We have read with great interest the recent article by Papadopoulos et al. [1] reporting early onset posterior subscapular cataract in 9 out of 28 patients with myotonic dystrophy type 2 (DM2). They also mentioned that this type of cataract was the first symptom in 7 (25%) of the studied DM2 patients.

Here, we would like to present our results regarding the incidence of Christmas tree cataract in patients with the most common form of DM, myotonic dystrophy type 1 (DM1). Christmas tree cataract is considered a characteristic finding in subjects with DM1. The retrospective review of medical records of 23 patients with DM1 revealed the presence of Christmas tree cataract in 13 patients (56%). The multicoloured, iridescent lens opacities were unilateral in 10 out of the 13 patients and asymmetric bilateral in 3 patients. Age when cataract was diagnosed was 47 ± 5 years (range: 35–52 years). The cataract was the first sign of the disease for 11 patients and was detected accidentally during a routine ophthalmological examination. Best corrected visual acuity was 0.06 ± 0.08 logMAR (range: −0.1 to 0.2 logMAR). The interval between diagnosis of cataract and DM1 was 10 ± 2 years (range: 7–14 years). This delay is explained by the fact that none of the patients presented typical symptoms of DM1 at the time of the diagnosis of the cataract. Remarkably, apart from Christmas tree cataract, no other form of cataract was detected in the study group, as well as no other pathology regarding the anterior or posterior segment was recorded.

Notably, in previous studies, Christmas tree cataract has been detected in nearly all patients with DM1, and viceversa 16.7% of subjects with Christmas tree cataract have been diagnosed with DM1 [2].

In conclusion, earlier detection of Christmas tree cataract, which constitutes a common ophthalmologic finding in DM1 patients [3, 4], and thus, referral for neuromuscular assessment could possibly eliminate delays in diagnosis of the disease. Noteworthy, it seems that Christmas cataract may be the first manifestation of DM1 in a higher percentage of patients than posterior subcapsular cataract in DM2 patients. Extended multicenter studies may elucidate the exact incidence of the different cataract types in these patients.