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	Capsular Subcapsular Nuclear Cortical Lamellar Sutural	Congenital capsular thickening may be associated with posterior or anterior polar cataracts and pyramidal cataract. The posterior form may be associated with a hylaoid remnant. Acquired capsular opacities can occur with pseudoexfoliation, Infra-red radiation (Glass blower’s cataract) or Secondary to blunt trauma when a Vossius’ ring may be formed. Nuclear - Congenital : Cataract is that secondary to Rubella - Age related : Nuclear sclerosis 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)	Anterior subcapsular lens changes may be associated with Wilson’s disease (sunflower cataract) or with drugs e.g., amiodarone Posterior subcapsular cataract changes may associated with secondary or complicated cataracts, drugs e.g., steroids, or be an age related cataract.

• 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.