Cataract Symptoms

History of Patients with Cataracts

The patient may complain the following:

• Subjective

• Seen objects appear distorted and blurred ( haziness, cloudiness, diplopia or double vision)

• Annoying glare

• Photophobia

 Objective

• Progressive loss of vision

• The usual black pupil appears clouded and progresses to milky white appearance

 Normal Function, Pathophysiology and Clinical Manifestations of Patients with Cataract Formation

Normal Eye Function	Pathophysiology	Clinical Manifestations
Lens fibers continuously produced, with older fibers being compressed toward center of the lens	With aging, nuclear portion of lens becomes increasingly dense; normal transparency of lens decreases	Gradual decrease in vision
Focuses light on retina	Light rays that strike opacity scatter Opacity filters out blue end of visible light spectrum Trauma to lens leads to rupture or break in lens capsule, causing rapid swelling and opacification of lens	Glare, halos around lights Ability to discriminate hues decreases; vision “rosier”  Sudden decrease in vision; blurred vision

The degree of vision loss depends on the location and extent of the opacity. Persons with opacity in the center portion of the lens can generally see better in dim light when the pupil is dilated.

Family History

Because many eye disorders are inherited, family history is necessary. Questions are directed specifically history of cataracts, glaucoma, diabetes mellitus, poor vision that could not be corrected by glasses, or blindness.

Assessment of Vision (specifically refraction)

A ray of light entering the eyes passes through the various transparent refractive media and is bent (refracted) to focus on the retina. The bending of the light rays and the location of the image depend on the shape and condition of the eye. The eye has the ability to adjust to near or far objects (accommodation) by means of the ciliary muscles, which contract or relax causing the lens to flatten or thicken as the need arises.

When the lens becomes less elastic and responds less to the need for accommodation, as occurs in persons past the age of 40 years, blurring of vision especially of near objects (presbyopia) results.

Inspection of Internal Structures

Difficulty in perceiving the fundus by an ophthalmologist may be caused by interference with the light penetrating the eyes as a result of intraocular inflammation, corneal scarring, or cataract.

Aging

Visual changes that occur with aging include presbyopia, decreased ability to tolerate glare, decreased peripheral fields, decrease ability to adapt to dim light and darkness.