Case history
Case history #1
A 65-year-old man presents with generally decreased vision and difficulty driving at night due to glare from oncoming headlights. He describes having trouble reading the small print on his television screen. He is healthy and has no history of any other eye problems. His best corrected visual acuity is 20/50 in the right eye and 20/40 in the left eye. On exam, there is a yellowish opacification of the lens in the left eye. On ophthalmoscopy, the red reflex in the left eye is obscured centrally, and the details of the fundus are indistinct. No other abnormalities are found.
Case history #2
A 27-year-old man presents after he was struck in the left eye with a paint ball. He notices a sudden decrease in vision in the left eye, from 20/20 before the accident, to counting-fingers vision after the accident. On exam, the left pupil appears whitish, and visual acuity is greatly decreased. The patient does not have any history of other medical problems. On dilated eye exam, the lens in the left eye appears whitish anteriorly, with a spoke-like pattern. On direct ophthalmoscopy, the red reflex is diminished and retinal details are indistinct.
Other presentations
A patient with a progressing nuclear sclerotic cataract may complain of an inadequate glasses prescription. The thickening of the lens can cause an increase in refractive power and make the patient appear increasingly myopic (near-sighted).
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