Posterior Subcapsular Cataract

September 14, 2005
Leonid Skorin, Jr, DO

Dull, constant, bifrontal headaches were the chief complaint of a 28-year-old woman who was referred for her first ophthalmologic examination. She had no specific ocular symptoms, but her primary care physician wanted to rule out an ophthalmologic cause for the headaches.

Dull, constant, bifrontal headaches were the chief complaint of a 28-year-old woman who was referred for her first ophthalmologic examination. She had no specific ocular symptoms, but her primary care physician wanted to rule out an ophthalmologic cause for the headaches.

The examination was unremarkable except for evidence in the left eye of an early posterior subcapsular cataract located above the visual axis. The patient had no history of ocular or head trauma and had not used systemic or topical corticosteroids. The headaches were relieved with correction of her astigmatic refracture error.

Six years later, the patient returned with complaints of increased visual blurring in the left eye. Unlike the first examination when the woman's visual acuity could be corrected to 20/20 in both eyes, the left eye's visual acuity now could only be corrected to 20/30. The posterior subcapsular cataract had progressed and involved the visual axis, as seen here with retroillumination.

Dr Leonid Skorin, Jr, of Dixon, Ill, notes that posterior subcapsular cataracts are the most common lens opacities affecting patients younger than 60 years. The early changes first appear as fine granules in the posterior subcapsular area of the lens. Vacuoles and more dense granular deposits (plaques) can progress peripherally in a sharply demarcated platelike configuration.

Because the visual axis is obscured early, this lens opacity causes a disproportionate loss of vision for its size and density. Night glare and blurred vision in bright sunlight are early symptoms. Near vision is often more significantly affected than distance vision; ie, in readers, the convergence-accommodation reflex causes miosis, confining the passage of light to the axial portion of the lens where the cataract is located.

Although the posterior subcapsular cataract can occur independently, as in this person, it is frequently related to chronic intraocular inflammation, corticosteroid use, blunt ocular trauma, radiation exposure, and electric shock. The condition can affect patients who have retinitis pigmentosa, Refsum's disease, and high myopia.

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