How do you manage a suspected cataract?
Refer to an optometrist for examination and visual acuity assessment
Counselling on how will affect vision + QoL + what surgery involves/risks/benefits
Surgery indications:
- Person wants to keep driving but does not meet DVLA minimum sight requirements
- Significant impact on QoL/ADLs
Why would you suspect and how do you manage a suspected cataract in paediatrics?
Urgent same day call to ophthalmology if:
- Opacity or absence of red reflex
- White pupillary reflex (Leukocoria)
Urgent written referral to ophthalmologist if:
- Inequality in colour, clarity or reflection
- No detectable abnormality but parent describes Hx suspicious of leukocoria e.g. in a photo (though this often a reflection of the optic disc in flash photography when off axis to camera)
How do cataracts present?
Gradual, painless reduction in visual acuity
Blurred vision
Difficulty seeing at night and reading text
Sensitivity to light/glare - esp. at night
‘Halos’ around lights and double vision in a single eye
Gradual reduction in perception of colour intensity (esp. blues)
Often in the elderly but can be congenital
How do you assess for cataracts in the elderly?
Clinical features, onset, duration; impact on daily life; ocular Hx, risk factors etc
Assess:
- Visual acuity - Snellen’s
- Ocular alignment and motility
- Pupillary function
- Ophthalmoscopy = opacity of the lens may appear as deficits in the red reflex; slit lamp for more detail
