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Can’t-Miss Cataract Signs

The more information you can provide to the surgeon, the better.

A quick introduction from the authors.

Cataract surgery is among the most common and successful surgical procedures performed in the United States. Recent technology innovations have made the visual outcomes of cataract surgery better than ever, and eye care providers can now transform patients’ lives via basic cataract surgery and refractive cataract surgery.

Care of cataract patients is a natural intersection point for ODs and MDs. When collaborating with a surgeon, the optometrist must be aware of the signs and symptoms a patient reports and communicate them accurately to the surgeon.

EARLY SIGNS AND SYMPTOMS

In the early stages of cataract development, patients usually complain of decreased quality of vision. Vision is not as sharp, and patients commonly report that they require more and more light to read small print, such as text on medicine bottles or menus at dimly lit restaurants. (If lighting is adequate, these patients often claim, their vision is fine.) Patients also report halos and glare while driving at night.

Clinicians may notice frequent changes to the patient’s glasses prescription and a yellowing of the lens in early stages of cataract development.

EVIDENCE OF PROGRESSING DISEASE

Patients with progressing cataracts may describe light sensitivity during the day as well; such sensitivity occurs especially if the patient has multiple types of cataract—that is, some combination of posterior subcapsular, nuclear, and cortical cataract. Patients may also describe a film or haze over their vision that will not go away. Patients with bilateral cataracts of unequal intensity or unilateral cataract are more aware of dimmed lights or colors in the eye that is more affected.

Clinical findings in moderate to advanced cataract include VA no longer improved by refractive correction and a dark yellow or brown appearance of the lens. 

IATROGENIC CATARACT

Cataracts may be induced by treatment of other ocular or systemic conditions. Typically, this occurs with long-term ocular or systemic steroid exposure.

Patients with iatrogenic cataracts report complaints similar to those of patients with age-related cataracts. Still, a thorough history is necessary to determine why this particular patient’s cataract developed. Clinicians who detect a steroid-induced cataract must also monitor the patient’s IOP, as steroid-induced glaucoma is not uncommon in these patients. 

Surgical procedures can also produce iatrogenic cataracts. Patients who have undergone trabeculectomy or vitrectomy commonly develop cataracts afterward. It is very important for the optometrist to communicate surgical history to the cataract surgeon: Surgical workup and IOL options may depend on this communication.

Don’t Forget the Surface

The presence of ocular surface disease (OSD) can directly affect patient satisfaction with cataract surgery. Optometrists are equipped to manage dry eye disease with pharmaceutical options such as cyclosporine ophthalmic emulsion 0.05% (»Restasis, Allergan) and lifitegrast ophthalmic solution 5% (»Xiidra, Shire), and they can address meibomian gland dysfunction with technologies such as microblepharoexfoliation (»BlephEx, RySurg), »MiBo Thermoflo (Mibo Medical Group), »iLux (Tear Film Innovations), and TearCare (Sight Sciences). The »TrueTear device (Allergan), an intranasal neurostimulating technology that helps patients create their own tears, may be used to increase tear production in some patients. Innovation in OSD treatment is one of the hottest areas in eye care, and the pipeline is filled with developing technologies.

The best time to start treating OSD in a cataract patient is when early signs of cataract are observed and evidence of OSD is present. By optimizing the patient’s ocular surface well in advance of surgery, the optometrists can keep patients—and surgeons—happy with outcomes.

CONCLUSION

Signs and symptoms clue in the clinician as to the stage of a cataract. The technology available to eye care providers—including diagnostics and intraoperative platforms—have increased the precision and safety of cataract surgery. Improved IOL technologies and a renewed focus on addressing ocular surface disease give patients a high likelihood of success.

All of this adds up to surgeons being more comfortable intervening sooner in the cataract progression cycle and optometrists referring patients sooner than they have in the past. The optometrist’s role in communicating pertinent history (for example, previous retinal procedures leading to iatrogenic cataract) is vital to surgical planning. Through a collaborative approach to care, patients’ experience with refractive cataract surgery can be better than ever.

author
Bridgette Connorton, OD
  • Optometrist, Shenandoah Eye Clinic, Baton Rouge, Louisiana
  • bconnortonod@shenandoaheyeclinic.com
  • Financial disclosure: None acknowledged 
author
Blake Williamson, MD, MPH, MS
  • Refractive, Refractive Cataract, MIGS Surgeon; Williamson Eye Center, Baton Rouge, Louisiana
  • blakewilliamson@weceye.com; Instagram: @williamsonlasik
  • Financial disclosure: Consultant (Allergan, Johnson & Johnson Vision, Shire)
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