Refractive error changes in cortical, nuclear, and posterior subcapsular cataracts

Abstract

AbstractIn addition to the well known myopic shift in nuclear cataracts, astigmatic shifts have been reported in cortical cataracts, although posterior subcapsular cataracts typically show no significant refractive error change. These refractive shifts are thought to be due to changes in refractive index that are either diffuse (nuclear) or in isolated sections (cortical). Correction of these refractive changes can be troublesome for the patient as updated spectacles provide magnification changes as well as improved vision and older patients can find it difficult to adapt. Both spherical and astigmatic spectacle magnification changes can have significant effects on the vestibulo‐ocular reflex gain and can lead to potentially unsafe adaptive gait on steps and stairs in older patients. Indeed, fully correcting large refractive changes in older, frail patients has been shown to increase the likelihood of falls and a conservative approach to correcting these refractive changes is recommended.