From the Guidelines
The most common finding on physical examination of a patient with cataract(s) is a change of color or opacities in the eye lens, which can be visualized as a cloudy or opaque appearance. This finding is typically observed during a standard eye exam using an ophthalmoscope or slit lamp, which allows for direct visualization of the lens 1. The cloudy or opaque appearance is due to the breakdown and clumping of proteins in the lens, which normally remain clear and transparent. Some key points to consider when examining a patient with cataracts include:
- The use of the Snellen eye chart or the Early Treatment Diabetic Retinopathy Study (ETDRS) chart to detect changes in visual acuity 1
- The potential for reduced visual acuity in patients with cataracts, although this is not specific to the physical examination finding of lens opacity
- The importance of regular eye examinations, particularly in older adults, as about half of US adults older than 65 years reported having an eye examination within the last 12 months in a 2007 study 1 In clinical practice, the presence of a cloudy or opaque lens is a key diagnostic feature of cataracts, and visualization of this finding on physical examination is crucial for diagnosis and management.
From the Research
Physical Examination Findings
The most common finding on physical examination of a patient with cataract(s) (lens opacity) is a decrease in visual acuity, which can vary based on the type and density of lens opacity 2, 3, 4.
- Decreased visual acuity is a common symptom, and it can be measured using a Snellen chart 3, 5.
- Other symptoms that may be found on physical examination include photophobia, monocular diplopia, myopic shift, and change in color vision, depending on the anatomical distribution of the opacities 4.
- A penlight test can be used to assess glare disability in patients with cataracts, and it has been shown to be effective in evaluating the decrease in vision created by glare 6.
- Slit-lamp examination after pupillary dilation is used to diagnose cataracts and classify the opacities according to their anatomical distribution 4.
- The type and severity of cataract can affect visual acuity and contrast sensitivity, with increased cataract severity strongly associated with a decrease in both visual acuity and contrast sensitivity 5.