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Medscape
23-07-2025
- Health
- Medscape
Identifying, Referring Cataracts in Primary Care
Cataract surgery is the most common surgery in medicine, and the first signs that a patient needs it may come in primary care. Everyone — '100% of people' — will get a cataract if they live long enough, David Rivera, MD, a cataract surgeon in private practice in Westerly, Rhode Island, told Medscape Medical News. The risk increases with age, certain conditions, such as diabetes and obesity, and for those who smoke or take steroids. Nearly 1 in 5 people aged 65-74 years in the US report that cataracts affect their vision. 'Most of the patients I do surgery on are in their 70s and 80s,' Rivera said. Commonly Reported Symptoms Patient reports that should trigger a primary care provider's (PCP's) referral to a specialist 'are blurriness, cloudiness, glare, halos around lights at night, and dull colors,' Rivera said. And though surgery is the only way to eliminate cataracts, surgery is not always immediately necessary, he said, unless patients report that their diminished vision affects everyday activities, such as driving, reading, or watching TV. One key question to ask a patient reporting symptoms, Rivera said, is whether vision fluctuates. If the patient has clear vision when they start reading, then blurriness as they continue, 'that's almost always dry eye,' he said, which can be treated with artificial tears and other lubricants. 'Whatever cataracts blur is going to be constant.' PCPs May Be First to Spot Cataract Signs Philip Eskew, DO, JD, MBA, a family physician in Mauldin, South Carolina, and vice president of Clinical Development at Proactive MD, told Medscape Medical News he often is the first to see signs of cataracts in his patients. He said he routinely checks for cataracts and other eye conditions in well visits, particularly for patients with diabetes or hypertension, using a panoptic ophthalmoscope. Though panoptic varieties are less common in primary care offices, most PCPs use ophthalmoscopes, he said. Ophthalmoscopes aim a light into the eye onto the retina, which reflects a typically reddish-orange light (though the color can vary with skin pigment) if the eyes are healthy. 'If you've got a severe cataract, you're going to see that red reflex, and instead of being nice and red, it might be more white and cloudy,' he said. 'Because ultraviolet [UV] light can contribute to cataract development. Eskew said, 'If you've got a patient who does a lot of outdoor work, especially in the sunshine,' that person may be at higher risk for cataracts, he said. Similarly, if patients have a long driving commute and are squinting into the sun, they may be at higher risk without UV-blocking sunglasses. 'We refer patients for [cataract] surgery when they have impaired vision, glare sensitivity, or trouble driving at night,' Eskew said. He added that insurance requirements are important to consider. 'Some insurance companies use a visual acuity of 20/40 or worse as a benchmark,' he said. 'Some might require documented best-corrected visual acuity of 20/60 or worse in both eyes.' Annual Vision Screening for Patients With Diabetes The most common vision-related referral from primary care is for patients with diabetes, Rivera said, and PCPs typically refer them for annual screening. People with diabetes are at higher risk for both developing cataracts and developing them at an earlier age, according to the American Diabetes Association. With any suspicion of an eye condition, a PCP can refer to either an optometrist or an ophthalmologist, Rivera said. 'If you're suspicious of a more complex condition, you may want to go directly to an ophthalmologist.' Sudden loss of vision should trigger an ophthalmologist referral, he said. 'That's almost never routine.' Children May Have Cataracts Though cataracts are more typically seen in older adults, 'finding them and treating them is crucial in kids,' M. Edward Wilson, MD, distinguished professor and chair of the Department of Ophthalmology at Storm Eye Institute in Charleston, South Carolina, told Medscape Medical News. 'Deprivation by a cataract blocking the light path can cause permanent amblyopia [lazy eye],' he explained. In kids, one of the checkpoints that all babies go through is a check of the red reflexes, he noted. 'Eyes are checked at birth, and they really should be checked at every well visit,' he said. Photo Screeners Popular Cataracts can appear at any time — congenitally, through trauma, or at any development point, Wilson pointed out. Now 'almost every pediatrician's office has a photo screener. It looks like a point-and-shoot camera, and it gives a pass/fail reading. It will pick up anything that blocks light, like a cataract, and they also look for a white pupil that might mean a retinoblastoma, which is the most common eye tumor in childhood.' If pediatricians don't have a photo screener, they can use an ophthalmoscope, he added. He also notes that vision screening now has a billing code, which addresses some complaints in the past that physicians had to buy the screener and they weren't getting reimbursed by payers. Supplements Can't Treat Cataracts Eskew says one misconception about cataracts is that they can be treated with the vitamin supplement AREDS. While supplements do not decrease the risk for cataract formation, 'they do slow the progression of age-related macular degeneration, he explained, which is a condition different from cataracts.' Rivera, Eskew, and Wilson reported having no relevant financial relationships.
BBC News
20-06-2025
- Health
- BBC News
Sunny weather: Do more expensive sunglasses give more protection?
We all know how the sun can age our skin, but experts warn it can also damage our or UV, light can lead to a number of conditions that can affect vision, such as cataracts. Our eyes can even get avoid eye damage, optometrists say we need to properly protect our eyes when out in the sun, but the good news is that we do not need expensive sunglasses for the protection we need. Dr Malgorzata Rozanoswka, from Cardiff University's School of Optometry and Vision Sciences, said adequate protection was required, including "proper sunglasses", sun cream with high sun protection factor (SPF) and wide brimmed hats."When you are on the beach, there is the reflection of the UV from water, from sand. It could be quite high," she added people hiking or climbing mountains needed more protection because "the higher the altitude, then the higher UV". How can UV damage our eyes? Starting outside the eye, our eyelids are at risk from exposure to the sun, because they are not somewhere we often think about applying skin is also susceptible to UV-associated cancers, much like the rest of our body, including melanoma. Inside our eyes, short-term exposure to UV can lead to photokeratitis, which is like sunburn that affects the cornea, rather than the skin. This painful condition is also known as "snow blindness" and can affect skiers and climbers who spend time at high altitude.A lack of protecting our eyes throughout our lifetime can also lead to deteriorating eyesight, increasing the risk of conditions such as cataracts and age-related macular degeneration (AMD).Dr Rozanowska said increased exposure to sunlight could increase the risk of the retina aging prematurely, as well as other parts of the eye."So there is a very well-established association of UV and cataracts, and those cancers of the surface of the eye," she said. "Honestly, just ones that fit my head, because I've got such a small head. But obviously also to protect from UV," said Hattie from Cardiff, speaking from the city's Bute friend Immy, from Buckinghamshire, added: "For me, it's more like fashion. I don't really think about protection."Searching for the right pair of sunglasses requires some some shops you will notice labels with categories from 0 to 4, referring to how dark the lenses are. Category 0 sunglasses let a lot of sunlight through, while category 4 are best for activities in more intense sunshine, such as skiing or hiking in mountains. Category 4 sunglasses block so much visible light that they are not considered safe to drive darker sunglasses do not mean better UV protection, and you cannot tell by looking at the colour of the lenses how much UV protection is offered. Dr Rozanowska recommended looking at the certificate on the frame to see whether sunglasses block UV best to look for is UV400, which blocks 99% of all UV, she said."When buying sunglasses, it's worth getting them from reputable sources and look for those certificates on the frame."Good sunglasses also do not have to cost a lot of money, with some cheaper sunglasses offering as much protection as expensive ones."The lenses are probably made from the same material as the very expensive designer sunglasses, as long as they have the certificate CE or UV 400," Dr Rozanowska those fake designer sunglasses we are tempted to buy from a market stall on holiday may look like a bargain, but they may be offering no protection at all from the sun."Even though they have very dark lenses, they can transmit a lot of UV light and wearing this type of sunglasses with dark lenses, this would make your pupils dilate and more of that UV light would be transmitted to the lens," she sunglasses with no UV protection can actually cause more harm to our eyes. Another thing to consider is that not all sunglasses offer good protection at the side of our eyes - a narrow arm can still allow for UV light to reach our eyes, resulting in eye typically spend a lot of time playing outdoors and their eyes can be more vulnerable to UV damage than adults, said Dr said lenses offered almost no protection from UV, so it was not necessary to force a child to wear sunglasses, instead creating shady areas for play. "So if you are playing on the grass surrounded by trees, there is enough shadow. That reflection from the grass is like 2%, it's almost nothing."It is important for children to play outside without any eye protection. It prevents the development of myopia or short-sightedness."
