A 70-year-old woman consults you for progressive vision problems.

The symptoms described — haloes at night, monocular diplopia, and improved near vision (second sight) — are classic signs of nuclear sclerosis-type cataracts. On exam, the most consistent finding would be an altered red reflex due to lens opacification.

Toronto Notes 2023 – Ophthalmology, Cataracts:

“Cataracts can cause glare, monocular diplopia, and improved near vision. A diminished or irregular red reflex is commonly seen on direct ophthalmoscopy.”

MCCQE1 Objectives – Internal Medicine > Ophthalmologic Disorders:

“The candidate must recognize symptoms and physical findings of cataracts, including changes in red reflex and visual acuity.”

Options A and B are associated with lipid deposition and Wilson’s disease, respectively. Retinal exudates (D) suggest diabetic or hypertensive retinopathy. Increased intraocular pressure (E) suggests glaucoma but is not supported by this clinical picture.

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