Senile Cataract (Age-related Cataract)

Senile cataract is an age-related, vision-impairing disease characterized by gradual progressive thickening of the lens of the eye. It is the world’s leading cause of treatable blindness. A patient with senile cataract often presents with a history of gradual progressive visual deterioration and disturbance in night and near vision. Characteristics of senile cataract include the following:

• Decreased visual acuity – The most common complaint of patients with senile cataract
• Glare – Can range from a decrease in contrast sensitivity in brightly lit environments or disabling glare during the day to glare with oncoming headlights at night
• Myopic shift – The progression of cataracts frequently increases the anteroposterior (AP) axis and therefore the diopteric power of the lens, resulting in a mild to moderate degree of increased myopia or myopic shift
• Monocular diplopia – At times, the nuclear changes are concentrated in the inner layers of the lens, resulting in a refractile area in the center of the lens, the so called “lens within a lens” phenomenon, which may lead to monocular diplopia that is not correctable with spectacles, prisms, or contact lenses

Diagnosis can also include the following:

• Examination of the ocular adnexa and intraocular structures – May provide clues to the patient’s cataract etiology, concomitant disease, and eventual visual prognosis
• Swinging flashlight test – Detects a Marcus Gunn pupil or a relative afferent pupillary defect (RAPD) indicative of optic nerve lesions or diffuse macular involvement
• Slit lamp examination – Should concentrate on the evaluation of not only lens opacity but also other ocular structures (eg, conjunctiva, cornea, iris, anterior chamber)
• Examination of nuclear size and brunescence – After dilation, nuclear size and brunescence as indicators of cataract density can be determined prior to phacoemulsification surgery
• Direct and indirect ophthalmoscopy – To evaluate the integrity of the posterior pole