Page 59 - NAME OF CONDITION: REFRACTIVE ERRORS

viii. Dilated examination of the fundus including, optic disc, macula and vitreous. If clarity

of media allows then the peripheral retina should be examined. This helps in planning
the prognosis of the surgical intervention.
ix. Indirect ophthalmoscopy is indicated for known myopes, eyes with past history of

trauma or retinal detachment in other eye.

b) Investigations:
i. Measurement of intraocular pressure (preferably by Applanation tonometry)
ii. Gonioscopy is not done as a routine. It can be performed if anterior chamber appears
shallow, IOP is raised, presence of any sign that can be related to secondary glaucoma
(e.g. pseudoexfoliation) or known cases of glaucoma.
iii. Keratometry and A scan biometry: It should be performed in both eyes. It should be
repeated if needed for unusual powers of IOL. Appropriate formula should be used
according to cases. In case of scarred cornea and irregular surface of cornea, the K

reading will not be possible. In this case the other eye should be taken into
consideration.
iv. Ultrasonogram of the posterior segment is indicated in traumatic cataracts,
complicated cataracts and unilateral mature cataracts.
v. Blood pressure
vi. Screening for diabetes mellitus
vii. Physician fitness is mandatory for cardiac patients and those with advanced systemic
problems.

viii. Patients who require general anesthesia need to undergo preanasthetic check up

c) Treatment:

Nonsurgical management
Patients with early cataract and all stages of nuclear cataracts may sometimes benefit by

spectacles. If they do benefit, then subsequent follow ups can be planned to determine the
timing of surgery, if required.
Management of a visually significant cataract is primarily surgical.

Indications for Surgery
An individual who is unable to carry out his/her desired activities due to dimness of vision
for which cataract surgery is likely to restore the visual function is the prime indication for
surgery. The other reasons for a cataract removal include the following:
i. Clinically significant anisometropia in the presence of a cataract where cataract
surgery is likely to facilitate binocularity.
ii. Conditions in which the lens opacity is dense enough to interfere with evaluation and
management of posterior segment conditions.
iii. Lens induced ocular inflammation

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