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For further information, see CMDT Part 7-13: Cataract

Key Features

  • Lens opacity (may be grossly visible)

  • Usually occurs bilaterally

  • Age-related cataract is the most common type

  • Most persons older than 60 have some degree of lens opacity

  • Multivitamin/mineral supplements and high dietary antioxidants may prevent the development of age-related cataract

  • Other causes

    • Congenital infections or inborn errors of metabolism

    • Secondary to systemic disease (diabetes mellitus, myotonic dystrophy, atopic dermatitis)

    • Drugs (eg, topical, systemic, or inhaled corticosteroids [long-term])

    • Uveitis

    • Radiation exposure

    • Ocular trauma

Clinical Findings

  • Gradually progressive blurred vision

  • No pain or redness

Diagnosis

  • Even in its early stages, a cataract can be seen through a dilated pupil with an ophthalmoscope or slit lamp

  • As the cataract progresses, retinal visualization becomes increasingly difficult

Treatment

  • When visual impairment significantly affects daily activities, surgical therapy is usually warranted

  • Treatment involves surgical removal and insertion of an intraocular lens of appropriate refractive power

  • Floppy iris syndrome

    • Risk is increased in patients taking α1-adrenergic receptor antagonists (eg, tamsulosin [highest risk], alfuzosin, doxazosin, silodosin, or terazosin)

    • There is no consensus on whether to stop α-blockers before surgery because the effects of the drug on the iris can persist for months to years

    • The surgeon must know if the patient is taking an α-blocker to prepare for iris issues during surgery

    • If the patient has not yet started an α-blocker and is planning to have cataract surgery shortly, it is best to wait until after surgery to begin the medication, if possible

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