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Evaluation of Pre-op Patient with Dense Cataract

#A. Get a good history. Did the patient use to see well in that eye or always poor vision ( lazy eye).  Any hx of old trauma?


#B. Check IOP. Look at that eye with slit lamp.Is the cornea OK? Is the cataract  displaced ( subluxated )?


Below is three step evaluation for a mature  cataract when you can’t see fundus.

 #1. Color perception. Cut off the lights. Cover the other eye completely. Using a red filter , ask pt what color is the light? If pt says red, pink, orange, or yellow, then that’s acceptable. You are actually checking macular function.

 #2. Check pupil response. Dim the  lights, have pt fixate at distance,  and swing the flashlight. Keep swinging the light. Back and forth, back and forth. If pupil dilates when it should constrict then that’s a positive test. Check out You-Tube for relative afferent papillary defect. You are checking optic nerve function.

#3. Then dilate pupil slightly ( Mydriacyl ) and ask pt to follow the light. Or to point at the light as you move light. “ Where is the light”  “Follow the light.” You are checking for retinal detachment and / or severe visual field constriction.

Any patient with a dense cataract should undergo this evaluation before referral for cataract surgery.. Not every patient with a white / dense cataract should undergo a cataract operation. Blind before cataract surgery and blind after cataract surgery is not good.


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