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 alpha-₁-adrenergic receptor antagonists (eg, tamsulosin [highest risk], alfuzosin, doxazosin, silodosin, or terazosin)

  • There is no consensus on whether to stop alpha-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 alpha-blocker to prepare for iris issues during surgery

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