Doing anamnesis carefully is an important thing in determining the progression and functional impairment of vision due to cataracts and identifying other causes of opacification of the lens.

Cataracts are diagnosed through anamnesis, physical examination, and complete supporting examinations.

The following symptoms of cataracts that are often complained of by patients:

1. Blurred vision
 Lens opacity causes a gradual decrease in vision progressively, without pain. The vision is not improved, even with a pinhole test

2. Glare
Cataract sufferers often complain of glare, which varies in degrees ranging from decreased contrast sensitivity to bright backgrounds (such as glare during the day). The patient complains of a glare at the opposite light at night. These complaints often occur in patients with cortical cataracts.

3. Sensitivity to contrast
Sensitivity to contrast determines the patient's ability to recognize subtle differences in images that differ in color, lighting, and location. This sensitivity test is better to explain the eye's function as optical. This test is better than using a Snellen chart to determine the certainty of vision function; however, this test is not a specific indicator of vision loss caused by cataracts.

4. Myopization
The progression of cataracts can initially increase the strength of the lens diopters, usually causing mild to moderate myopia. But after all this time, along with the deteriorating quality of the lens, this comfort gradually disappeared and followed by a sclerotic nuclear cataract. The asymmetrical myopization in both eyes causes anisometropia. Anisometropia cannot be corrected and only treated by cataract extraction.

Diurnal vision variation
In central cataracts, patients sometimes complain of decreased vision during the day or bright conditions and improve in the evening. In contrast, patients with peripheral cortical cataracts sometimes complain of better vision in bright light than in dim light.

6. Cataract distortion. 
Sharp-cornered objects appear blunt or bumpy.

7. Halo
Patients can complain of seeing halo (a rainbow-colored circle around a bright light source). This halo must be distinguished from halo in people with glaucoma.

8. Monocular diplopia
A double image can form on the retina due to irregular refraction of the cloudy lens, giving rise to monocular diplopia distinguished from binocular diplopia by cover tests and pinholes.

9. Changes in color perception
Changes in the color of the nucleus that becomes yellowish, causing changes in color perception. So that objects that are seen to be more yellowish or brownish than the actual color.

10. Black spots
Patients complain about the emergence of black spots that do not move in the field of view—differentiated from complaints on the retina or vitreous body that often moves. 


Examination

Sharp vision test
Cataract examination includes a complete eye examination starting with a sharp test of vision. In senile cataracts, sharp vision decreases slowly according to the grading density of the lens's turbidity, according to Burrato.

At grade 1 the vision is still good> 6/12, with a lens that looks a little murky,
grade 2: nucleus with mild turbidity, vision 6/12 ± 6/30, with a yellowish nucleus.
Grade 3, the nucleus with medium turbidity, vision 3/60 ± 6/30, cortex has experienced turbidity. Grade 4. The nucleus has hardened, vision between 1/60 ± 3/60, the nucleus is brownish yellow.
Grade 5, the nucleus is very hard with a vision 1/60 or worse with a brown or black nucleus.

2. Oblique illumination
Oblique illumination examination can show the color of the lens in the pupillary area, which varies from each type of cataract.

3. Iris shadow test
When light is shined onto the pupil, a crescentic shadow will form at the pupillary edge of the gray cloudy lens, as long as there is a clear cortex between the turbidity and the pupillary edge when the lens is clear or cloudy as a whole, it does not form iris shadow. Iris Shadow is a sign of immature cataract

4. Slit lamp
A slit-lamp examination is performed with dilated pupils. This examination describes the morphology, location, size, shape, color pattern, and density of nucleus turbidity. The examination of the lens is conducted by shining it from the side. The lens will look cloudy gray or whitish with a black background. The anterior camera can become shallow, and the iris is pushed forward, the angle of the anterior camera narrows so that intraocular pressure increases, consequently secondary glaucoma will occur.
Inspection with a slit lamp is also important in checking lens turbidity and other eye structures (eg, conjunctiva, cornea, iris, anterior camera).

Ophthalmoscopy
In addition, direct or indirect ophthalmoscopy examination is important to evaluate the posterior part of the eye so that the prognosis after lens extraction can be determined. In the reflex fundus with ophthalmoscope examination, the turbidity appears black with an orange background. And in the mature stage, only found white or appear black without an orange background, this shows that the lens is completely turbid.