Cataract classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Rohan Bir Singh, M.B.B.S.[2]

Classification

The classification of cataracts is based on four different criteria.

1. Morphology,
2. Age of Onset
3. Maturity
4. Etiology
5. Location of opacity

Morphology	Anterior cortical cataract Anterior polar cataract Anterior subcapsular cataract Nuclear cataract Posterior cortical cataract Posterior polar cataract Posterior subcapsular cataract (PSC) After-cataract
Maturity	Immature Senile Cataract (IMSC) - partially opaque lens, disc view hazy Mature Senile Cataract (MSC) - Completely opaque lens, no disc view Hypermature Senile Cataract (HMSC) - Liquefied cortical matter: Morgagnian Cataract Congenital cataract
Location of opacity	Anterior cortical cataract Anterior polar cataract Anterior subcapsular cataract Nuclear cataract Posterior cortical cataract Posterior polar cataract (importance lies in higher risk of complication - posterior capsular tears during surgery) Posterior subcapsular cataract (PSC) (clinically common)

• Congenital cataract

• Sutural cataract
• Lamellar cataract
• Zonular cataract
• Total cataract
• Secondary cataract

• Drug-induced cataract (e.g. Corticosteroids)

• Traumatic cataract

• Blunt trauma (capsule usually intact)
• Penetrating trauma (capsular rupture & leakage of lens material - calls for an emergency surgery for extraction of lens and leaked material to minimize further damage)

• Classified by location of opacity within lens structure (However, mixed morphology is quite commonly seen, e.g. PSC with nuclear changes & cortical spokes of cataract)

• Anterior cortical cataract
• Anterior polar cataract
• Anterior subcapsular cataract

• Nuclear cataract - Grading correlates with hardness & difficulty of surgical removal

• 1 - Grey
• 2 - Yellow
• 3 - Amber
• 4 - Brown/Black (Note: "Black cataract" translated in some languages (like Hindi) refers to Glaucoma, not the color of the lens nucleus)

• Posterior cortical cataract
• Posterior polar cataract (importance lies in higher risk of complication - posterior capsular tears during surgery)
• Posterior subcapsular cataract (PSC) (clinically common)

• After-cataract - posterior capsular opacification subsequent to a successful extracapsular cataract surgery (usually within 3 months - 2 years) with or without IOL implantation. Requires a quick & painless office procedure with Nd:YAG laser capsulotomy to restore optical clarity.