A 70-year-old man presents to the clinic for decreased visual acuity in both eyes. The patient has been having problems driving at night over the past 6-8 months and has noticed “haziness” in his vision as well. He denies any diplopia (double vision), dizziness, headache, or vertigo. Patient also denies any eye pain, tenderness or sensitivity to light. Patient has not notice any eye “floaters” or “flashing lights”. His other medical problems are hypertension and benign prostatic hypertrophy. Patient does regularly see an optometrist for presbyopia (age-related farsightedness) and gets screened annually for glaucoma with non-contact tonometry.
What is the most likely diagnosis based on this history?
The correct answer is:
D) Cataracts
The patient is most likely suffering from cataracts. Cataracts present with painless, opacification of lens which results in decreased vision. Uveitis is an inflammation of the uvea and is typically associated with systemic inflammatory disorders such as rheumatoid arthritis, sarcoidosis, and HLA-B27 associated conditions. Open-angle (chronic) and closed angle (acute) glaucoma happens when the optic disc is compressed secondary to increased intraocular pressure, resulting in vision loss. Retinal detachment is the separation of neurosensory layer of the retina from the outermost pigmented epithelium. It presents suddenly with “flashes” and “floaters” as well as monocular loss of vision as a “curtain is drawn down”, it is a surgical emergency.
