins resulting in protein aggregation & accumulation of fluorescent chromophores causes what type of acquired cataracts?

Answer 34

nuclear sclerosis

Question 35

T/F: nuclear sclerosis is not age-related

Answer 35

false

Question 36

which age-related cataract presents as dehydration & compaction of the nucleus & nuclear yellowing due to chromophore accumulation?

Answer 36

nuclear sclerosis

Question 37

in nuclear sclerosis, what causes light scatter?

Answer 37

denaturation of proteins by free radicals

Question 38

how do nuclear sclerotic cataracts progress?

Answer 38

usually a slow, uniform progression

Question 39

what impact do nuclear sclerotic cataracts have on visual acuity?

Answer 39

- VA reduction | - increased density & stiffness can lead to myopic shift

Question 40

which cataract typically begins in the lower nasal quadrant & as vacuoles between the lens fibers that can be transient?

Answer 40

cortical cataracts

Question 41

which age-related cataract is due to: - denaturation & coagulation of lens proteins - decreased level of amino acids & protein synthesis - increased hydration caused by decrease in potassium

Answer 41

cortical cataracts

Question 42

which age-related cataracts has opacification that results in cuneiform (wedge-shaped) or radial spoke-like opacities?

Answer 42

cortical cataracts

Question 43

when cortical cataracts present with vacuoles, what impact does it have on visual acuity?

Answer 43

no impact on VA

Question 44

what is a common symptom in cortical cataracts? what is it due to?

Answer 44

glare → due to light scatter

Question 45

what age-related cataract is caused by swelling of lens due to osmotic effect of aggregated insoluble proteins?

Answer 45

mature cortical cataracts

Question 46

which age-related cataract has a "mother of pearl" appearance?

Answer 46

mature cortical cataracts

Question 47

what are the sequelae of mature cortical cataracts?

Answer 47

can cause shallow anterior chamber & elevated IOP

Question 48

what age-related cataract occurs when leakage of liquified cortex results in capsular wrinkling?

Answer 48

hypermature cortical cataracts

Question 49

in a hypermature cortical cataract, what can happen as a result of the liquified cortex?

Answer 49

nucleus can sink inferiorly

Question 50

T/F: hypermature cortical cataracts can cause shallow anterior chamber & elevated IOP

Answer 50

true

Question 51

what impact do hypermature cortical cataracts have on visual acuity? how would you test their visual acuity?

Answer 51

significant VA reduction - hand motion - light perception

Question 52

what structure of the lens cannot be viewed in a dilated pupil with a hypermature cortical cataract?

Answer 52

posterior pole

Question 53

in hypermature cortical cataracts, what can occur when lens proteins leak out of the lens?

Answer 53

it can trigger a severe nongranulomatous inflammatory reaction

Question 54

in hypermature cortical cataracts, accumulation of macrophages & protein in the trabecular meshwork can lead to what?

Answer 54

glaucoma

Question 55

what type of age-related cataracts occur due to metaplastic change in epithelial cells?

Answer 55

anterior subcapsular

Question 56

in anterior subcapsular cataracts, the epithelial cells become?

Answer 56

elongated

Question 57

anterior subcapsular cataracts can also be caused by what? what is it called?

Answer 57

angle-closure attacks (glaucomflecken)

Question 58

angle-closure attacks in anterior subcapsular cataracts are caused by what?

Answer 58

necrosis of the lens epithelium

Question 59

which type of age-related cataract presents as a plaque-like opacification due to migration of adjacent epithelial cells into the damaged area?

Answer 59

anterior subcapsular cataracts

Question 60

which age-related cataract is caused by dysplastic change in the germinal epithelium? what happens to the cells?

Answer 60

posterior subcapsular | - cells become distorted, swollen & unorganized

Question 61

posterior subcapsular cataracts can be secondary to what?

Answer 61

- diabetes - corticosteroid use - inflammation - retinitis pigmentosa - atopic dermatitis

Question 62

what impact do posterior subcapsular cataracts have on visual acuity?

Answer 62

it may affect near vision more than distance

Question 63

in diabetes, what causes an accumulation of sorbitol & leakage of water into the lens?

Answer 63

increased glucose levels

Question 64

what is also known as a christmas tree cataract?

Answer 64

myotonic dystrophy

Question 65

in cataracts caused by myotonic dystrophy, are the cataracts nasal, central, or temporal? what color are they? what structure of the lens is it present in?

Answer 65

central, polychromatic, present in the cortex

Question 66

what is also known as sunflower cataracts?

Answer 66

Wilson's disease

Question 67

which metabolic disorder causes copper deposits in the central lens with stellate processes?

Answer 67

Wilson's disease

Question 68

where are cataracts due to Wilson's disease located?

Answer 68

under anterior capsule

Question 69

T/F: sunflower cataracts cannot resolve with appropriate systemic treatment of the disease

Answer 69

false

Question 70

in patients with atopic dermatitis, when would they develop cataracts?

Answer 70

2nd-4th decade

Question 71

are cataracts from atopic dermatitis unilateral or bilateral? how do they progress?

Answer 71

often bilateral & mature quickly

Question 72

what condition causes a shield cataract, commonly an anterior subcapsular plaque?

Answer 72

atopic dermatitis

Question 73

in patients with atopic dermatitis with cataracts, what is another presentation? (besides an anterior subcapsular plaque)

Answer 73

stellate posterior subcapsular opacity

Question 74

corticosteroids most commonly cause what type of cataract?

Answer 74

posterior subcapsular cataracts

Question 75

which drug induces a stellate anterior subcapsular cataract with granular deposits?

Answer 75

chlorpromazine

Question 76

what is the most common cause of unilateral cataracts in young individuals?

Answer 76

blunt trauma

Question 77

what is a pigment imprint from pupillary ruff onto anterior lens capsule called?

Answer 77

Vossius ring

Question 78

true exfoliation of the anterior lens capsule is caused by what?

Answer 78

heat (infrared radiation) trauma

Question 79

inflammation such as uveitis, retinal detachment & retinitis pigmentosa can result in which type of cataract most commonly?

Answer 79

PSC

Question 80

what is a systemic condition that results in fibrillary residue deposits?

Answer 80

pseudoexfoliation

Question 81

pseudoexfoliation increases the risk of what? & why?

Answer 81

increased risk of glaucoma due to elevated IOP

Question 82

what impact do cataracts resulting from pseudoexfoliation have on visual acuity?

Answer 82

no impact on visual acuity

Question 83

pseudoexfoliation causes enzyme degradation of zonules which leads to?

Answer 83

zonular weakness & phakodenesis

Question 84

what is the displacement of lens from its normal position?

Answer 84

ectopia lentis

Question 85

what can cause ectopia lentis?

Answer 85

- trauma - Marfan syndrome - pseudoexfoliation syndrome - high myopia

Question 86

if a patient with Marfan syndrome develops ectopia lentis, where is the lens usually displaced to? is it bilateral or unilateral?

Answer 86

bilateral, superotemporal