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Draw anatomy of the lens Slide 12.

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Draw the anatomy of lens.

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Development of lens.

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Image of cataract under slit lamp

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Slide 11: There's nucleus sclerotic, cortical, posterior subcapsular
For nucleus sclerotic: it is the hardening of lens which changes its flexibility and therefore it is unable to accommodate easily, affecting vision.
COrtical cataract: it is wide opacitites that develop in lens cortex this fissures can cause the light that enter the eye to scatter creating prob such as blurred vision, glare, contrast and wrong depth perception
Posterior subcapsular cataract: It begins as a small opaque area at the back of the lens, it can interfere with reading and halo effects and glare around light it can develop rapidly within months.

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image of IOL under slit lamp

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How should this man's vision be evaluated whilst in the consultation room?
Pinhole during VA

What's cataract?
A medical condition in which the lens of the eye becomes progressively opaque, resulting in blurred vision

How can cataract impact a person's quality of life?
Due to the blurred vision and no surgery, the person will be unable to have clear vision and at times, be confused, restricting the person's ability to enjoy life like he was able to in the past
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How would you classify cataract?
- anterior cortical cataract
- posterior cortical cataract
- anterior polar cataract
- posterior polar cataract
- anterior subcapsular cataract
- posterior subcapsular cataract

Which tests would you request? -- slit lamp examination of the crystalline lens

How to examine cataract?
- using the slit lamp

How different cataract affects vision?

Development of lens

How would you describe the site of opacities below?

3 common types of cataract

What should Mr Tan do now? Are there any additional relevant factors in the history which should be revisited?

What are the types of surgery for cataract?

image of IOL implantation
-refer to image-

How would it look like if Slit lamp is performed?
-refer to image-

How would you advise Mr Tan?
Ask him to wear sunglasses when outside and wear caps to reduce UV radiation reaching the eyes

What is the leading cause of blindness?
Glaucoma and cataract

What secondary eye conditions can advance cataract cause?

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1. Check VA - to check his Rx
Check the Rx of his new spectacles. If the results tally, we can evaluate that the guy may have other conditions/diseases that cause his blurry vision.
2. Cataract is a medical condition in which the lens of the eye becomes progressively opaque, resulting in blurred vision.
3. Blurry vision decreases a person's quality of life. Thus, he is not able to do activities such as reading and driving at night due to the bright light, halos and blurred vision.
4. Posterior subcapsular cataract
Nuclear Cataract
Congenital
Cortical
Morgagnian
Zonular
Traumatic
5. Slit-lamp - to check clarity of crystalline lens using optic section
6. Using optic section - see if the lens have any opacity/cloudiness
7. Nuclear cataract
8. Nuclear : interferes with a person's ability to see at distance
Cortical: near and distance vision and notice glare/halo effect
Posterior subcapsular: cause glare and blurriness
9.  Anatomy of Lens
Source: http://www.outlanderanatomy.com/a-real-eye-opener-the-eye-part-4/
10. Development of Lens
Source: http://www.oculist.net/downaton502/prof/ebook/duanes/pages/v1/v1c074.html

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Slide 3:
Pinhole Test when visual acuity can not be corrected normally
Binocular Vision Testing

Slide 4:
a medical condition in which the lens of the eye becomes progressively opaque, resulting in blurred vision.

Slide 5:
Cataracts cause blurry vision which cannot be corrected with spectacles, this will impact many of his daily activities.
Over time the cataract will worsen and the patient would find it harder to see and may result in temporary vision loss

Slide 6:
Types of Cataract:
Nuclear Cataract
Posterior Subcapsular
Cortical
Morgagnian
Zonular
Congenital
Traumatic
Grading of Cataracts
0-3/4, with 0 being the least severe and 3/4 being the most severe

Slide 7:
Fundus examination
Slit Lamp:
Parallelepiped
Optic section
Vision Field Testing
Fluid pressure testing within eyes(before surgery)

Slide 9:
Slit Lamp examine the iris,lens and cornea
Retinal exam, dilating drops needed

Slide 10:
Grade 3 Nuclear Cataract

Slide 11:
Cortical cataract has fissures that can cause the light that enters the eye to scatter,creating problems with blurred vision,glare,contrast, and depth perception.

Posterior subcapsular cataract can interfere with reading and create "halo" effects and glare

Nuclear cataract changes the eye's ability to focus and close-up vision may temporarily improve, but this is temporary

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How should this man’s vision be evaluated whilst in the consultation room?
-Perform VA test. If no improvement, use pinhole to check.

What’s cataract?
-A medical condition in which the lens of the eye becomes progressively opaque resulting in blurred vision.

How can cataract impact a person’s quality of life?
-If not treated, the person’s eye sight will be affected greatly. E.g. unable to read newspaper. Severe cataract will eventually lead to blindness.

How would you classify cataract?
1. Cortical cataract – opacities that start in the periphery of the lens and work their way to the center in a spoke-like fashion.

2. Nuclear cataract - beginning with a gradual hardening and yellowing of the central zone of the lens.

3. Posterior subcapsular cataract - a small opaque or cloudy area on the "posterior," or back surface of the lens.

Which tests would you request?
- Tonometry
- slit lamp

How to examine cataract?
-VA test– measure how well px can read.

- Slit lamp – to see the lens.

- Retinal exam – doctor will dilate px’s pupil and use ophthalmoscope to examine eye for signs of cataract.

How different cataract affects vision?
When a nuclear cataract first developed, it can bring about a temporary improvement in your near vision. However, the improve vision is short-lived and will disappear as the cataract worsen.On the other hand, subcapsular cataract may not produce any symptoms until its well developed. Posterior subcapsular cataract often interferes with your reading vision, reduces your vision in bright light, and causes glare or halos around lights at night. Cortical cataract can cause the light that enters the eye to scatter, creating problems with blurred vision, glare, contrast and depth perception.

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Slide 3: History taking, subjective and objective refraction, Binocular Vision Tests, Slit lamp to check for atrophy in iris.

Slide 4: it the denaturing of the crystalline lens which causes it to become compact and sclerosed.

Slide 5: Blurred vision, tunnel vision.

Slide 6: 3 types of cataract: nuclear cataract, cortical cataract, posterior subcapsular cataract.

Slide 7: Slit lamp examination

Slide 9: Optic sections to check the yellowing of different layers of the crystalline lens.

Slide 10: Nuclear cataract

Slide 11:
Cortical: Blurred vision, glare, contrast, depth perception

Nuclear: improves near vision but degrades distance vision (temporary), gradual change

Posterior subcapsular: can interfere with reading, creates halo effect with glare when looking at lights, develops rapidly and symptoms develop within months.

Slide 12:

Slide 13: The lens thickens, diameter increases, the lens sclerose over time, Suture lines will become more complicated,

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Slide 3:
How should this man's vision be evaluated whilst in the consultation room?
Visual Acuity test (Dist and near) to evaluate how bad his eyesight is.
If needed, pinhole test can be conducted too.

What is cataract?
Cataract is the clouding of the lens in the eye which leads to a decrease in vision.

How can cataract impact a person's quality of life?
Due to the blurry vision caused by cataract, doing daily activities like driving can be potentially be very dangerous for the patient as he would not be able to stay alert and see clearly. At the same time, reading would also be difficult for the patient. Chances of tripping will increase and for elderly patients, it could be extremely dangerous.

How would you classify cataract?
There are...
Anterior polar cataract
Posterior polar cataract
Cortical cataract
Nuclear cataract
Posterior Subcapsular cataract

Which tests would you request?
slit lamp
ophthalmoscopy

how to examine cataract:
check crystalline lens for opacity

how different cataract affects vision:
anterior polar: vision unaffected
posterior polar:
cortical: causes scattering of light, blurred vision, causes glare, contrast and depth perception
nuclear: yellowing and hardening of lens, affects eye's ability to focus and its accommodation
posterior subcapsular: interfere with reading, create halo, glare around lights

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Slide 2: How should this man’s vision be evaluated whilst in the consultation room?
-Visual Acuity
-Pinhole (if needed)

Slide 3: What’s cataract?
-Cataract occurs when there is a change in optical homogenity (reduction in transparency).

Slide 4: How can cataract impact a person’s quality of life?
-Cataract can cause blurry vision,.

Slide 5: How would you classify cataract?
-Cortical / Nucleus / Posterior Subcapsular / Morgagnian / Traumatic (Grade 0-4)

Slide 6: Which tests would you request?

Slit lamp

Slide 9: Using slit lamp, perform optic section to identify the existence of cataract & the type it is.

Slide 10: Nuclear cataract

Slide 11 : How different cataract affects vision?

Cortical Cataract - These fissures can cause the light that enters the eye to scatter, creating problems with blurred vision, glare , contrast, and depth perception

Post. Subc - Subcapsular cataracts can interfere with reading and create "halo" effects and glare around lights

Nuclear :

Nuclear cataracts cause light to scatter when it passes through the lens, decreasing the amount of light that reaches the retina.

When a nuclear cataract first develops, it can bring about a temporary improvement in your near vision, called “second sight.”

Nuclear cataracts interfere with a person’s ability to see objects in the distance.

Nuclear cataracts may make it more difficult to drive at night.

Nuclear cataracts can result in the loss of color discrimination ability.

Nuclear cataracts can result in monocular diplopia, which is double vision in only one eye.

Nuclear cataracts may induce other eye problems, such as myopia.

Slide 13
Development of lens :