Lens Opacities Classification System Research Articles

Ocular Dominance Shift in Refractive Cataract Surgery: A prospective, observational study.

To explore the features of the dominant and non-dominant eyes in patients with cataracts and predict ocular dominance shift (ODS) based on preoperative indicators. and setting: This prospective, observational study was conducted in Changsha Aier Eye Hospital in Changsha, Hunan province, China. Patients with age-related cataracts who underwent unilateral cataract surgery were enrolled in this study. Before the procedure, uncorrected visual acuity (UCVA) was assessed, and non-cycloplegic subjective refraction evaluations were conducted to determine best-corrected visual acuity (BCVA). Total astigmatism, corneal astigmatism, and intraocular astigmatism were measured using OPD-Scan III. Cataract type was assessed using slit-lamp biomicroscopy based on the Lens Opacities Classification System III (LOCS III). Ocular dominance (OD) was determined under corrected conditions using the hole-in-card test. Follow-up visits occurred at 1 day, 1 week, and 1-month post-surgery. After 1 month, OD was re-evaluated, and participants completed the Catquest-9SF questionnaire. 94 patients (188 eyes) were enrolled in the study. The analysis showed that the ODS rate of unilateral cataract surgery was 40.4%. In addition, age, uncorrected visual acuity of non-dominant eye, posterior subcapsular cataract and total astigmatism are risk factors for ODS. Besides, no difference in vision-related quality of life was detected between patients who had ODS and those who did not. We identified several preoperative parameters as potential risk factors of ODS after cataract surgery. These findings provide guidance for predicting changes in the dominant eye, thus improve the precise selection of intraocular lenses and the implementation of monovision strategies.

Feasibility of shear wave elastography for evaluating lens stiffness in patients with age-related cataracts: A quantitative analysis

BackgroundShear wave elastography (SWE) is a novel imaging technique that provides quantitative assessments of tissue stiffness. This non-invasive method offers real-time, quantitative measurements and has been widely applied to various tissues, providing valuable diagnostic insights. PurposeThis study aimed to investigate the feasibility of using SWE to evaluate the stiffness of the lens in patients with age-related cataracts. Materials and methodsA comparative analysis involving 92 patients diagnosed with age-related cataracts and 39 healthy controls was conducted. Lens stiffness was quantified using SWE measurements. The lens nucleus of all participants was graded based on the Lens Opacities Classification System II (LOCS II). Correlations between the stiffness of the lens and age were also analyzed. ResultsThe study indicates that both the stiffness of the lens and the lens nucleus were significantly higher in patients with age-related cataracts compared to healthy controls (P < 0.001). In patients with age-related cataracts, although lens nucleus stiffness variations across different grades of cataract severity were not statistically significant, all grades displayed increased stiffness relative to healthy controls. Additionally, a significant positive correlation between lens stiffness and age was observed in all participants (P < 0.001). ConclusionSWE appears to be a promising imaging technique for quantitatively assessing the mechanical characteristics of the lens in patients with age-related cataracts.

Intraoperative quantitative crystalline lens nuclear opacities analysis based on crystalline lenSx platform

PurposeThe main objective is to quantify the lens nuclear opacity using spectral-domain optical coherence tomography (SD-OCT) and to evaluate its association with Lens Opacities Classification System III (LOCS-III) system, lens thickness (LT), and surgical parameters. The secondary objective is to assess the diagnostic model performance for hard nuclear cataract.MethodsThis study included 70 eyes of 57 adults with cataract, with 49 (70%) and 21 (30%) in training and validation cohort, respectively. Correlations of the average nuclear density (AND) /maximum nuclear density (MND) with LOCS-III scores, LT, and surgical parameters were analyzed. Univariate and multivariate logistic regression analysis, receiver operating characteristic curves and calibration curves were performed for the diagnostic of hard nuclear cataract.ResultsThe pre-operative uncorrected distance visual acuity (UDVA), intraocular pressure (IOP), mean axial length (AL), and LT were 1.20 ± 0.47 log MAR, 15.50 ± 2.87 mmHg, 27.34 ± 3.77 mm and 4.32 ± 0.45 mm, respectively. The average nuclear opalescence (NO) and nuclear colour (NC) scores were 3.61 ± 0.94 and 3.50 ± 0.91 (ranging from 1.00 to 6.90), respectively. The average AND and MND were 137.94 ± 17.01 and 230.01 ± 8.91, respectively. NC and NO scores both significantly correlated with the AND (rNC = 0.733, p = 0.000; rNO = 0.755, p = 0.000) and MND (rNC = 0.643, p = 0.000; rNO = 0.634, p = 0.000). In the training cohort, the area under the curve (AUC) of the model was 0.769 (P < 0.001, 95%CI 0.620–0.919), which had a good degree of differentiation (Fig. 2a). The calibration curve showed good agreement between predicted and actual probability.ConclusionThe nuclear density measurement on SD-OCT images can serve as an objective and reliable indicator for quantifying nuclear density.

Surgical Efficiency Comparison Between Two Phacoemulsification Systems.

To assess the surgical efficiency in cataract surgery comparing two phacoemulsification systems. Prospective, consecutive-comparative study in a two-site private practice. Three hundred and one eyes undergoing standard or femtosecond laser-assisted (FLACS) cataract surgery with either the R-Evo Smart (BVI, Waltham, USA) and/or the Centurion Vision System (Alcon, Fort Worth, USA). Preoperative eye characteristics (degree of cataract using the lens opacities classification system LOCS III grading) and intraoperative outcomes (total ultrasound time and total estimated fluid aspirated/drainage bag weighting) were registered in all cases. One hundred and fifty-five eyes undergone cataract surgery with the R-Evo Smart and 146 eyes with the Centurion Vision System phacoemulsification systems. Mean cataract grade was 3.07 ± 0.78 and 2.96 ± 0.85 for the R-Evo Smart and Centurion Vision System groups, respectively (p = 0.12). Mean total ultrasound time was 18.99 ± 12.85 and 40.24 ± 21.91 seconds for the R-Evo Smart and Centurion Vision System groups, respectively (p < 0.01). Mean total estimated fluid aspirated/drainage bag weighting was 53.00 ± 14.56 g and 54.33 ± 14.88 cc for the R-Evo Smart and Centurion Vision System groups, respectively (p = 0.21). Considering non-FLACS surgery (98 eyes with the R-Evo Smart and 63 eyes with the Centurion Vision System), mean cataract grade was 2.95 ± 0.74 and 2.97 ± 0.91 for the R-Evo Smart and Centurion Vision System groups, respectively (p = 0.44). Mean total ultrasound time was 19.96 ± 11.20 and 42.84 ± 28.35 seconds for the R-Evo Smart and Centurion Vision System groups, respectively (p < 0.01). Mean total estimated fluid aspirated/drainage bag weighting was 55.95 ± 14.76 g and 55.97 ± 13.62 cc for the R-Evo Smart and Centurion Vision System groups, respectively (p = 0.49). No adverse events were found in the two groups of eyes. The objective measurement of surgical efficiency through total ultrasound time during lens removal and fluid consumption during both lens removal and irrigation/aspiration proved R-Evo Smart to be an efficient phacoemulsification platform, in comparison with the current standard of care Centurion Vision System.

Nuclear Grades based on Lens Opacities Classification System III associated with Phacoemulsification Parameters and Postoperative Central Corneal Thickness

Abstract&#x0D; Introduction &amp; Objectives : To determine association of nuclear cataract grades based on Lens Opacities Classification System (LOCS) III with phacoemulsification parameters and postoperative Central Corneal Thickness (CCT) and visual acuity.&#x0D; Methods : This was a prospective observational study in patient with uncomplicated senile cataract who gave consent and underwent phacoemulsification. Institutional Ethics Committee clearance was taken for the study. Preoperative nuclear cataract was evaluated using Lens Opacities Classification System (LOCS) III. Only nuclear grading NO and NC was obtained. All procedures was performed using peristaltic phaco machine and in the bag IOL implantation. Phacoemulsification parameters (US Total Time and CDE) were noted and compared in different grades of cataract. CCT change was recorded at day one after surgery.&#x0D; Results : Forty-six patients were evaluated. The mean USTT was 120.85 (56-252) seconds, mean CDE was 21.10 (5.70 – 43.38), and mean CCT change after surgery was 81.54(27 – 240). Nuclear grading of LOCS also had linear correlation with US Total Time (NO p&lt;0.001, r=0.734; NC p&lt;0.001, r=0.790) and CDE (NO p&lt;0.001, r=0.728; NC p&lt;0.001, r=0.685). There was significant correlation between CCT change with postoperative VA (p=0.002, r=0.443) and CDE (p&lt;0.001, r= 0.553). CCT change also correlate with nuclear opacity (p=0.012, r=0.367) and nuclear color (p=0.035, r=0.312).&#x0D; Conclusion : Nuclear grading of LOCS III related to the amount of time and energy used in phacoemulsification, and also CCT change after surgery as a qualitative measurement of corneal edema. Increasing postoperative CCT affected patient's visual acuity after cataract surgery.

Mix-and-match vs bilateral trifocal and bilateral EDOF intraocular lens implantation: the spline curve battle.

To compare the postoperative visual acuity curves following 3 pseudophakic presbyopic correction techniques. Department of Ophthalmology, University Hospital of Alexandroupolis, Alexandroupolis, Greece. Prospective, randomized, comparative trial. For this study, patients with stage 2 Lens Opacities Classification System III cataract were divided into 3 study groups: (1) premium monovision group, including patients who received the Panoptix intraocular lens (IOL) in the recessive eye and Vivity IOL in the dominant one; (2) bilateral trifocal group, including those who received bilaterally the Panoptix IOL; and (3) bilateral xEDOF group, including patients who received bilaterally the Vivity IOL. Postoperative bilateral uncorrected distance visual acuity was measured at 25.5, 28, 33, 40, 50, 66, 100, 200, and 300 cm distances. Spline curve fitting was attempted, and areas of the curves (AOCs) and curvature k were calculated. All patients responded to the National Eye Institute Visual Functioning Questionnaire-25 (NEI-VFQ-25). 90 patients were equally divided into the 3 groups. Premium monovision and bilateral trifocal implantations delivered similar visual acuity (all AOC P > .05); however, the trifocal patients suffered from drops in vision acuity in certain distance ranges as expressed by negative curvature values. Bilateral xEDOF patients demonstrated worse near vision acuity ( P < .05). Premium monovision patients reported better scores in NEI-VFQ 25 ( P = .03) and in the near activities ( P = .02) and distant activities ( P = .04) subscales. All surgical options provided impressive outcomes. Premium monovision appeared to deliver the best results.

Senile Cataract Formation Does Not Affect Crystalline Lens Thickness.

Characterizing lens thickness (LT) in patients with cataracts is important for better understanding the lens aging process and for designing new intraocular lens power formulas. This study aimed to analyze the influence of common senile cataract formation on the LT, anterior (ACS) and posterior (PCS) cortex space, and nuclear thickness (NT), controlling for sex, age, and axial length. A cross-sectional study was performed. A consecutive sample of 603 volunteers (403 women, 200 men) aged 59.1 ± 18.8years was recruited. The standardized Lens Opacification Classification System (LOCS)-III was used to classify eyes (randomly selected) into cataractous and non-cataractous groups. Also, they were classified according to the cataract location (presence or absence of cortical, nuclear, or posterior subcapsular cataract). Optical biometry was performed to measure LT, ACS, NT, and PCS. Propensity score was used to match participants one-to-one for sex, age, and axial length. Groups were compared using the Student's ttest or Yuen's test. The four classifications divided unmatched eyes into: 361 cataractous lenses and 242 non-cataractous, 226 cortical and 377 non-cortical cataractous, 313 nuclear and 290 non-nuclear cataractous and 242 subcapsular and 361 non-subcapsular cataractous. Before matching, cataractous eyes showed significantly higher LT (4.52 ± 0.39 vs. 3.94 ± 0.46mm, p < 0.001), ACS (0.75 ± 0.20 vs. 0.58 ± 0.23mm, p < 0.001), NT (3.34 ± 0.23 vs. 3.18 ± 0.25mm, p < 0.001) and PCS (0.42 ± 0.19 vs. 0.37 ± 0.19mm, p = 0.003). Matched lens, cortical, nuclear, and subcapsular cataract samples comprised 146, 258, 182, and 226 eyes, respectively. After matching, no significant differences were observed in LT (4.34 ± 0.37 vs. 4.33 ± 0.36mm, p = 0.94), ACS (0.72 ± 0.20 vs. 0.76 ± 0.19mm, p = 0.08), NT (3.31 ± 0.22 vs. 3.30 ± 0.23mm, p = 0.24) and PCS (0.42 ± 0.19 vs. 0.43 ± 0.16mm, p = 0.79). The presence of senile cortical, nuclear, and posterior subcapsular cataract have no effect on LT, ACS, NT, and PCS. Confounding factors should be controlled for when measuring LT and its main components.

Changes in endothelial cell density after conventional phacoemulsification and FLACS in eyes with dense cataracts.

To compare the safety, effectiveness, and changes in endothelial cell density (ECD) after standard phacoemulsification and femtosecond laser-assisted cataract surgery (FLACS) in dense cataracts (Lens Opacities Classification System III grade 3.0 NO and above). Nethradhama Superspeciality Eye Hospital, Bangalore, India. Prospective, randomized, comparative study. 100 eyes of 100 patients were randomly assigned to either conventional phacoemulsification surgery (CPS) or FLACS (LENSAR Laser System) using predefined patterns of nuclear fragmentations. Measured outcomes included intraoperative phacoemulsification time, irrigation fluid volume, surgical time, and complication rates. ECD was evaluated at baseline, 2 weeks, and 6 months postoperatively. The CPS group had significantly higher mean total phacoemulsification time (11.17 ± 6.5 seconds vs 8.03 ± 3.77 seconds), effective phacoemulsification time (6.14 ± 3.62 seconds vs 4.42 ± 2.07 seconds), and total surgical time (8.18 ± 2.36 minutes vs 7.11 ± 1.55 minutes) than the FLACS group ( P < .001). Volume of irrigation fluid was comparable between the 2 groups (CPS, 36.7 ± 12.18 mL; FLACS, 38.64 ± 13.73 mL ( P = .45). Mean corneal edema score and central corneal thickness values on postoperative day 1 were significantly higher for the CPS group. At 6 months, % ECD loss was significantly higher in the CPS group (16.08%) vs the FLACS group (12.8%) ( P < .001). 3 eyes in the CPS group had wound burns of varying severity. FLACS with customized nuclear fragmentation patterns resulted in significantly less intraoperative phacoemulsification time, surgical time, and endothelial cell loss compared with conventional phacoemulsification when treating dense cataracts. CTRI/2021/12/038887.

Thickness of the crystalline lens does not depend on cataract formation

Aims/Purpose: To assess the influence of cataract formation on the lens thickness (LT), anterior (ACS) and posterior (PCS) cortex space and nuclear thickness (NT).Methods: A prospective cross‐sectional study including patients seeking for cataract surgery was performed. The standardized Lens Opacification Classification System (LOCS)‐III was used to classify lens opacities. A control group composed of non‐cataractous patients was also created. In addition, cataract patients were also classified according to the cataract location (presence or absence of cortical, nuclear or posterior subcapsular cataract). Optical biometry was performed to measure LT, ACS, NT and PCS. Propensity score was used to match cataract and non‐cataract patients one‐to‐one for sex, age and axial length. Groups were compared using the Student's t‐test or Yuen's test.Results: A sample of 603 volunteers (403 females, 200 males) aged 59.1 ± 18.8 years was recruited. Before matching, the lens cataract and the non‐cataract group was composed of 361 cataractous and 242 non‐cataractous volunteers. Also, all participants were classified into cortical and non‐cortical cataract groups (226 vs. 377), nuclear and non‐nuclear cataract groups (313 vs. 209) and into subcapsular and non‐subcapsular cataract groups (242 vs. 361). Before matching, cataract groups showed significant (p ≤ 0.003) higher LT (4.52 ± 0.39 vs. 3.94 ± 0.46 mm), ACS (0.75 ± 0.20 vs. 0.58 ± 0.23 mm), NT (3.34 ± 0.23 vs. 3.18 ± 0.25 mm) and PCS (0.42 ± 0.19 vs. 0.37 ± 0.19 mm). After matching, the lens, cortical, nuclear and subcapsular cataract samples were composed of 146, 258, 182 and 226 participants, respectively. Then, no significant (p ≥ 0.08) differences were found for LT, ACS, NT and PCS.Conclusions: Thickness of the lens and/or its main components is not changed due to cataract formation. The progressive lens growth associated to aging might be the main confounding factor misleading the outcomes of previous studies that reported differences in LT between cataractous and non‐cataractous patients.

Effects of cataract on peripapillary retinal nerve fibre layer and ganglion cell‐inner plexiform layer thickness measurement by cirrus optical coherence tomography

Aims/Purpose: To assess the effect of cataract on peripapillary retinal nerve fibre layer (pRNFL) thickness and macular ganglion cell‐inner plexiform layer (mGC‐IPL) thickness measured by Cirrus (Carl Zeiss Meditec, Dublin, California, USA) spectral domain–optical coherence tomography (OCT).Methods: Cirrus OCT was used to measure the pRNFL thickness and mGC‐IPL thickness in 44 patients (63 eyes) patients with cataract, including 43 glaucoma eyes. Cataracts were graded according to the Lens Opacities Classification System III. The study aimed to identify factors that could contribute to segmentation errors and variations in the signal strength index (SSI) or average thickness of mGC‐IPL and pRNFL.Results: The prevalence of preoperative segmentation error were higher in pRNFL measurements compared with mGC‐IPL measurements (36.5% vs. 19.0%, p = 0.046). Multivariate analysis showed that segmentation error in RNFL measurements was significantly associated with preoperative SSI. Multivariate analysis indicated that preoperative SSI was highly correlated with changes with average thickness changes of mGC‐IPL and pRNFL.Conclusions: Among eyes with cataract, the occurrence of segmentation errors was more common in measurements of the pRNFL compared to measurements of mGC‐IPL. Following cataract surgery, there was a slight increase in all thickness parameters in both mGC‐IPL and pRNFL measurements, although the differences were not statistically significant (p = 0.102 and p = 0.151, respectively). It is important to identify segmentation errors, particularly in pRNFL measurements of eyes with cataract and low SSI.

An Observational Study on Morphological Types of Cataracts in Hypertensive Patients

Purpose: To evaluate common morphological types of cataracts in patients with hypertension (HTN) alone (hypertensive patients) planned for cataract surgery. Methods: It is a prospective cross-sectional study. It was conducted in the Department of Ophthalmology at a tertiary eye care centre from January 2022 to June 2022. Hypertensive patients, without any other systemic diseases, who presented with cataract in either of their eyes were included in the study. The classification of cataract was performed according to the Lens Opacities Classification System III. Results: Two hundred and eighty eyes of 140 patients were included in the study. The mean age of presentation was 64.9 ± 7.38 years(median 67 years; range 39.81 years). There were 63 (45%) males, and the rest were females. Of 140, 14 patients were below the age of 55 years, 2 patients were above 75 years, and the majority (42 patients) belonged to the age group between 67 and 70 years. Nuclear sclerosis (NS) cataract was the most common morphological type found in the eyes of hypertensive patients followed by posterior subcapsular cataract (PSC). PSC significantly correlated with HTN when compared to other types of cataracts excluding NS (P &lt; 0.0001). No significant relation was found between the grade of HTN and the grade of NS. Conclusion: Apart from the risk of formation of any type of cataract, NS and PSC were more commonly found in patients with HTN. Moreover, PSC was closely related to HTN when compared to other types of cataracts excluding NS.

Objective and independent measurement of scattering caused by the cornea and crystalline lens

meritxell.vilaseca@upc.eduThere are several methods that provide information on the intraocular scattering. Procedures based on the observation of the lens through the slit lamp from which a gradation of the state of every cataract is assessed (e.g. lens opacities classification system III ‐ LOCS III) are the most widely used in clinics. Nevertheless, they provide information related to the back‐scattered light and not forward scattering, which is responsible for the degradation of vision. To do so, a procedure that assess retinal straylight using a device based on a psychophysical compensation‐comparison approach was proposed, in which the subject's task is a forced‐choice between two half fields to decide which one flickers more intensely. From these measurements, a psychometric function is fitted and used to determine the straylight compensation level log(s) on the basis of a few stimuli responses.As an alternative approach, some attempts have been made to use the double‐pass as a means of objectively estimating forward scattering. The double‐pass technique is a procedure that is able to capture the complete optical information of the eye, including the effect of higher‐order aberrations and intraocular scattering within a small visual angle. Artal et al. proposed the Objective Scatter Index (OSI) calculated from double‐pass images for estimating scattering with the intention to grade cataracts. This technique was also used successfully to account for scattered light in patients with keratitis and uveitis, and those undergoing refractive surgery. More recently, a new Frequency Scatter Index (FSI3) based on the analysis of double‐pass retinal images in the frequency domain has also been suggested, as a means of minimizing the impact of optical aberrations on the results obtained.Nevertheless, all of the former methods provide information on the total scattered light in the eye, which consists of the combined contributions originating from different ocular structures. In this regards, we recently proposed a technique for the objective and independent assessment of scattering caused by the cornea and the lens based on the analysis of the contrast of the third and fourth Purkinje images. The technique was preliminarily validated first by using artificial eyes with different levels of corneal and lens scattering; second, it was validated in eyes wearing customized contact lenses to simulate corneal scattering and eyes with nuclear cataracts. Finally, it was tested on a larger population of eyes with cataracts and corneal disorders to prove its clinical usefulness.In this work, we review all the above‐mentioned techniques that have been proposed for objective intraocular scattering assessment, putting especial emphasis on the last one based on Purkinje images, and compare their results and clinical performance.

Lens Opacities Classification System III-Based Computational Model of Nuclear Cataracts

Lens Opacities Classification System III-Based Computational Model of Nuclear Cataracts

Differences between the Results Assessed by Slit Lamp Examination and Anterior Segment Photography in Terms of Cataract Grading

Purpose: We compared the cataract grades with slit lamp examination and anterior segment photography using the Lens Opacities Classification System (LOCS) III criteria. We also explored the effect of a yellow filter on the photographic results.Methods: Eighty eyes with cataracts were examined by three inspectors (1, 2, and 3). Anterior segment photographs taken by inspector 1 were divided into two groups depending on whether cortical opacity or nuclear sclerosis predominated. In each group, the cataract grades determined by inspector 1 on slit lamp examination and anterior segment photography were compared. Also, after randomly assigning the anterior segment photographs taken by inspector 1 to inspectors 2 and 3, the cataract grades of these photographs were compared to the grades of photographs taken by all inspectors using a yellow filter.Results: The average cortical opacity evaluated by inspector 1 on slit lamp examination (3.48 ± 0.91) was significantly higher than that apparent on anterior segment photographs (2.35 ± 0.77) (&lt;i&gt;p&lt;/i&gt; &lt; 0.001). In the photographs, the average cortical opacity when a yellow filter was used was significantly higher for both inspectors 1 (&lt;i&gt;p&lt;/i&gt; &lt; 0.001) and 2 (&lt;i&gt;p&lt;/i&gt; = 0.022) than when the filter was absent. The average extent of nuclear sclerosis evaluated by inspector 1 on slit lamp examination (4.08 ± 0.94) was significantly higher than that of anterior segment photography (3.73 ± 1.24) (&lt;i&gt;p&lt;/i&gt; = 0.042).Conclusions: Cataract evaluation via anterior segment photography underestimates the extent of damage compared to direct slit lamp examination. However, use of a yellow filter during photography aids cataract evaluation, especially cortical opacity.

Axial length acquisition success rates and agreement of four optical biometers and one ultrasound biometer in eyes with dense cataracts

BackgroundTo evaluate the axial length acquisition success rates and agreement between various biometric parameters obtained with different biometers in dense cataracts.MethodsFifty-one eyes were measured using Anterion®, Argos® and IOLMaster® 700 swept-source optical coherence tomography (SS-OCT) biometers, a Pentacam® AXL partial coherence interferometry (PCI) biometer, and an OcuScan® RxP ultrasound biometer. We measured keratometry (K1, flattest keratometry and K2, steepest keratometry), white-to-white (WTW), anterior chamber depth (ACD), lens thickness (LT) and axial length. Cataracts were classified according to the Lens Opacities Classification System III grading system, the dysfunctional lens index (DLI) and Pentacam® nucleus staging (PNS) metrics. Percentage of acquisition success rate and a Bland–Altman analysis for the agreement between biometers were calculated.ResultsThe mean LOCS III score was 3.63 ± 0.92, the mean DLI was 2.95 ± 1.30 and the mean PNS was 2.36 ± 1.20. The acquisition success rates for the Anterion®, Argos®, IOLMaster® 700, Pentacam® AXL and OcuScan® RxP biometers were 94.12%, 100%, 98.04%, 60.78% and 100%, respectively. There were significant differences in the success rates between biometers (P = 0.014). There were statistically significant differences between biometers for all parameters evaluated (P < 0.05). The range of the limit of agreement (LoA) for all comparisons of K1 and K2 were > 1.00 D. The LoA for WTW ranged from 0.095 to 1.050 mm. The LoA for ACD and LT ranged from 0.307 to 0.114 mm and from 0.378 to 0.108 mm, respectively. The LoA for axial length ranged from 0.129 to 2.378 mm.ConclusionsAmong optical biometers, those based on SS-OCT technology are more successful at measuring axial length in eyes with dense cataracts.Trial Registration: The study was registered with the National Institutes of Health (clinical trial identifier NCT05239715, http://www.clinicaltrials.gov).

Cataract Grade and Pupil: Comparison Between Conventional Phacoemulsification and Low-Energy Femtosecond Laser Assisted Cataract Surgery.

This study presents a comparison of pupil changes according to cataract grade between low-energy femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification (CP) in the same patient. Data from surgical records from patients submitted to cataract surgery with CP in one eye and FLACS in the other were retrospectively reviewed. The inclusion criterion was both eyes of the same patient having the same cataract grade in accordance with Lens Opacity Classification System (LOCS) III. Total pupil variation (TPV) was measured after recorded images, with intraindividual comparison between techniques, according to cataract grade (≤3 and >3), age and cumulative dissipated energy (CDE). The study included a total of 124 eyes of 62 patients (mean age 72.65 ± 7.64 years). Analysis showed a statistically significant difference in TPV between techniques in the grade ≤3 cataract group (0.08 ± 0.22 mm²; p=0.034), with less pupil narrowing with FLACS, but not in the grade >3 group (0.01 ± 0.23 mm²; p=0.849). Regarding CDE, a significant difference (p<0.001) was found between techniques in both softer and harder cataracts, with lower values for FLACS. Correlation between CDE and TPV was significant for CP (p=0.021) but not for FLACS (p=0.922). TPV was significantly lower in older patients (age >74 years) for both techniques (p<0.001). There was a statistically significant difference between techniques (although of mild clinical relevance), with less reduction of pupil area with FLACS in softer cataracts (grade ≤3), as compared to CP. Higher levels of CDE are associated with more pupil narrowing in CP.

Phacoemulsification Tip Elongation Under Standardized Resistance: An Objective Measure of Human Crystalline Lens Hardness.

To establish a correlation between phacoemulsification tip normalized driving voltage (NDV) and crystalline lens hardness and use it as an objective measure of lens hardness. The study used a phaco tip equipped with previously validated elongation control adjusting the driving voltage (DV) to produce invariant elongation regardless of resistance. The laboratory study measured the mean and maximum DV of the phaco tip immersed in glycerol-balanced salt solution and correlated the DV with the kinematic viscosity at 25, 50, and 75 µm tip elongation. The NDV were obtained by dividing the DV in glycerol by the DV in the balanced salt solution. The clinical arm of the study recorded DV of 20 consecutive cataract surgeries. The correlation of mean and maximum NDV to Lens Opacities Classification System (LOCS) III classification, patient's age and effective phaco time were evaluated. The mean and maximum NDV correlated with the kinematic viscosity of the glycerol solution (P < 0.001 in all cases). Mean and maximum NDV during cataract surgery correlated with patients' age, effective phaco time, LOCS III nuclear color, and nuclear opalescence (P < 0.001 in all cases). When a feedback algorithm is running, DV variation strictly correlates with encountered resistance in glycerol solutions and real-life surgery. NDV significantly correlates with the LOCS classification. Future developments might include sensing tips that react to lens hardness in real time. The study correlates for the first time phaco tip DV and crystalline lens mechanical properties, establishing an objective and reliable measure of lens hardness. This may lead to smart phaco tips reacting to cataract hardness change in real time and sparing ultrasound dispersion.

Correlation Between Lens Density Measured by Swept-Source Optical Coherence Tomography and Phacodynamic Parameters of Centurion Phacoemulsification

Purpose To evaluate the correlation between lens density measured by IOL-Master 700 based on swept-source optical coherence tomography (SS-OCT) technology and the phacodynamic parameters of Centurion phacoemulsification in cataract surgery. Methods This prospective study included 66 patients (83 eyes) with age-related cataracts. Using the Lens Opacities Classification System III (LOCS III), the lens nuclear color (NC), lens nuclear opalescence (NO), cortical (C), and posterior subcapsular (P) opacities were obtained. Six meridian orientations of IOL-Master 700 images were captured, and the lens and nuclear regions were analyzed using ImageJ to generate the average lens nucleus density (AND) and average lens density (ALD). Phacodynamic parameters were recorded. The correlation between lens density and the phacodynamic parameters was analyzed. According to the AND, patients were divided into four groups (soft, medium-hard, hard, and extremely hard nucleus), and the phacodynamic parameters were compared among groups. Results The correlation between the AND obtained by LOCS III grading and SS-OCT-based cataract quantification system score (NC and NO) was statistically significant (r NC = 0.795, r NO=0.794, both p = .000). AND correlated significantly with cumulative dissipated energy (CDE, r = 0.545, p = .000), total ultrasound time (TUST, r = 0.354, p = .001), and total torsional ultrasound time (TTUT, r = 0.314, p = .004). Among the four groups divided by AND, the difference in CDE (P 13 = 0.002, P 14 < 0.001, P 24 = 0.002) was statistically significant. Conclusion AND measured by IOL-Master 700, SS-OCT correlated significantly with LOCS III classification and phacodynamic parameters of the Centurion system, especially with CDE, TUST, and TTUT. AND can be used as an indicator for quantitative evaluation and help inform the surgical plan.

New technology using crystalline lens autofluorescence for presbyopia and cataract grading.

To investigate whether fundus autofluorescence (FAF) obtained using an ultra-wide field (UWF) fundus camera with an artificial opacity pattern can grade the degree of presbyopia and nuclear cataract. Sixty eyes of 30 patients were enrolled in this prospective diagnostic study. The nuclear cataract (nuclear color/opalescence (NC/NO)) was graded according to the Lens Opacity Classification System III. The monocular near point of accommodation (NPA) was measured in eyes with NC3/NO3 or less. The mean gray value difference between the central 8 artificial opacity lesions and peripheral 8 artificial opacity lesions in the retinal AF was measured. The correlation between the mean gray value difference, NPA, and nuclear cataract grade was analyzed. The mean nuclear cataract grade of 60 eyes was 3.2 ± 1.6 and mean NPA of 37 eyes was 45.3 ± 16.1 cm. The mean gray value differences increased with increasing nuclear cataract grade (eyes with NC/NO grade 1, 53.3 ± 11.4; 2, 78.3 ± 13.6; 3, 95.2 ± 12.2; 4, 101.6 ± 11.9; 5, 109.0 ± 22.9; and 6, 121.1 ± 12.0; p < 0.001). The mean gray value difference was positively correlated with both the monocular NPA (R2 = 0.637; β coefficient = 1.009; 95% CI, 0.748 to 1.271; p < 0.001) and nuclear cataract grade (R2 = 0.661; β coefficient = 12.437; 95% CI, 10.097 to 14.778; p < 0.001). The FAF camera with an artificial opacity pattern attached can be used to effectively diagnose the degree of presbyopia and nuclear cataract.

Analysis of the Dysfunctional Lens Index as a Novel Criterion for Surgical Decision-Making in Age-Related Cataracts

ABSTRACT Background The dysfunctional lens index (DLI) provided by a ray-tracing aberrometry system is an objective index in cataract assessment. The purpose of this study is to evaluate correlations among Lens Opacities Classification System III (LOCS III) grades, Catquest 9SF scores, and the (DLI) and the DLI’s role in surgical decision-making in age-related mixed cataract. Methods This trial was registered at NIH (clinicaltrial.gov) on January 5, 2021 (NCT04711395). In this prospective cross-sectional study, age-related mixed cataract patients were recruited. One high-volume and two low-volume surgeons made surgical decisions based on corrected distance visual acuity (CDVA), LOCS III graded photographs, and Catquest 9SF scores. Their decision-making agreement was evaluated with Cohen’s kappa coefficient. Correlations among the parameters were analyzed. The optimal cut-off DLI was calculated using a receiver operating characteristic curve. Results Overall, 106 patients (106 eyes) were included. Very good agreement levels were noted among the high- and low-volume surgeons (Cohen’s kappa coefficient, 0.848) (95% CI, 0.748–0.948). The DLI had the strongest correlation with Catquest 9SF scores (R2 = 0.566), followed by with posterior subcapsular (R2 = 0.418), nuclear opalescence (R2 = 0.388), and cortical (R2 = 0.333, all P < .0001) cataract LOCS III grades. Catquest 9SF scores were correlated with cortical (R2 = 0.249), nuclear opalescence (R2 = 0.278), and posterior subcapsular (R2 = 0.235, all P < .0001) cataract LOCS III grades. A cut-off DLI of 5.36 was identified as a surgical criterion (specificity, 86.9%; sensitivity, 93.3%). Conclusions The DLI is valuable for objectively assessing patient complaints and lens opacity severity. LOCS III remains effective and economical in assessing early cortical cataracts with relatively clear central lenses. A cut-off DLI ≤5.36 could be a criterion for preoperative decision-making.