Does Myotonic Dystrophy Cause Cataracts?
At a Glance
Yes, myotonic dystrophy (DM1 and DM2) frequently causes early-onset cataracts, which are often the first symptom of the disease. Regular eye exams are crucial. While cataract surgery is safe and effective, it must use local anesthesia to avoid severe risks from general anesthesia.
In this answer
3 sections
Yes, people living with myotonic dystrophy (both DM1 and DM2) should see an eye doctor (ophthalmologist) for annual check-ups, even if their vision seems fine. Myotonic dystrophy frequently causes cataracts, which are cloudy areas in the normally clear lens of the eye [1]. In fact, early-onset cataracts are often the very first symptom of the disease, sometimes appearing years before any muscle weakness [2][3]. Regular comprehensive eye exams are the best way to catch and treat these issues early.
The ‘Christmas Tree’ Cataract
A specific type of cataract, often referred to as a “Christmas tree” cataract, is highly characteristic of myotonic dystrophy [4][5]. Under the light of an eye doctor’s microscope, these look like polychromatic (multicolored) iridescent spots [4][5].
While cataracts are usually associated with aging, people with myotonic dystrophy tend to develop them much earlier in life [2][3]. This occurs because the underlying genetic cause of DM affects the cells of the eye’s lens [6][7]. Whether you have DM1 or DM2, your risk for developing these early cataracts is very high [5][1].
Getting the Right Eye Exam
To detect early-stage cataracts, you need a slit-lamp examination [4][5]. A slit-lamp is a special microscope used by ophthalmologists to look deep into the structures of your eye. Regular, annual monitoring through these exams is crucial for tracking the health of your eyes and deciding the best time for treatment [1][4].
People with myotonic dystrophy may also experience other eye issues, such as drooping eyelids (ptosis), which your doctor can evaluate during these routine visits.
Treating Cataracts in Myotonic Dystrophy
If you develop cataracts that interfere with your daily life, the standard treatment is cataract surgery. During this procedure, the cloudy lens is removed and replaced with a clear artificial lens.
For patients with myotonic dystrophy, cataract surgery is generally safe and highly effective at restoring clear vision [8][9]. However, your care team should be aware of a few DM-specific considerations:
- Anesthesia: General anesthesia carries significant risks for people with myotonic dystrophy, including severe respiratory issues and muscle spasms known as a myotonic crisis [10][11]. Because of this, cataract surgery is usually performed using local anesthesia (numbing drops or injections), which is much safer [8][10].
- Capsular Phimosis: After cataract surgery, patients with myotonic dystrophy have a higher risk of capsular phimosis (shrinking of the tissue holding the artificial lens) and posterior capsular opacification (a secondary clouding of the vision) [8].
- Specialized Planning: To prevent these post-surgical issues, your eye surgeon may choose specific types of artificial lenses or use a device called a capsular tension ring during the surgery [12][13].
Because of these specific risks, it is highly recommended to work with an ophthalmologist who understands myotonic dystrophy, or who is willing to consult with your neurologist.
Common questions in this guide
Does myotonic dystrophy cause cataracts?
What is a Christmas tree cataract?
How are cataracts diagnosed in myotonic dystrophy?
Is cataract surgery safe for people with myotonic dystrophy?
What are the risks after cataract surgery for myotonic dystrophy?
Questions to Ask Your Doctor
Curated prompts to bring to your next appointment.
- 1.Are you familiar with the specific surgical considerations for patients with myotonic dystrophy, particularly the risks of capsular phimosis?
- 2.Are you comfortable coordinating with my neurologist before planning any potential cataract surgery?
- 3.What precautions will be taken to ensure that only local anesthesia is used if I need eye surgery?
- 4.If I need cataract surgery, what type of intraocular lens do you recommend to minimize the risk of capsular contraction?
- 5.How frequently should I schedule a slit-lamp exam with you to monitor my baseline eye health?
Questions For You
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References
References (13)
- 1
Myotonic dystrophy type 1: palliative care guidelines.
Willis D, Willis T, Bassie C, et al.
BMJ supportive & palliative care 2024; doi:10.1136/spcare-2023-004748.
PMID: 38253488 - 2
Having an eye for myotonic dystrophy: A qualitative study on experiences and support needs in myotonic dystrophy type 1 patients with a diagnostic delay after early-onset cataract.
Karnebeek IEA, Boon HTM, Huis AMP, et al.
Neuromuscular disorders : NMD 2022; (32(10)):829-835 doi:10.1016/j.nmd.2022.09.003.
PMID: 36192279 - 3
Early onset posterior subscapular cataract in a series of myotonic dystrophy type 2 patients.
Papadopoulos C, Kekou K, Xirou S, et al.
Eye (London, England) 2018; (32(3)):622-625 doi:10.1038/eye.2017.280.
PMID: 29219952 - 4
Clinical guide for the diagnosis and follow-up of myotonic dystrophy type 1, MD1 or Steinert's disease.
Gutiérrez Gutiérrez G, Díaz-Manera J, Almendrote M, et al.
Medicina clinica 2019; (153(2)):82.e1-82.e17 doi:10.1016/j.medcli.2018.10.028.
PMID: 30685181 - 5
Clinical guide for the diagnosis and follow-up of myotonic dystrophy type 1, MD1 or Steinert's disease.
Gutiérrez Gutiérrez G, Díaz-Manera J, Almendrote M, et al.
Neurologia 2020; (35(3)):185-206 doi:10.1016/j.nrl.2019.01.001.
PMID: 31003788 - 6
Mitigating RNA Toxicity in Myotonic Dystrophy using Small Molecules.
Reddy K, Jenquin JR, Cleary JD, Berglund JA
International journal of molecular sciences 2019; (20(16)) doi:10.3390/ijms20164017.
PMID: 31426500 - 7
Reversal of RNA toxicity in myotonic dystrophy via a decoy RNA-binding protein with high affinity for expanded CUG repeats.
Arandel L, Matloka M, Klein AF, et al.
Nature biomedical engineering 2022; (6(2)):207-220 doi:10.1038/s41551-021-00838-2.
PMID: 35145256 - 8
Ocular Features and Clinical Approach to Cataract and Corneal Refractive Surgery in Patients with Myotonic Dystrophy.
Moshirfar M, Webster CR, Seitz TS, et al.
Clinical ophthalmology (Auckland, N.Z.) 2022; (16()):2837-2842 doi:10.2147/OPTH.S372633.
PMID: 36046572 - 9
Efficacy and safety of ropivacaine HCl in peribulbar anaesthesia for cataract surgery in patients with myotonic dystrophy type 1.
Palladino A, De Bernardo M, Scutifero M, et al.
Acta myologica : myopathies and cardiomyopathies : official journal of the Mediterranean Society of Myology 2020; (39(2)):90-93 doi:10.36185/2532-1900-011.
PMID: 32904905 - 10
Dexmedetomidine infusion for sedation in a patient with myotonic dystrophy.
Liu AY, Dower A, Nair S
Anaesthesia reports 2020; (8(2)):135-137 doi:10.1002/anr3.12070.
PMID: 33210091 - 11
Cardiac Involvement and Arrhythmias Associated with Myotonic Dystrophy.
McBride D, Deshmukh A, Shore S, et al.
Reviews in cardiovascular medicine 2022; (23(4)) doi:10.31083/j.rcm2304126.
PMID: 36177340 - 12
Anterior Capsule Opening Contraction and Late Intraocular Lens Dislocation after Cataract Surgery in Patients with Weak or Partially Absent Zonular Support.
Vanags J, Erts R, Laganovska G
Medicina (Kaunas, Lithuania) 2021; (57(1)) doi:10.3390/medicina57010035.
PMID: 33401604 - 13
Comparison Study of Anterior Capsule Contraction of Hydrophilic and Hydrophobic Intraocular Lenses Under the Same Size Capsulotomy.
Wang Y, Wang W, Zhu Y, et al.
Translational vision science & technology 2022; (11(1)):24 doi:10.1167/tvst.11.1.24.
PMID: 35040916
This page is for informational purposes only and does not replace professional medical advice. Always consult your ophthalmologist and neurologist regarding vision monitoring and surgical planning for myotonic dystrophy.
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