Cataract is a very common, but treatable cause of poor vision. Often, in elderly patients the visual acuity is reduced due to a macular degeneration, too.
With OCT it can be decided whether the cataract surgery may be useful, for example, in case of dry or atrophic macular degeneration. Since the OCT laser beam can easily pass through the cloudy lens, OCT may be sometimes more worth than biomicroscopy.
Question: in this case, is the reduced visual acuitity only caused by cataract? Should surgery be performed in every cataract?
Answer: cataract in this patient is clearly visible on biomicroscopy, one may think that OCT is not needed. But in additional OCT an age related macualer degeneration is shown and quantified, too. Particularly, the outer segment receptors are not well seen even in OCT due to AMD and less due to the cataract, but actually no exudation can be detected. A cataract surgery may be well recommended. But it is very important to make the patient clear previously that an “eagle eye” never will be possible because of the atrophic maculopathy.
Many patients still hope for a miracle, especially if they are confronted with advertising and cataract surgery is trivialized by physicians or other patients. But still with the fact, that cataract surgery is so save to the patient of today, a quiet conversation between doctor and his patient is needed to clear out of the way unrealistic hopes. Otherwise only frustrations arise on both sides. OCT may help to illustrate the findings and to ensure a good relationship between the doctor and his patient. And above all, an easily follow up will be possible to collect converts from a dry to a wet AMD at an very early stage and save vision.
Case of the month 12.2011 christmas tree cataract
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