Morphology of and visual performance with posterior subcapsular cataract

PURPOSE: To study the prevalence and clinical profile of etiologically diverse posterior subcapsular cataracts (PSCs) and their effect on visual performance. SETTING: Iladevi Cataract & IOL Research Centre, Ahmedabad, India. METHODS: This prospective observational study comprised 160 eyes of 100 consecutive patients with PSC. Exclusion criteria included cortical opacities, cataract other than PSC, and a nondilating pupil. Lenticular changes such as gross appearance, density of opacity in the central 7.0 mm, and location and approximate area of cataract involvement were noted. The uncorrected distance and near acuities, best corrected visual acuity (BCVA), contrast sensitivity with BCVA, and history of glare were recorded. RESULTS: Sixty patients had bilateral PSC. The most prevalent cataracts were of unknown etiology (32.5%). The most common coexisting disease or factor was atopy (30.6%). Others were myopia, steroid use, diabetes, uveitis, retinitis pigmentosa (RP), glaucoma, and trauma. Most patients (47.0%) were 41 to 50 years old. The PSC was vacuolar in 45.0% of eyes, solid in 15.6%, and mixed in 39.4%. Vacuolar PSC was the most common type in the myopia, diabetes, RP, and trauma groups. Solid PSC was seen with myopia, diabetes, and glaucoma. Mixed PSC was the most common type in the steroid, atopy, uveitis, and idiopathic groups. Eighty-seven percent of patients had reduced visual acuity; 76%, glare; and 46%, decreased contrast sensitivity. More eyes with vacuolar PSC had decreased visual acuity and contrast sensitivity, followed by eyes with solid PSC and eyes with mixed PSC. CONCLUSIONS: Most PSCs were of unknown etiology; a significant number of eyes had more than 1 etiology. Vacuolar PSC was the most common type, with more eyes in this group having significantly reduced visual acuity and contrast sensitivity. Specific morphological patterns occurred with some conditions (eg, RP, myopia, diabetes).