DIAGNOSTIC AIDS

1.History - a comprehensive history is an important component

specially the onset and the nature of the chief complaint.
2. Ocular Examination - basic eye examination comprises of the
following parts should be done on the patient.
A. Gross Eye Examination- Biomicroscopic (Slit Lamp) Examination
B. Visual Acuity Testing (with and without correction)
C. Intraocular pressure determination
D. Movement of Extraocular Muscles
E. Funduscopic Examination

3. Ancillary Examination- social ophthalmologist and laboratory

examinations are done as aids in the formulation of the complete
diagnosis.
4. Systemic Examination- general systemic examination is done in
cases wherein the clinician suspects the lens problem to be part of the
presentation of a systemic condition.

Ocular Examination
A. Gross Eye Examination- Biomicroscopic (Slit Lamp) Examination

Patients with cataract present with

varying degrees of lenticular pacifications.
It may vary from a slight haziness of the
lens to a dense opacification from water
clefts to vacuoles, and from a white to
brunescent lens. The pacification's may
also vary with location. They may be found
in the cortex, nucleus, posterior capsule or
a combination of the above. Usually, the
anterior is quiet with no signs of
inflammation like cells and flare.

In patients with posterior subcapsular cataract, the posterior capsular

opacification os frequently located in the visual axis but may occur
outside of it as well. The affected are appears irregular and looks like
the surface of the moon on slit lamp examination. Its growth is often
rapid.
Seen as a dense discoid opacity. The central fibrous mass consists of
degenerated lens fibers surrounded by several small globular vacuoles
containing what appears as a refractile substance as well as some lens

B. Visual Acuity Testing (with and without correction)

Opacities of the crystalline lens

directly affect vision, thus causing
functional impairment and visual
loss. Most patients with cataract
present with reduction of vision even
with correction. Persisent subcapsular
lens epithelium favors regeneration of
lens
fibers.
The
proliferating
epithelium ma produce multiple
layers, leading to opacification. The
cells may undergo myofibroblastic
differentiation and their contraction
produces numerous tiny wrinkles in
the posterior capsule, resulting in
visual distortion.

C. Intraocular pressure determination

Most patients present with normal intraocular pressures. However if

complications of cataract set in, the intraocular pressure may vary.
ophthalmologists and optometrists define normal intraocular pressure as that
between 10 mmHg and 20 mmHg.The average value of intraocular pressure
is 15.5 mmHg with fluctuations of about 2.75 mmHg.Intraocular pressure
may become elevated due to anatomical problems, inflammation of the eye,
genetic factors, or as a side-effect from medication. Intraocular pressure
usually increases with age and is genetically influenced.

D. Movement of Extraocular Muscles

Since the extra ocular muscles are usually not involved,

patient exhibit full movement on all directions of gaze.
E. Funduscopic Examination

Patients who have relative good visual acuity, the fundus is

usually normal. However, if the patient has a relatively poor vision
and the lens is very dense, the fundus cannot be appreciated. If the
patient has a poor vision and the fundus can be appreciated, the
fundus findings may vary depending on the posterior segment
pathology.

Clear media, normal healthy optic nerves, normal

macula, vessels and periphery