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https://projects.jira.snomed.org/browse/IHTSDO-791

Document review: JIRA IHTSDO-791 (artf222563) Rework hierarchy:Cataract Documentation Review (Please note this page is not public)

Amendment History

Review Timetable

© International Health Terminology Standards Development Organisation 2012. All rights reserved.

SNOMED CT® was originally created by the College of American Pathologists.

The International Release of SNOMED CT® is distributed by the International Health Terminology Standards Development Organisation (IHTSDO), and is subject to the IHTSDO’s SNOMED CT® Affiliate Licence. Details of the SNOMED CT® Affiliate Licence may be found at http://www.ihtsdo.org/our-standards/licensing/.

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1 Glossary

2 Introduction

2.1 Purpose

The purpose of this project is to rework the SNOMED CT cataract sub-hierarchy, defined as 193570009|Cataract (disorder)| and its descendants, to accomplish the following:

• Make the Cataract sub-hierarchy consistent with typical SNOMED CT modeling patterns for diseases.

• Make the sub-hierarchy consistent with common clinical practice and classifications of cataracts.

• Recommend clear and consistent guidance for the management of requests for new content related to cataract disorders.

2.2 Audience and stakeholder domain 

The audience for this document includes all standards terminology leaders, implementers and users of SNOMED CT.

A further significant audience is the community of SNOMED CT terminologists that may be requested to implement the recommended specification.

Specifically, the audience will include anyone interested in authoring or using SNOMED CT in the domain of cataract disorders, including the community of clinical ophthalmologists and their support staffs (as potential users).

.2.2.1 Input from stakeholders

In addition to conforming to the desired SNOMED CT modeling patterns, the revised cataract hierarchy should be consistent with current ophthalmological practice and be suitable for use in an international standard. Clinical input was sought from Dr. Stevie Tan, an ophthalmologist who is active in the SNOMED CT community and graciously agreed to help with this project. Dr. Tan subsequently consulted Dr. Nic Reus, who kindly provided a reference to a clinically useful cataract classification scheme, based on an electronic version of the cataract chapter from an ophthalmology textbook.

2.2.2 Degree of consensus on the statement of problem

There appears to be a reasonable degree of consensus about the problem, since it is clearly described in JIRA item IHTSDO-791 (artf222563) and there is no evidence to suggest that the problem as stated there is controversial.

3 Statement of the problem or need

3.1 Summary of problem or need, as reported

As reported, the primary problems with the cataract sub-hierarchy are missing attributes that could make primitive concepts defined, inconsistent modeling of finding sites, inconsistent modeling of associated morphologies, inconsistent pre-coordination, and concepts that are currently modeled as primitive even though the concept definitions appear to be sufficient for making them fully defined.

3.2 Summary of requested solution

The requested solution is to review the concepts in the cataract disorder sub-hierarchy to correct the deficiencies reported above.

3.3 Statement of problem as understood

The cataract disorder sub-hierarchy requires revision to make it more consistent and possibly to improve its hierarchical structure. Areas needing review include:

• Designation of concepts as primitive or defined

• Values of the FINDING SITE attribute

• Values of the ASSOCIATED MORPHOLOGY attribute

• Representation of laterality

• Conformance to a consistent modeling pattern

• Conformance to current editorial policies regarding FSNs and synonyms.

IHTSDO-791 was created in 2011, and it appears that many of the requested revisions have been made in subsequent International Releases.

3.4 Detailed analysis of reported problem, including background

The January 2016 International Release of SNOMED CT was originally used for this detailed analysis. In addition to the IHTSDO SNOMED CT browser (http://browser.ihtsdotools.org), Apelon DTS was used for selected counts and queries. This is an open source tool available from http://www.apelondts.org.

The analysis has been revisited using the January 2017 International Release, and modifications to this Inception/Elaboration document have been made where significant difference between the two releases were observed.  As noted above, IHTSDO-791 tracker item is accompanied by a detailed “Cataract Report” and many of the proposed changes have made since the original tracker item was created more than five years ago. This revised Inception/Elaboration document has consequently been modified to make it easier to identify “at a glance” the cases where no further content changes are deemed necessary. These cases are shown in a blue, italic font so that a reviewer can more easily focus on proposed changes that still deserve consideration.

3.4.1 Primitive Concepts Missing Attributes that Could Make Them Defined

Multiple concepts in the cataract sub-hierarchy appear to be missing attributes that could be added to make these concepts fully defined. In this regard, the following specific issues were identified in the IHTSDO-791 tracker item:

3.4.1.1 Inconsistent Use of the OCCURRENCE Attribute for Cataract Concepts Related to Periods of Life

• 193571008|Infantile, juvenile and presenile cataracts (disorder)| has OCCURRENCE attributes with values of 255398004|Childhood (qualifier value)| and 3658006|Infancy (qualifier value)|.

• Recommended action as of the January 2017 release: This concept should be considered for retirement because it currently has two OCCURRENCE attributes, one with a value 3658006 |Infancy (qualifier value)| and the other with a value of 255398004 |Childhood (qualifier value)|. The children of 282032007 |Periods of life (qualifier value)| are intended to be mutually exclusive siblings. Thus, it is not possible for a concept to be both a disorder of childhood and and a disorder of infancy. There should only be one OCCURRENCE attribute in any single concept.

• 79410001|Congenital cataract (disorder)| has an OCCURRENCE attribute with a value of 255399007|Congenital (qualifier value)|, and this attribute is inherited by its descendants.

• Recommended action as of the January 2017 release: None.

• 39450006|Age-related cataract (disorder)| does not have an OCCURRENCE attribute. This issue is the subject of IHTSDO-811, which has been closed because it is being incorporated into this project, as described in Section 3.5. The meaning of the phrase "age-related" is unclear, because it presumably refers to old age but could arguably refer to any age (such as infancy, for example). Note that “Senile cataract” is an associated description and IHTSDO-791 appears to say this was previously the FSN for 39450006.

• Recommended action as of the January 2017 release: Change the FSN to represent the semantics explicitly. Either "Old-age related cataract" or "Senile cataract" is a better FSN than "Age-related cataract." Also add an OCCURRENCE attribute with a value of 271872005|Old age (qualifier value)| to the stated definition.

3.4.1.2 Toxic Cataract

• IHTSDO-791 states that 38583007|Toxic cataract (disorder)| currently has no relationship to 441952005|Poisoning (disorder)|. Note that SCTID 441952005 now has a fully specified name of “Poisoning caused by chemical substance (disorder)” and this concept is now a direct children of 75478009|Poisoning (disorder)|.

• Recommended action as of the January 2017 release: Add a CAUSATIVE AGENT attribute with a value of 35331000 |Toxic substance (substance)| instead of a DUE TO attribute with a value of 441952005 | Poisoning caused by chemical substance (disorder)| because this will represent the semantics more directly.

3.4.1.3 Concussion Cataract

• IHTSDO-791 states that 231967008|Concussion cataract (disorder)| has no relationship to “Concussion (110030002).” Searching for the latter SCTID in the January 2016 International Release yields 110030002|Concussion injury of brain (disorder)|, indicating that the FSN has been changed since IHTSDO-791 was created. However, it appears that the suggested relationship between these two concepts is not correct, because concussion cataract is a type of traumatic cataract in which there is an injury to the lens itself and is not secondary to a concussion injury of the brain.
  
  

•  Recommended action as of the January 2017 release: None.

3.4.2 Imprecise Finding Site

• IHTSDO-791 states that 53889007|Nuclear cataract (disorder)| should have a FINDING SITE of 56707006|Structure of nucleus of lens (body structure)| in order to be consistent with the finding sites of its subconcepts. In January 2016 International Release, there is a FINDING SITE attribute with a value of 56707006|Structure of nucleus of lens (body structure)| in the definition of 53889007|Nuclear cataract (disorder)|.

• Recommended action as of the January 2017 release: None.

3.4.3 Cataract as a Morphologic Abnormality

• Currently, 128306009|Cataract (morphologic abnormality)| is a direct child of 128305008|Abnormally opaque structure (morphologic abnormality)|. IHTSDO-791 raises a question about whether “cataract should be a morphology.” As explained in Section 3.5, this question is closely related to IHTSDO-424, which proposes that 128305008|Abnormally opaque structure (morphologic abnormality)| replace 128306009|Cataract (morphologic abnormality)| as the value of the PROCEDURE MORPHOLOGY attribute for cataract procedures.

• Recommended action as of the January 2017 release: The 128306009|Cataract (morphologic abnormality)| concept is problematic because it arguably conflates a structure and a finding site. All cases where there is an ASSOCIATED MORPHOLOGY attribute with a value of 128306009|Cataract (morphologic abnormality)| should be identified and the value of the attribute should be changed to its immediate parent 128305008|Abnormally opaque structure (morphologic abnormality)|. These ASSOCIATED MORPHOLOGY attributes will typically be found in a role group containing a FINDING SITE attribute with a value of 78076003 |Structure of lens of eye (body structure)| or one of its subtypes. The 128306009|Cataract (morphologic abnormality)| concept can be retired once all of the concepts that use it as an attribute value have been remodeled.

• Note: This replacement action can presumably be accomplished by a batch process (such as a global search and replace operation). Accordingly, it is not explicitly stated in this document as a recommended action for each cataract concept. When the recommended action for an individual concept is shown as “None,” that does not include the batch replacement of 128306009|Cataract (morphologic abnormality)| with 128305008|Abnormally opaque structure (morphologic abnormality)|. When other changes are required, however, the change from 128306009|Cataract (morphologic abnormality)| to 128305008|Abnormally opaque structure (morphologic abnormality)| will often be included in the description of the recommendation.

• 3.4.4 Pre-coordination of Laterality

• IHTSDO-791 suggests that 95722004|Bilateral cataracts (disorder)| be retired because it represents bilaterality by using pre-coordinated lateralized anatomy concepts, whereas post-coordination by users should be the preferred approach to representing laterality. However, considerable analysis of laterality issues has occurred since IHTSDO-791 was created. Post-coordination by users would require support for nesting so that the LATERALITY attribute can be applied to a body structure concept. A decision on laterality was reached in October 2015, and pre-coordinated body structure concepts will be added as needed. For bilateral concepts, two relationship groups are used, as is the case for 95722004|Bilateral cataracts (disorder)|.

• Recommended action as of the January 2017 release: None.

3.4.5 Concepts That Appear to be Defined but are Classified as Primitive

• IHTSDO-791 suggest that all the concepts listed in Table 1 be made fully defined after additional attributes are added as specified by the Cataract Pattern Report, as detailed in Section 3.4.6. Eight of the 21 concepts in Table 1 are already fully defined in the January 2016 International Release. Thus, the suggestions only apply to the 13 concepts that are still primitive.

• Recommended action as of the January 2017 release: Since all of the primitive concepts in Table 1 remain primitive in the January 2017 release, see Section 6.1.1.4 for a recommended approach to defining these concepts.

3.4.6 Details of the Cataract Pattern Report

The Cataract Pattern Report associated with IHTSDO-791 is an attempt to enforce consistent modeling patterns for concepts in the cataract disorders sub-hierarchy. It is linked to this document as Appendix A. Each concept mentioned in the Cataract Pattern Report is represented in the following sections. For each concept, the recommendations in the Cataract Pattern Report were originally compared with the state of the concept in the January 2016 International Release. A subsequent comparison was made with the state of the concept in the January 2017 release.

3.4.6.1 Postoperative cataract syndrome

• The Cataract Pattern Report suggests modifying the definition of 70388009|Postoperative cataract syndrome (disorder)| by adding an AFTER attribute with a value of 387713003|Surgical procedure (procedure)|. The report also questions whether this change would allow this concept to become fully defined. This change has already been made in the January 2016 International Release, but the concept is still primitive.

• This concept arguably requires further editorial review because it refers to a complex disease following cataract surgery, as opposed to a cataract that develops following eye surgery. Known as Pseudophakic Cystoid Macular Edema or Irvine Glass Syndrome, a more detailed description of this disorder is available at http://eyewiki.aao.org/Pseudophakic_Cystoid_Macular_Edema_(Irvine-Gass_Syndrome): where the following explanation appears:

• Recommended action as of the January 2017 release: Make the value of the AFTER attribute more specific by changing it from  387713003|Surgical procedure (procedure)| to 110473004|Cataract surgery (procedure)|.

3.4.6.2 Combined nonsenile cataract vs. Infantile, juvenile and presenile cataracts

• The Cataract Pattern Report points out that 193579005|Combined nonsenile cataract (disorder)| has the same attributes as 193571008|Infantile, juvenile and presenile cataracts (disorder)|.

• As noted in Section 3.4.1.1, 193571008|Infantile, juvenile and presenile cataracts (disorder)| should be considered for retirement. 193579005|Combined nonsenile cataract (disorder)| is most likely a residual concept from the ICD-9-CM integration. It is not clinically useful as a grouper concept and should be retired as well.

• Recommended action as of the January 2017 release: Retire 193579005|Combined nonsenile cataract (disorder)|.

3.4.6.3 Adherent cataract

• The Cataract Pattern Report suggests that the definition of 111000003|Adherent cataract (disorder)| be modified by adding an ASSOCIATED MORPHOLOGY attribute with a value of 42685002|Adhesion (morphologic abnormality)| and it questions whether adding this attribute could make the concept fully defined. In the January 2016 International Release, 111000003|Adherent cataract (disorder)| does have an ASSOCIATED MORPHOLOGY attribute with a value of 42685002|Adhesion (morphologic abnormality)|, but the concept is still primitive.

• Recommended action as of the January 2017 release: None.

3.4.6.4 Diabetic cataract

• The Cataract Pattern Report suggests that the definition of 43959009|Diabetic cataract (disorder)| be modified by adding an ASSOCIATED WITH attribute having a value of 73211009|Diabetes mellitus (disorder)|, and it also raises the question of whether adding this attribute could make the concept fully defined. In the January 2016 International Release, 43959009|Diabetic cataract (disorder)|has a more specific DUE TO attribute (which is a child of the ASSOCIATED WITH attribute) with a value of 73211009|Diabetes mellitus (disorder)|and the concept is now fully defined.

• Recommended action as of the January 2017 release: Change the FSN to “Cataract co-occurrent with and due to diabetes”. In accordance with recommendations from the Event-Condition-Episode Group, the more specific DUE TO attribute is strongly preferred over ASSOCIATED WITH, which has essentially been deprecated for use in stated definitions.

3.4.6.5 Drug-induced cataract

• The Cataract Pattern Report suggests that the definition of 193609000|Drug-induced cataract (disorder)| be modified by the addition of a CAUSATIVE AGENT attribute with a value of 410942007|Drug or medicament (substance)|. This attribute has been added in the January 2016 International Release, and the concept is now fully defined.

• Recommended action as of the January 2017 release: None.

3.4.6.6 Cataract associated with radiation

• The Cataract Pattern Report suggests that the definition of 416071001|Cataract associated with infrared radiation (disorder)| be modified by adding a CAUSATIVE AGENT attribute with a value of 17871006|Infrared radiation (physical force)|, and it raises the question of whether adding this attribute could make the concept fully defined. In the January 2016 International Release, a CAUSATIVE AGENT attribute with a value of 17871006|Infrared radiation (physical force)| has been added to the definition and the concept is now fully defined.

• Recommended action as of the January 2017 release: None.

3.4.6.7 Cataract associated with infrared radiation

• The Cataract Pattern Report suggests that the definition of 416071001|Cataract associated with infrared radiation (disorder)| be modified by adding a CAUSATIVE AGENT attribute with a value of 17871006|Infrared radiation (physical force)|, and it raises the question of whether adding this attribute could make the concept fully defined. In the January 2016 International Release, a CAUSATIVE AGENT attribute with a value of 17871006|Infrared radiation (physical force)| has been added to the definition and the concept is now fully defined.
  
  
  

• Recommended action as of the January 2017 release: None.

3.4.6.8 Cataract in inflammatory disorder

• The Cataract Pattern Report suggests that the definition of 23273003|Cataract in inflammatory disorder (disorder)| be modified by adding an ASSOCIATED WITH attribute with a value of 128139000|Inflammatory disorder (disorder)|, and it raises the question of whether adding this attribute could make the concept fully defined. In the January 2017 International Release, the suggested attribute is present and the concept is now fully defined.

• Recommended action as of the January 2017 release: Change the ASSOCIATED WITH attribute to the more specific DUE TO.

 3.4.6.9 Vossius' ring

• The Cataract Pattern Report suggests the addition of a FINDING SITE attribute with a value of 77155007|Structure of lens capsule (body structure)| to the definition of 72180004|Vossius' ring (disorder)|. This attribute has been added in the January 2016 International Release, and the concept remains primitive.
  
  
  

• Recommended action as of the January 2017 release: None.

3.4.6.10 Capsular cataract

• The Cataract Pattern Report suggests the addition of a FINDING SITE attribute with a value of 77155007|Structure of lens capsule (body structure)| to the definition of 204125003|Capsular cataract (disorder)|. This attribute has been added in the January 2016 International Release, and the concept remains primitive.
  
  
  

• Recommended action as of the January 2017 release: None.

3.4.6.11 Diabetic cataract associated with type II diabetes mellitus

• The Cataract Pattern Report suggests that the definition of 420756003|Diabetic cataract associated with type II diabetes mellitus (disorder)| be modified by adding an ASSOCIATED WITH attribute having a value of 44054006|Diabetes mellitus type 2 (disorder)|. In the January 2016 International Release, 43959009|Diabetic cataract (disorder)| has a more specific DUE TO attribute (which is a child of the ASSOCIATED WITH attribute) with a value of 44054006|Diabetes mellitus type 2 (disorder)| and the concept remains fully defined.

• Recommended action as of the January 2017 release: Change the FSN to “Cataract co-occurent with and due to type II diabetes mellitus. In accordance with recommendations from the Event-Condition-Episode Group, the more specific DUE TO attribute is strongly preferred over ASSOCIATED WITH, which has essentially been deprecated for use in stated definitions.

3.4.6.12 Diabetic cataract associated with type I diabetes mellitus

• The Cataract Pattern Report suggests that the definition of 421920002|Diabetic cataract associated with type I diabetes mellitus (disorder)| be modified by adding an ASSOCIATED WITH attribute having a value of 46635009|Diabetes mellitus type 1 (disorder)|. In the January 2016 International Release, 43959009|Diabetic cataract (disorder)| has a more specific DUE TO attribute (which is a child of the ASSOCIATED WITH attribute) with a value of 46635009|Diabetes mellitus type 1 (disorder)| and the concept remains fully defined.

• Recommended action as of the January 2017 release: Change the FSN to the “Cataract co-occurrent with and due to type 1 diabetes mellitus.” In accordance with recommendations from the Event-Condition-Episode Group, the more specific DUE TO attribute is strongly preferred over ASSOCIATED WITH, which has essentially been deprecated for use in stated definitions.

3.4.6.13 Cataract with neovascularization

• The Cataract Pattern Report suggests that the definition of 76309006|Cataract with neovascularization (disorder)| be modified by adding an ASSOCIATED MORPHOLOGY attribute having a value of 13018008|Neovascularization (morphologic abnormality)|, and the report also raises the question of whether adding this attribute could make the concept fully defined. This attribute has been added in the January 2016 International Release, but the concept remains primitive.

• Recommended action as of the January 2017 release: Make the concept fully defined by using two role groups.One should have an ASSOCIATED MORPHOLOGY attribute with a value of 128305008 |Abnormally opaque structure (morphologic abnormality)| and a FINDING SITE attribute withe a value of 78076003 |Structure of lens of eye (body structure)|. The other should have an ASSOCIATED MORPHOLOGY attribute with a value of 13018008 | Neovascularization (morphologic abnormality) | and FINDING SITE attribute of 81745001 | Structure of eye proper (body structure) |.

3.4.6.14 Immature cortical cataract

• The Cataract Pattern Report suggests that the definition of 311789006|Immature cortical cataract (disorder)| be modified by adding an FINDING SITE attribute having a value of 33347001|Structure of cortex of lens (body structure)|. This attribute has been added in the January 2016 International Release. The concept remained primitive in the January 2016 release but is fully defined in the January 2017 release.

• Recommended action as of the January 2017 release: None.

3.4.6.15 Cortical senile cataract

• The Cataract Pattern Report suggests the addition of a FINDING SITE attribute with a value of 33347001|Structure of cortex of lens (body structure)| to the definition of 78875003|Cortical senile cataract (disorder)|. This attribute has been added in the January 2016 International Release, and the concept remains primitive.
  
  
  

• Recommended action as of the January 2017 release: None.

3.4.6.16 Cortical cataract

• The Cataract Pattern Report suggests the addition of a FINDING SITE attribute with a value of 33347001|Structure of cortex of lens (body structure)| to the definition of 193576003|Cortical cataract (disorder)|. This attribute has been added in the January 2016 International Release, and the concept is now fully defined.
  
  
  

• Recommended action as of the January 2017 release: None.

3.4.6.17 Immature cataract

• The Cataract Pattern Report suggests the addition of a FINDING SITE attribute with a value of 33347001|Structure of cortex of lens (body structure)| to the definition of 446474007|Immature cataract (disorder)|. This attribute has been added in the January 2016 International Release, and the concept remains primitive.
  
  
  

• Recommended action as of the January 2017 release: None.

3.4.6.18 Nuclear senile cataract

• The Cataract Pattern Report suggests the addition of a FINDING SITE attribute with a value of 56707006|Structure of nucleus of lens (body structure)| to the definition of 193589009|Nuclear senile cataract (disorder)|. This attribute has been added in the January 2016 International Release, and the concept is now fully defined.

• Recommended action as of the January 2017 release: None.

3.4.6.19 Nuclear sclerotic cataract

• The Cataract Pattern Report suggests the addition of a FINDING SITE attribute with a value of 56707006|Structure of nucleus of lens (body structure)| to the definition of 359766000|Nuclear sclerotic cataract (disorder)|. This attribute has been added in the January 2016 International Release, and the concept remains primitive.
  
  
  

• Recommended action as of the January 2017 release: Move the FINDING SITE attribute into a new role group with an ASSOCIATED MORPHOLOGY attribute having a value of 43846000| Sclerosis (morphologic abnormality)| to fully define the concept.

3.4.6.20 Traumatic cataract

• The Cataract Pattern Report suggests the addition of an ASSOCIATED MORPHOLOGY attribute with a value of 19130008|Traumatic abnormality (morphologic abnormality)| to the definition of 34361001|Traumatic cataract (disorder)|. In the January 2016 International Release, however, this concept has an ASSOCIATED MORPHOLOGY attribute with a value of 128306009|Cataract (morphologic abnormality)| and a DUE TO attribute with a value of 262755005|Injury of the lens (disorder)|, which captures the meaning or “traumatic.” The concept is fully defined, and it appears that its current state is preferable to the suggestion in the Cataract Pattern Report.
  
  
  

• Recommended action as of the January 2017 release: None.

 3.4.6.21 Total Traumatic cataract

• The Cataract Pattern Report suggests the addition of an ASSOCIATED MORPHOLOGY attribute with a value of 19130008|Traumatic abnormality (morphologic abnormality)| to the definition of 8656007 |Total traumatic cataract (disorder)|. In the January 2016 International Release, however, this primitive concept is a direct child of 34361001|Traumatic cataract (disorder)| and consequently inherits all of its attributes. 
  
  
  

• Recommended action as of the January 2017 release: None.

3.4.6.22 Concussion cataract

• 231967008|Concussion cataract (disorder)| was discussed in Section 3.4.1.3. The Cataract Pattern Report suggests the addition of an ASSOCIATED MORPHOLOGY attribute with a value of 19130008|Traumatic abnormality (morphologic abnormality)| to the definition of this concept. However, the definition follows the same pattern as 34361001|Traumatic cataract (disorder)|, in that it has an ASSOCIATED MORPHOLOGY attribute with a value of 128306009|Cataract (morphologic abnormality)| and a DUE TO attribute with a value of 262755005|Injury of the lens (disorder)|.
  
  
  

• Recommended action as of the January 2017 release: None.

 3.4.6.23 Localized traumatic opacity

• The Cataract Pattern Report suggests the addition of an ASSOCIATED MORPHOLOGY attribute with a value of 19130008|Traumatic abnormality (morphologic abnormality)| to the definition of 43972005|Localized traumatic opacity (disorder)|. In the January 2016 International Release, however, this primitive concept has two role groups. One role group pairs a FINDING SITE attribute having a value of 78076003|Structure of lens of eye (body structure)| with an ASSOCIATED MORPHOLOGY attribute having a value of 19130008|Traumatic abnormality (morphologic abnormality)|. The other role group pairs a FINDING SITE attribute having a value of 78066003|Structure of lens of eye (body structure)| with an ASSOCIATED MORPHOLOGY attribute having a value of 128306009|Cataract (morphologic abnormality)|. In addition, there is an IS-A relationship to 262755005|Injury of the lens (disorder)|. Note that this is a different pattern from that used in 34361001|Traumatic cataract (disorder)| and 8656007 |Total traumatic cataract (disorder)|. From a semantic standpoint, it seems preferable to say that a traumatic cataract or opacity is due to an injury to the lens instead of saying that it is a kind of injury to the lens.
  
  
  

• Recommended action as of the January 2017 release: None.

3.4.6.24 Partial resolved traumatic cataract

• The Cataract Pattern Report suggests the addition of an ASSOCIATED MORPHOLOGY attribute with a value of 19130008|Traumatic abnormality (morphologic abnormality)| to the definition of 193598007|Partial resolved traumatic cataract (disorder)|. In the January 2016 International Release, however, this concept has an ASSOCIATED MORPHOLOGY attribute with a value of 128306009|Cataract (morphologic abnormality)| and a DUE TO attribute with a value of and |Injury of lens (disorder)|. The concept remains primitive, but its current state appears to be preferable to the suggestion in the Cataract Pattern Report.
  
  
  

• Recommended action as of the January 2017 release: None.

3.4.6.25 Cataract in degenerative disorder