Cataracts in younger patients

ByUday Devgan, MD

A central posterior subcapsular cataract in a younger patient.

With the increasing use of corticosteroids to treat allergic and immune-based diseases, it seems as if there is an increasing number of young patients with posterior subcapsular cataracts.

I saw a young patient recently, in his early 40s, who complained of excessive glare and poor vision in his right eye. In the dark exam room, he could read 20/30 letters, but when the lights were brightened, his vision dropped dramatically. Glare testing further worsened his visual acuity.

Upon dilation, a significant central posterior subcapsular cataract was noted. The patient had a history of using ocular steroids for irritation and nasal steroids for allergic rhinitis.

Cataract surgery in these younger patients is more challenging because the ocular tissues behave differently, with increased elasticity of structures such as the anterior capsule and the cornea. Making a precisely controlled capsulorrhexis is more difficult, and the effect of limbal relaxing incisions is weakened. But perhaps the biggest challenge is explaining to patients that our manmade lens implants will provide good vision but not perfect vision. Only teenagers have perfect vision, but they don't appreciate it. Maybe my mother was right — youth is wasted on the young.