The senile Cataract

The purpose of this article is a condensed overview of contemporaneous state of art and knowledge" of age-related cataract. As an introduction, some aspects of terminology, epidemiology, lens anatomy and pathophysiology of age-related cataract, selected for clinical interest and relevance, are outlined. Clinical aspects include signs and symptoms: Objective criteria for cortical, nuclear and posterior subcapsular cataract are described, followed by typical symptoms such as decreased visual acuity, contrast sensitivity and foggy vision, altered colour perception, decreased mesopic and scotopic vision, glare, myopization and monocular diplopia. Diagnostic evaluation consists of a general ophthalmic examination, including history, refraction and vision testing, tonometry and morphologic examination of anterior and posterior segment, and is supplemented by special tests and examinations, such as interference vision (retinometer), keratometry including corneal topo-/tomography, biometry (ultrasound and optical), specular microscopy of the corneal endothelium and OCT of the central retina. Treatment is exclusively surgical: Evaluating the indication for surgery individually, weighing chances and risks, determining individual decisions such as anesthesia, surgical technical options, target refraction and intraocular lens options is discussed in detail. Finally, some perioperative considerations for medical treatment and infection prophylaxis are outlined. The last section deals with short- and long-term complications and their management - including early pressure rises, corneal edema, inflammatory response and endophthalmitis, and, in the longer term, secondary cataract, refractive problems, cystoid macular edema and retinal detachment.