|Year : 1979 | Volume
| Issue : 3 | Page : 37-40
Documentation of lens diseases
SK Angra, Madan Mohan
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
S K Angra
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi-110016
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Angra S K, Mohan M. Documentation of lens diseases. Indian J Ophthalmol 1979;27:37-40
The lenticular diseases are extremely prevalent in the whole world which solicit the proper recording of the observations to know the natural history and clinical profile of such disorders. The documentation of the clinical signs, is of utmost importance for evaluation of the progress of the disease and proper follow up. Observers often use some method of recording these signs diagramatically which may be difficult for others to interpret. Thus the values of the clinical record becomes limited. Photographic method of recordings have also limitations of resolution, depth and superimposition of various characters, which a human eye can appreciate. No standardised scheme of documenting lens diseases is available in the literature although there exists conventional graphic documentation of corneal, and retinal disorders.
An attempt has been made to evolve and practice a practical standardised simple plan to document lenticular diseases, topographically based on our experience in the lens clinic.
Method: The topographic documentation consists of three parts [Figure - 1].
i) Plan view
ii) Sectional view
iii) Relation of lens to anterior segments.
I. Plan view: The lens is depicted in the plan view by a circle, seen through the corneal window of 12 mm diameter. The crystalline lens is taken as 10 mm. in diameter. The equator of the lens is often obscured by iris even in fully dilated pupil. This fact is to be given proper attention while drawing the lens. For proper depiction of the size of the lesion, the plan view is divided into 3o squares and each square is denoted by numericals vertically and alphabets horizontally. Faint dotted circles are also drawn to show pupillary signs of 2 mm., 4 mm. and 6 mm. in diameter.
II. Sectional view: Many of the features can be depicted in the plan view of the lens. But the sectional view gives the exact involvement in terms of the depth and plane in particular meridian and area. Any three planes can be selected and adequately labelled.
III. Relation of the disease to anterior segment: The position of lens in relation to other structures of the anterior segment is denoted. The concomittant changes in the cornea and iris can also be documented in this diagram.
Depictions: Only three main colours are used grey/black for cortical changes, brown or red for nuclear changes and blue for capsular changes. The polychromatic lusture is shown in yellow colour. The pathologic changes are drawn as shown according to the scheme laid down. [Figure - 1][Figure - 2][Figure - 3]. The morphological changes in the shape, size of the lens as well the pathological changes are drawn as in vivo.
Annotations: Additional annotations are necessary to indicate the area/level of involvement and degree of the involvement. This will make the graphic representation self explanatory.
a) Abbreviations for the pathological disorders are to be written in lower case letters and these are to be standardised as under:
be - bread crumb appearance
cl - calcification
ct - cataract
dl - dislocation/luxation
fv - fluid vacuoles
lc - lenticonus
Ig - lentiglobus
px - pseudoexfoliation
lq - liquifaction
mg - morgagani globules
o - hydration
pm - persistant Pupillary membrane
ps - post synechia
sc - sclerosis
sl - subluxation
ss - sutural separation
f - fissures/tear we - water clefts
x - exfoliation
b) Anatomical levels are given in capital followed by lower case letters e.g.
Cp - capsule
Cx - cortex
Eq - equator
L - lamellar
PI - pole
Su - sutures
Zl - zonule.
For the proper positioning of the zone or area involved the terms, anterior (a) and posterior (b) are written as post script to symbol letter of the zone involved e.g. anterior cortical cataract: (Cxcta).
c) Degree: The degree of the change is denoted by a grading system on 1-4 scale.
1. Minimal changes. 2. Mild changes. 3. Moderate changes. 4. Severe changes.
This is recorded at the end after the symbol letter of the zone involved e.g. nuclear cataract of moderate degree; Net 3.
d) Descriptive: To add the description to what is documented, certain abbreviations are prefixed to the disease itself, e.g. Comp. Cxctp 2-complicated mild posterior cortical cataract. Such abbreviations are:
Bd - blue dot
Comp - complicated
Cong. - congenital
Cunae - cunaeform
Cup - cuppuliform
Hm - hypermature
Im. - immature
M - mature
Pct. - punctate
S - senile
| Discussion|| |
The crystalline lens is a peculiar structure in which the disease imprints are more or less permanent and persist throughout the life. These get burried inside the lens. This makes the recording of such changes of prime importance as these are to be referred throughout life.
The best method of recording the lesions is to keep the photographic records, but this has its own limitations. The resolution of the eye under a microscope is more than of a camera [Figure - 4]. Thus there is a need for documenting the lesions in graphic form even beside the photographic records.
The drawing of lesions in the crystalline lens has its own draw backs. The problem encountered sometimes, is that the schematic drawing fails to project the lens changes in the observer's mind. But by this scheme it is possible to superimpose the drawings and depict the special features e.g. folds, irregularities or other unusual aspects. Also when the cataract is dense to obscure the finer details of posterior layers, such a standardised scheme projects this uncertainty by dotted lines annotated by a question mark. Further, the true picture is projected more when it is shown in relation to diseases of its neighbouring structures and labelled with the annotations showing the disease, the zone involved, the degree of severity and the proper location on a topographic chart designed by us.
| Summary|| |
A standardised scheme for graphic documentation of the disease of the crystalline lens is recommended for the clinical records.
| References|| |
Bron A.J., 1973, Brit. Jour. Oplithal.,
Schepens C.L., 1969, Symposium on Retina and Retinal Surgery, P. 39, Trans. of New Orleans Acad. of Ophth., Mosby St. Louis.
Tarrizo M.L., 1973. Field Methods for control of Trachoma. WHO Ch. p 33, Geneva.
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]