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Make your diagnosis in the comments, and look for the answer in next month’s Blink.

Last Month’s Blink

Metabolic Cataract: A Presenting Sign of Uncontrolled Diabetes Mellitus

Written by Asaf Achiron, MD, The Edith Wolfson Medical Center, Holon, Israel, and Uri Aviv, MD, Sackler School of Medicine, Tel Aviv University, Israel. Photo by Dr. Achiron.

A 55-year-old taxi driver with hypertension and dyslipidemia presented to our clinic with blurred vision in his left eye that had been deteriorating for the past 2 months and was interfering with his work. On examination, visual acuity in his left eye was counting fingers at 5 ft and 20/100 in the right. He had advanced bilateral cortical and posterior subcapsular cataracts in both eyes. During routine blood tests prior to surgery, fasting serum glucose measured 212 mg/dL with hemoglobin A_1c of 9.7%. The patient was subsequently diagnosed with diabetes mellitus (DM) and started on sitagliptin/metformin 50/1,000 mg and glimepiride 2 mg. Cataract surgeries were unremarkable, and the patient’s vision improved to 20/20 bilaterally.

Early diagnosis of DM can be challenging. Blurred vision and visual loss commonly present as initial symptoms.^1,2 Although acute diabetic cataracts are rarely encountered in clinical practice today, a young adult with rapidly maturing bilateral cortical cataracts should have a diabetic workup.

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1 Gong J et al. Br J Gen Pract. 2014;64(629):614-615.

2 Koffler M et al. Isr J Med Sci. 1990;26(7):393-394.

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