[Optic nerve pathology in the structure of diagnostic errors inpatients referred for cataract surgery]. / Patologiyazritel'nogo nerva v strukture diagnosticheskikh oshibok pri napravlenii patsientov na khirurgicheskoe lechenie katarakty.

AIM: to study the frequency of misdiagnosis of cataract in patients with optic nerve pathology or amblyopia and to identify its main causes. MATERIAL AND METHODS: The study enrolled 381 patients (381 eyes) wrongly diagnosed with cataract. A standard set of eye tests was performed. In-depth examination of the macular area was done through biomicroscopy with contactless aspheric lenses of 60 and 90 D. Part of the patients underwent optical coherence tomography and static perimetry as well as examination of electrical sensitivity threshold and electrical lability of the optic nerve. RESULTS: In 190 patients (190 eyes - 49.9%), the true cause of central vision impairment was optic nerve pathology associated with its partial atrophy of different origins: vascular (77.8%) or post-traumatic (22.2%). Glaucomatous atrophy of the optic nerve was found in 175 patients within the age range from 57 to 70 years (175 eyes - 45.9%). These were newly diagnosed cases of advanced open-angle glaucoma. In 16 eyes (4.2%), the true cause of low vision appeared to be amblyopia of some type: strabismic (9 eyes - 56.3%), refractive (4 eyes - 25%), or mixed (3 eyes - 18.7%). CONCLUSION: The main diagnostic errors of attending ophthalmologists were the following: underestimation of the discrepancy between low visual functions and small degree of lens opacity as well as the neglect of careful examination of the fundus (specifically, the optic disc and macula), additional perimetry, thorough history taking, and cover-testing for suspected amblyopia.

[Diagnostic errors when referring patients for cataract surgery].

AIM: To study the frequency of patients with macular pathology being wrongly diagnosed with cataract and possible reasons for this to occur. MATERIAL AND METHODS: A total of 1390 patients (1390 eyes), in whom cataract turned out to be not the main cause of visual impairment, were recruited as research subjects. To reveal the reasons for misdiagnosis, we resorted to methods of ophthalmic examination that are available at ambulatory care facilities, i.e. visual acuity measurement, slit lamp biomicroscopy of the anterior and posterior eye segments, direct and indirect ophthalmoscopy. RESULTS: In most patients (72.6%) visual acuity was decreased due to macular pathology, especially age-related macular degeneration (AMD)--736 eyes (72.9%). Less common were degenerative myopia (10%), idiopathic macular hole (8.4%), epiretinal macular fibrosis (5.1%), and secondary macular changes of vascular, traumatic, or inflammatory genesis (3.6%). In 76.6% of eyes with macular pathology ophthalmoscopy was perfectly feasible and could be performed by a local ophthalmologist. Only in 23.4% of cases there was a dense posterior capsule opacification or nuclear cataract that impeded visualization of macular structures. CONCLUSIONS: The main reason for misdiagnosis of macular pathology and referring the patient to cataract surgeon was the neglect of apparent discordance between visual acuity and lens transparency. One should aim at adequate assessment of macular zone by all means, including non-contact ophthalmoscopy with 60 or 90 D aspherical lenses or Hruby lens and red-free examination.