A 48-year-old woman comes to the office due to impaired vision. For the last year, she has had progressive loss of visual acuity. The patient is unable to read her computer screen and has stopped driving at night due to excessive glare from oncoming headlights. History is notable for chronic HIV infection, which has been well controlled with a multidrug antiretroviral regimen. Examination shows opacification of the lenses bilaterally. Which of the following is the most appropriate next step in management of this patient's eye condition?

Question

A 48-year-old woman comes to the office due to impaired vision.  For the last year, she has had progressive loss of visual acuity.  The patient is unable to read her computer screen and has stopped driving at night due to excessive glare from oncoming headlights.  History is notable for chronic HIV infection, which has been well controlled with a multidrug antiretroviral regimen.  Examination shows opacification of the lenses bilaterally.  Which of the following is the most appropriate next step in management of this patient's eye condition?

Quizplus · Accepted Answer

11ec25c8_d867_53f0_bc81_e38c49e21995_MD0003_00 This patient has cataracts, characterized by opacification of the lens with chronic loss of visual acuity. Patients often experience excessive glare and halos around bright lights due to scattering of light in the lens. Examination findings include visible cloudiness in the lens, decreased visualization of retinal detail, and loss of the red reflex. red reflex Cataracts typically develop in patients age >60. However, they may be seen in younger patients due to diabetes mellitus, ocular trauma, glucocorticoid use, or external radiation exposure. In addition, patients with chronic HIV infection are at increased risk for cataracts, possibly due to accelerated aging or chronic immune suppression, and often develop cataracts at an early age. Treatment for cataracts includes surgical removal of the lens with implantation of a prosthetic lens, which is typically performed when cataracts begin to impair activities of daily living. (Choice A) Antioxidant supplements (eg, vitamins C and E, zinc) are recommended for patients with early signs of age-related macular degeneration. Examination in this disorder shows deposits of cellular debris (drusen) in the retina, not opacification of the lens. drusen (Choice B) Cytomegalovirus (CMV) retinitis presents with central vision loss, scotomata (ie, blind spots), floaters, and photopsia (ie, flashing lights). Unlike this patient's chronic symptoms, symptoms of CMV retinitis are typically subacute (weeks) and unilateral, and examination shows yellow-white fluffy lesions adjacent to the fovea and retinal vessels. yellow-white fluffy lesions (Choice C) Herpes simplex keratitis is characterized by branching ulcers of the cornea, which may be visualized on inspection with fluorescein dye staining. However, it presents acutely with unilateral eye pain, redness, and tearing. (Choice D) Latanoprost eye drops are used in treatment of open-angle glaucoma, which presents with chronic, insidious loss of peripheral vision. Educational objective: Cataracts typically develop in patients age >60 but may be seen in younger individuals due to HIV infection, diabetes mellitus, ocular trauma, glucocorticoid use, or external radiation exposure. Treatment for cataracts includes surgical removal of the lens with implantation of a prosthetic lens. References: HIV-infected individuals on long-term antiretroviral therapy are at higher risk for ocular disease. (http://www.ncbi.nlm.nih.gov/pubmed/28521845)

A 48-Year-Old Woman Comes to the Office Due to Impaired