Board Certified Ophthalmologist Lens and Cataract Questions and Answers

Question 1

A 58-year-old patient with a history of severe rheumatoid arthritis, managed for over a decade with oral prednisone, presents with a chief complaint of disabling glare when driving at night and difficulty reading, which has worsened over the last year. Visual acuity is 20/50 in the right eye and 20/40 in the left. Slit-lamp examination is most likely to reveal which type of cataract?

Accepted Answer

Posterior subcapsular

Answer

Long-term systemic corticosteroid use is a well-established and significant risk factor for the development of posterior subcapsular cataracts (PSC). The symptoms of glare and difficulty with near vision are classic for PSCs because the opacity is located at the nodal point of the eye's optical system.

Question 2

An 82-year-old man presents with a dense, white, mature cataract in his left eye, reducing vision to hand motion. The posterior segment cannot be visualized. Which of the following is the most critical ancillary test to perform to assess for co-existing posterior segment pathology before proceeding with cataract surgery?

Accepted Answer

B-scan ultrasonography

Answer

When a cataract is so dense that it prevents visualization of the retina and optic nerve, B-scan ultrasonography is essential. It allows the surgeon to rule out significant posterior segment pathologies such as retinal detachment, large tumors, or dense vitreous hemorrhage, which would dramatically alter the surgical plan and visual prognosis.

Question 3

The remarkable transparency and high refractive index of the human crystalline lens are primarily maintained by a high concentration of which family of water-soluble structural proteins?

Accepted Answer

Crystallins

Answer

The crystalline lens is composed of approximately 60% protein, and 90% of these water-soluble proteins are crystallins (alpha, beta, and gamma). These proteins are arranged in a highly ordered, short-range structure that minimizes light scatter, thereby ensuring lens transparency.

Question 4

A patient is evaluated on postoperative day 1 after uneventful phacoemulsification. They report minimal pain but significant blurriness. Examination reveals 20/200 vision, diffuse limbus-to-limbus corneal edema, and a deep, quiet anterior chamber with 1+ cell and no fibrin or hypopyon. What is the most likely diagnosis?

Accepted Answer

Toxic Anterior Segment Syndrome (TASS)

Answer

Toxic Anterior Segment Syndrome (TASS) is a sterile inflammatory reaction that typically presents within 12-24 hours of surgery. The hallmark signs are diffuse, limbus-to-limbus corneal edema and a significant anterior chamber reaction that is out of proportion to any pain and lacks the classic signs of infection like a hypopyon or significant vitritis. Infectious endophthalmitis usually presents later (3-7 days), with more severe pain, and often involves the vitreous.

Question 5

Which of the following is the LEAST established independent risk factor for the development of age-related cataracts?

Accepted Answer

Systemic hypertension

Answer

While diabetes, chronic UV exposure, and myopia are all well-established independent risk factors for cataract formation, the association with systemic hypertension is less direct and not as strongly supported as an independent risk factor in many large-scale studies. Often, its association is confounded by other co-existing conditions like diabetes.

Board Certified Ophthalmologist Practice Test

Board Certified Ophthalmologist Practice Test

Board Certified Ophthalmologist Lens and Cataract Questions and Answers