JKOS Journal of the Korean Ophthalmological Society J Korean Ophthalmol Soc 0378-6471 2092-9374 Korean Ophthalmological Society 10.3341/jkos.2016.57.6.963 jkos-57-963 Original Article Oil Droplet Cataract: Cause of Decreased Vision of Unknown Etiology LeeHaeng Jin MD KimJung Yeul MD LeeMin Woo MD LeeYeon Hee MD Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Korea Address reprint requests to Yeon Hee Lee, MD Department of Ophthalmology, Chungnam National University Hospital, #282 Munhwa-ro, Jung-gu, Daejeon 35015, Korea Tel: 82-42-280-8447, Fax: 82-42-255-3745 E-mail: opticalyh@hanmail.net 09 2016 25 09 2016 576 963 968 05062015 25102015 30122015 Copyright © 2016 Korean Ophthalmological Society 2016 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Purpose

To report cases of oil droplet cataract, one cause of decreased vision of unknown etiology.

 Methods

We performed a retrospective chart review analysis of patients referred to the neuro-ophthalmology clinic due to unknown etiology of decreased visual acuity and diagnosed with oil droplet cataract. Clinical features including history, result of ophthalmologic examinations, and clinical course were evaluated.

 Results

Among the patients referred to the neuro-ophthalmology clinic due to unknown etiology of decreased visual acuity, 6 patients were diagnosed with oil droplet cataract. The patients ranged from 38 to 63 years of age and their best corrected visual acuities at their first visits were between 0.1 and 0.7. Ophthalmologic examinations including neuro-ophthalmologic tests were normal except for changes in lens nucleus and peculiar fundus reflexes were observed using retinoscopy in all patients. Five eyes of 4 patients underwent cataract surgery and all 5 eyes achieved the best corrected visual acuity of 1.0 or higher.

 Conclusions

Oil droplet cataract is a cause of decreased visual acuity of unknown etiology that can be missed. The disease abnormalities are difficult to observe because only subtle changes in lens nucleus are apparent on slit lamp examination; however characteristic fundus reflexes can be identified using retinoscopy. Ophthalmologists should thoroughly understand the oil droplet cataract and diagnose it in the early stages to avoid misdiagnosis and unnecessary costs.

 Decreased vision of unknown etiology Oil droplet cataract Retinoscopy References Eifrig DE Identifying oil-drop cataracts J Cataract Refract Surg 1994 201056 Soong HK Dastjerdi MH Lenticular myopia from oil-drop abdominal: a cautionary note in laser in situ keratomileusis J Cataract Refract Surg 2004 30243840 Mohammadpour M Jabbarvand M Oil-drop cataracts J Cataract Refract Surg 2008 341425 Heher KL Stark WJ Miller NR Oil-drop cataracts J Cataract Refract Surg 1993 193068 Rubin ML The case of the myopic capitalist Surv Ophthalmol 1968 131223 Lee KE Klein BE Klein R Wong TY Changes in refraction over 10 years in an adult population: the Beaver Dam Eye study Invest Ophthalmol Vis Sci 2002 43256671 Wu Z Lim JI Sadda SR Axial length: a risk factor for cataractogenesis Ann Acad Med Singapore 2006 354169 Wong TY Foster PJ Johnson GJ Seah SK Refractive errors, axial ocular dimensions, and age-related cataracts: the Tanjong Pagar survey Invest Ophthalmol Vis Sci 2003 44147985 Guzowski M Wang JJ Rochtchina E Five-year refractive changes in an older population: the Blue Mountains Eye Study Ophthalmology 2003 110136470 Cho YK Huang W Nishimura E Myopic refractive shift represents dense nuclear sclerosis and thin lens in lenticular myopia Clin Exp Optom 2013 9647985 Samarawickrama C Wang JJ Burlutsky G Nuclear cataract and myopic shift in refraction Am J Ophthalmol 2007 1444579 Brown NP Koretz JF Bron AJ The development and maintenance of emmetropia Eye (Lond) 1999 13Pt 18392 Brown NA Hill AR Cataract: the relation between myopia and cataract morphology Br J Ophthalmol 1987 7140514 Kaufman BJ Sugar J Discrete nuclear sclerosis in young patients with myopia Arch Ophthalmol 1996 114117880 Kuroda T Fujikado T Maeda N Wavefront analysis in eyes with nuclear or cortical cataract Am J Ophthalmol 2002 13419 Congdon NG Taylor HR Age-related cataract Johnson GJ Minassian DC West S Weale R The Epidemiology of Eye Disease 2nd ed. London London 2003 chap. 8. Kashima K Trus BL Unser M Aging studies on normal lens using the Scheimpflug abdominal camera Invest Ophthalmol Vis Sci 1993 342639 Panchapakesan J Rochtchina E Mitchell P Myopic refractive shift caused by incident cataract: the Blue Mountains Eye Study Ophthalmic Epidemiol 2003 102417 van Heyningen R What happens to the human lens in cataract Sci Am 1975 233702 77–81. Figures and Tables

Comparison of lens status between patients and normal controls. Slit lamp photographs (A) and scheimpflug image of the right eye in patient 1 (B). The center of nucleus is relatively homogeneously foggy compared to the fairly clear cortex. The average and maximal opacity of the lens were 8.7% and 11.8%. Pentacam nucleus staging was stage 2. In normal eye, the average and maximal opacity of lens were 0% (C). PNS =Pentacam Nucleus Staging; Std. Dev = standard deviation.

Fundus photography of patient 2. The left eye has oil droplet cataract. But the right eye has a clear lens. The view of the left fundus (B) is not hazy compared to the right fundus (A).

Comparison of fundus reflex between patients and normal controls. Retinoscopy can identify characteristic dark silluette (arrows) fundus reflexes (A) in contrast with normal reflex (B).

Demographics of patients

Patient Age (years) Gender Laterality Disease status Initial UCVA Initial BCVA Axial length (mm) Autorefraction (diopters, SE)
1* 38 Female OD Oil droplet cataract 0.2 0.7 25.01 −14.5
      OS Oil droplet cataract 0.05 0.2 25.49 −13.0
2* 55 Female OS Oil droplet cataract 0.4 0.5 23.01 −4.0
      OD Normal 1.2 1.2 23.20 0.25
3* 63 Male OD Oil droplet cataract 0.02 0.4 24.82 −6.0
      OS Normal 0.4 1.0 24.67 −1.5
4 51 Female OD Oil droplet cataract 0.3 0.4 – −0.5
      OS Normal 0.6 0.8 – 0.25
5 62 Female OD Oil droplet cataract 0.02 0.1 – −9.0
      OS Normal 0.2 0.4 – −5.0
6* 50 Male OD Oil droplet cataract 0.04 0.5 28.53 −12.0
      OS Normal 0.04 1.0 29.04 −6.0

UCVA = uncorrected visual acuity; BCVA = best corrected visual acuity; SE = spherical equivalent.

Phacoemulsification and posterior chamber intraocular lens implantation was performed.

Changes of visual acuity after phacoemulsification and posterior chamber intraocular lens implantation

Patient Age (years) Gender Laterality Preoperative BCVA Postoperative BCVA Autorefraction (diopters, SE)
1 38 Female OD 0.7 1.0 −0.5
      OS 0.2 1.0 −0.25
2 55 Female OS 0.9 1.2 −2.0
3 63 Male OD 0.4 1.0 −0.25
6 50 Male OD 0.5 1.6 −0.5

BCVA = best corrected visual acuity; SE = spherical equivalent.