Ophthalmoscopy

The ophthalmologist must perform a full fundus examination to evaluate the macula, optic nerve, vitreous, retinal vessels, and retinal periphery. Particular attention is paid to macular degeneration or other maculopathy that may limit visual outcome after an otherwise uneventful cataract extraction. The indirect ophthalmoscope is not generally useful for judging the visual significance of cataract, except in severe cases such as when the cataract is white. Although the direct ophthalmoscope, retinal contact lens, and noncontact fundus lens are more useful in judging media clarity, the ophthalmologist must keep in mind that these methods also provide light that is more intense than that available to the patient under ambient lighting conditions.

Patients with diabetes mellitus are examined carefully for the presence of macular edema, retinal ischemia, and background and proliferative retinopathy. Even in uncomplicated cataract surgery and in patients with minimal or no retinopathy, diabetic eye disease can progress postoperatively. Retinal ischemia may potentiate posterior or anterior neovascularization postoperatively, especially if the surgeon uses an intracapsular technique or ruptures the posterior capsule during extracapsular cataract extraction. Careful examination of the retinal periphery may reveal the presence of vitreoretinal traction or preexisting retinal holes and lattice degeneration that may warrant preoperative treatment.

• Hong T, Mitchell P, de Loryn T, Rochtchina E, Cugati S, Wang JJ. Development and progression of diabetic retinopathy 12 months after phacoemulsification cataract surgery. Ophthalmology. 2009;116(8):1510–1514.

Excerpted from BCSC 2020-2021 series: Section 11 - Lens and Cataract. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.