Question

CASE STUDY 12.1 A 75-year-old man discusses vision concerns with his ophthalmologist at his yearly visit. After a careful history and physical examination, he is diagnosed with bilateral cataracts. 1. What are the clinical manifestations associated with cataracts? 2. What is the underlying pathophysiology associ- ated with cataracts? 3. How are cataracts diagnosed? 4. What are the possible treatments for cataracts? 5. What are the issues related to appropriate management of cataracts?

Answer 1

1. Clinical manifestations of cataract are :-

- painless ,blurry vision

- perception that surroundings are dimmer

- light scattering ,reduced contrast sensitivity

- sensitivity to glare

- reduced visual acuity

- double vision

- colour shift

- reduced light transmission

- astigmatism

2. Pathophysiology of cataract :-

- The lens is made mostly of water and protein fibers.

- Opacity occurs when the lens protein clumps together . With aging ,lens protein progressively denature causing increase in density and yellowish brown colouration of the lens .

- Ability for lens to refract lights reduce which cause reduce visual acuity . Cloudy lens lacks the ability to transmit and focus light rays on the retina .

- Chemical modification of the lens cause it to be thicken and harden .

3. Cataract are diagnosed by the following investigations :-

- Snellen visual acuity test

- Assessment of the degree of visual acuity

- Opthalmoscopy

- Slit -lamp bimicroscopic examination

4. Treatment of cataract - No non surgical treatment cures cataract . Glasses ,lens ,bifocals are used to improve vision.

Surgical management - if reduced vision from cataract does not interfere with normal activities then surgery is not required. Cataracts are removed on OPD basis. Surgical management include :-

- Phacoemulsification ( method of extracapsular cataract surgery )

- lens replacement ( aphakic eyeglasses ,contact lenses ,and intraocular lens implantation )