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Opacity of the lens that ↓ visual acuity. Caused by oxidative damage to the lens, leading to ↑ deposition of insoluble proteins in otherwise transparent tissue (Figure 15.1). Risk factors include smoking, diabetes, and corticosteroid therapy.
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Symptoms/Exam: Presents with painless blurred vision (Figure 15.2). Symptoms are progressive, developing over months or years. Lens opacities can be grossly visible or seen as a diminished red reflex.
Diagnosis: Slit-lamp biomicroscopy during ophthalmologic exam (see Figure 15.1).
Management: Decision to treat is based on the degree of functional impairment imposed by the cataracts. Surgery consists of removal of the cataract and placement of an intraocular lens; improves visual acuity in 95% of cases.
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A group of disorders characterized by ↑ intraocular pressure, leading to irreversible damage to the optic nerve.
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↑ intraocular pressure due to abnormal aqueous drainage through the trabecular meshwork of the eye (Figures 15.3 and 15.4). The most common form of glaucoma, accounting for >90% of cases. Prevalence is ↑ in first-degree relatives of affected individuals and in persons with diabetes. May also develop after uveitis or trauma. Risk factors include age >65 years, ⊕ family history of glaucoma, black ancestry, and diabetes.
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Insidious onset; patients are often asymptomatic until vision is seriously compromised; painless.
Characterized by bilateral peripheral vision loss, leading to ↑ tunnel vision (Figure 15.5).
Patients may also complain of “halos around lights.”
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