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Snapshot
  • A 72-year-old man is referred to an ophthalmologist for progressive vision loss. He reports difficulty driving at night. Medical history is unremarkable. The patient's pupils are dilated and undergoes slit-lamp testing. He was found to have opacification of the cataracts. Preparations are made to undergo cataract surgery.
Introduction
  • Overview
    • intraocular lens opacification
      • leads to vision impairment
  • Epidemiology
    • incidence
      • most common cause of reversible blindness
    • risk factors
      • increasing age 
      • non-age-related risk factors
        • type 2 diabetes mellitus
        • cigarette smoking
        • long-term systemic corticosteroid use
        • galactosemia
        • ocular trauma
        • ionizing radiation
  • Pathophysiology
    • age-related cataracts
      • degenerative changes in the cellular structure of the lens which causes the lens to lose its transparency via unclear mechanisms
  • Associated conditions
    • Refsum disease
    • Alport syndrome
    • myotonic dystrophy
    • galactokinase deficiency
    • classic galactosemia
    • neurofibromatosis 2
  • Prognosis
    • good outcome with cataracts surgery
Presentation
  • Symptoms
    • progressive and painless vision loss 
    • difficulty with night driving
  • Physical exam
    • darkening of the red reflex 
    • opacification of the lens 
Studies
  • Clinical diagnosis
Differential
  • Episcleritis
    • differentiating factor
      • sclera should be normal in cataracts
  • Diabetic retinopathy
    • differentiating factor
      • neovascularization in proliferative diabetic retinopathy
      • retinal hemorrhage and macular edema in nonproliferative diabetic retinopathy
Treatment
  • Surgical
    • cataract surgery
      • indication
        • first-line treatment
Complications
  • Reversible blindness
  • Endophthalmitis

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(M2.OP.14.5) A 75-year-old man with a history of hypertension and diabetes presents to his primary care physician for blurry vision and difficulty driving at night. The patient reports a gradual blurring of vision in both eyes over the last 10 years. He states that he is retired and was not bothered by the blurriness but is now having difficulty driving at night due to glare from oncoming traffic. The patient denies any eye pain, flashes, floaters, tearing, redness, or periods of complete vision loss. He lives at home alone, smokes 1 pack per day, drinks 2 alcoholic drinks every night, and eats mostly canned food. His temperature is 98.5°F (36.9°C), blood pressure is 184/110 mmHg, pulse is 70/min, respirations are 13/min, and oxygen saturation is 98% on room air. Cranial nerves II-XII are grossly intact and the patient has a stable gait. The patient's vision is 20/100 in both eyes. Slit-lamp exam is performed as seen in Figure A. Which of the following is the most likely diagnosis?

QID: 105371
FIGURES:
1

Diabetic retinopathy

0%

(0/43)

2

Macular degeneration

5%

(2/43)

3

Retinal detachment

0%

(0/43)

4

Senile cataracts

93%

(40/43)

5

Vitamin A deficiency

0%

(0/43)

M 6 E

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