Evaluation of the Mature Cataract Baxter McLendon MD FACS Clinical Professor of Ophthalmology Medical University of South Carolina Charleston, South Carolina USA

Many ocular surveys have reported poor vision post cataract surgery as a leading cause of blindness. WHY IS THIS ? Poor pre-op evaluation/ selection probably accounts for some of this blindness.

The Problem No view of posterior pole with mature (white or brown) cataract All mature cataracts should NOT automatically under go surgery

Pre-op Slit Lamp Evaluation IOP mm Hg No bullous keratopathy Red reflex present No anterior uveitis / cells in A. C. No vitreous in A.C. / no rubeosis No phacodonesis / iridodonesis No traumatic mydriasis No iris retroillumination defect No pupillary ruff abnormality/ defect

B Scan (Ultrasound) May Help Diagnose Retinal Detachment Vitreous Opacity [ blood, etc. ] Posterior Pole Tumor Choroidal Detachment Posterior Scleral Thickening Staphyloma

Three Step Clinical Test Takes 90 seconds / easy Can be done in or outside the clinic setting especially when B Scan is not available No additional cost/ travel for patient Helps determine post-op PROGNOSIS

#1 Check Pupils Dim the lights Have patient look (fixate) at end of room Brisk or sluggish pupil compared to other eye Afferent pupillary defect (Marcus Gunn)

#2 Color Perception Only one chance to do test correctly. Don’t let pt see test color pre - testing Cover/occlude completely the other eye Dim the lights (illumination) “ What color is this light?”

#2 Color Perception Check color red: red, pink, orange, or yellow are all acceptable answers Check color blue: blue or green are acceptable [ correct ]

If the patient can NOT distinguish colors do NOT operate on mature cataract

#3 Light Projection Dilate mature cataract pupil Have patient look at the light. “ Where is the light“. “Follow the light “ Have pt. point in the direction of the light [ up, down, right, left, etc. ]

Three Step Clinical Test Checking pupils: optic nerve Checking color perception: macula and optic nerve Light projection: retinal detachment, diffuse C-R, and advanced glaucoma

In Conclusion If all three tests are normal, then the prognosis is usually quite good for improved vision after mature cataract surgery. This is quick, easy, and in 90 seconds you can determine if the patient is a good candidate or not for mature cataract extraction