Cataract

Diagnosis/Definition

A cataract is a congenital or acquired opacification of part or all of the normally clear crystalline lens.
The most common complaint of cataract is painless, progressive loss of central visual acuity.
Other common symptoms include disabling glare from bright lights, such as headlights during nighttime driving, and glare off rainy pavement.
Visually significant cataract is a lens opacification that interferes with vision to the point that lifestyle is limited.

Initial Diagnosis and Management

Moderately advanced cataracts will show a decreased red reflex or a patchy break up of the red reflex by direct ophthalmoscopy.
The development of cataracts in older patients can be markedly asymmetric. Cataracts often cannot be detected without special equipment (i.e., a slit lamp biomicroscope).
Pinhole visual acuity will help determine if the decrease in vision is refractive (i.e., the patient needs new glasses).
Asymptomatic patients with visual acuity of 20/40 or better may be followed.

Ongoing Management and Objectives

Cataracts do not improve with time.
There is no definitive primary care treatment for symptomatic cataract.

Indications for Specialty Care Referral

Any cataract in infants and children.

Adults with symptomatic, slow, progressive, painless decrease in vision that affects activities of daily living (i.e., driving, reading).

Patients whose visual acuity improves with a pinhole should be referred to optometry for measurement of new glasses. Ophthalmology does not prescribe routine glasses prescriptions.

Any patient requiring cataract surgery may receive care at MAMC Ophthalmology.

Criteria for Return to Primary Care

Ophthalmologic evaluation shows no organic etiology for decrease in vision (amblyopia).