Anterior Segment
Cataract (Age-Related)
Also known as: cataract, age-related cataract, nuclear sclerosis, nuclear sclerotic cataract, cortical cataract, posterior subcapsular cataract, PSC, lens opacity
Filed as: Routine
Source-cited from the record's own evidence list. Clinical content programme led by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom. How the clinical content is governed
Clinical decision support only
Overview
Progressive opacification of the crystalline lens and the most common cause of reversible vision impairment in older adults. Referral timing is driven by functional impact — glare, driving standards, reading, and patient goals — not by a fixed acuity threshold. The key clinical task is confirming the lens actually explains the vision, and optimising the ocular surface and refraction before surgical referral.
Recognition
Symptoms: what patients report
- Gradual, painless blur progressing over months to years, usually bilateral but often asymmetric.
- Glare and haloes, characteristically worse with night driving and low sun.
- Reduced contrast and colour perception; whites appear yellowed.
- Monocular ghosting or doubling that persists with the fellow eye covered.
- Frequent spectacle prescription changes, classically a myopic shift with nuclear sclerosis.
Signs: what the examination shows
- Lens opacity on slit lamp: nuclear yellowing/brunescence, cortical spokes, or posterior subcapsular plaque best seen on retroillumination.
- Dulled or shadowed red reflex consistent with the opacity pattern.
- Myopic shift on refraction relative to previous records (nuclear sclerosis).
- Visual acuity that worsens disproportionately with glare testing, especially in posterior subcapsular cataract.
- Degraded fundus view in proportion to the lens change — a clearer view than the acuity suggests points away from the lens as the cause.
What OptoGuide™ covers for cataract (age-related)
- Pattern reasoning: what this combination of findings points to, and its differentiators
- Don't-miss risks and escalation triggers
- Management tiers with linked Australian therapeutics
- Referral urgency, specialty, and letter drafting
Sources
- Cataract — EyeWiki
- Cataracts: A Review. Chen SP, Woreta F, Chang DF. JAMA. 2025;333(23):2093-2103.
- Cataracts. Liu YC, Wilkins M, Kim T, Malyugin B, Mehta JS. Lancet (London, England). 2017;390(10094):600-612.
- Morphology of and Visual Performance With Posterior Subcapsular Cataract. Vasavada AR, Mamidipudi PR, Sharma PS. Journal of Cataract and Refractive Surgery. 2004;30(10):2097-104.
Standard texts: Kanski's Clinical Ophthalmology: A Systematic Approach, The Wills Eye Manual, Oxford Handbook of Ophthalmology, Oxford American Handbook of Ophthalmology, Signs in Ophthalmology: Causes & Differential Diagnosis.