The article by Kaufman and Sugar1 in the October 1996 issue of the Archives describes a group of patients who have visual loss from discrete nuclear sclerosis. We agree that this finding is often underdiagnosed or misdiagnosed. Such patients have been referred to us for "unknown visual loss or possible disease of the retina." The difficulty in making the diagnosis stems from the fact that nuclear sclerosis is often difficult to see at the slit lamp because the change in the refractive property of the lens may not be associated with discoloration. In addition, a small central part of the lens may have nuclear sclerosis, causing blurring of vision that cannot be corrected with a more minus correction.
Changes in the retinoscopy reflex may identify early nuclear sclerosis. We have found that another excellent method to diagnose subtle nuclear sclerosis is to perform a Hruby lens examination of the
Folk JC, Gehrs KM, Kolder HE. Diagnosis of Occult Lenticular Nuclear Sclerosis Using the Hruby Lens. Arch Ophthalmol. 1997;115(8):1086. doi:10.1001/archopht.1997.01100160256029