Review Question - QID 105371

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Cataracts Epidemiology Risk factors QID: 105371 (M2.OP.14.5)

QID 105371 (Type "105371" in App Search)

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?

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Diabetic retinopathy

1/47

Macular degeneration

2/47

Retinal detachment

0/47

Senile cataracts

91%

43/47

Vitamin A deficiency

0/47

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This patient is presenting with gradual worsening of his vision with clouding of the lens on slit-lamp exam suggesting a diagnosis of senile cataracts.

Senile cataracts are the leading cause of visual impairment worldwide. Senile cataracts are due to the denaturation of lens proteins which cause opacification of the lens. Although it is a natural phenomenon that occurs as the lens ages, the rate of formation of cataracts can be increased by diabetes, hypertension, UV light, steroids, trauma, and radiation exposure. The diagnosis can be supported with a slit-lamp exam which will show opacification of the lens. The definitive treatment of cataracts is lens extraction.

Figure A shows a magnified view of the eye as seen through a slit-lamp. Through the pupil, a clouding of the lens can be seen.

Incorrect Answers:
Answer 1: Diabetic retinopathy is a common disease that leads to blurred vision and ultimately blindness. Though this patient has diabetes, his slit-lamp exam demonstrates opacification of the lens suggesting a diagnosis of cataracts.

Answer 2: Macular degeneration is differentiated into wet and dry. Wet is due to neovascularization and dry is characterized by drusens between the retina and choroid. Macular degeneration leads to gradual visual loss, decreased color vision, and an increased risk for retinal detachment. Opacification of the lens on slit-lamp exam is not a common finding.

Answer 3: Retinal detachment typically presents unilaterally with flashes of light and floaters followed by visual loss in a "curtain coming down" distribution.

Answer 5: Vitamin A deficiency can cause night blindness but it takes years to deplete liver stores. Vitamin A is essential in the eye for corneal and conjunctival epithelial cell function and is involved in the phototransduction process. However, an opacified cornea would not be seen in this condition.

Bullet Summary:
Senile cataracts can present with gradual worsening of vision, difficulties with night vision, and clouding of the lens on slit-lamp exam.

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