Lens Opacities Classification System Research Articles

The Association Between Aqueous Connective Tissue Growth Factor and the Severity of Age-related Cataracts as Graded by the Lens Opacities Classification System III

ABSTRACTPurpose: To evaluate the relationship between aqueous humor concentrations of connective tissue growth factor (CTGF) and the severity of age-related cataracts.Materials and Methods: We conducted a prospective clinical study on 43 eyes of 43 patients with senile cataracts scheduled to undergo routine phacoemulsification surgery. Before surgery, all patients were graded for cataract severity using the Lens Opacities Classification System III in terms of four features: nuclear opalescence (NO), nuclear color (NC), cortical cataracts (C), and posterior sub-capsular cataracts (P). During surgery, aqueous humor samples were obtained from all patients, and sandwich enzyme-linked immunosorbent assays (ELISAs) were used to determine CTGF concentrations. To assess any relationship between cataract severity and CTGF levels of the aqueous humor, various correlation analyses and multiple linear regression were used.Results: We found a positive correlation between the overall cataract grade and aqueous CTGF level (p < 0.05). In addition, four features of the cataract grade (nuclear opalescence, nuclear color, cortical cataract and posterior sub-capsular cataract) were positively correlated with the aqueous CTGF concentration (p < 0.05). The final regression model identified overall cataract grade as an independent predictor of increased CTGF levels in the aqueous humor (p < 0.05).Conclusions: CTGF tends to increase in the aqueous humor as the severity of age-related cataracts increases. Therefore, this cytokine may play an important role in the pathogenesis of age-related cataracts. Additional studies are required for clarification of this finding.

Association between metabolic syndrome and age-related cataract.

To determine the effect of metabolic syndrome on age-related cataract formation. We analyzed data for 2852 subjects [41.8% men and 58.2% women; mean (±SD) age, 52.9±13.9y], taken from the Korea National Health and Nutrition Examination Survey 2008. Metabolic syndrome was diagnosed by criteria proposed by the Joint Interim Societies. Cataract was diagnosed by using the Lens Opacities Classification System III. The association between metabolic syndrome and cataract was determined using age-adjusted and multivariable logistic regression analyses. In multivariable analyses, men with metabolic syndrome had a 64% increased risk of nuclear cataract [odds ratio (OR), 1.64; 95% confidence interval (CI), 1.12-2.39]. Women with metabolic syndrome had a 56% increased risk of cortical cataract (OR, 1.56; 95% CI, 1.06-2.30). Men and women with metabolic syndrome had a 46% (OR, 1.46; 95% CI, 1.01-2.12) and 49% (OR, 1.49; 95% CI, 1.07-2.08) increased risk of any cataract, respectively. The prevalence of nuclear and any cataract significantly increased with an increasing number of disturbed metabolic components in men, and prevalence of all types of cataracts increased in women. Men using hypoglycemic medication had an increased risk of nuclear (OR, 2.62; 95% CI, 1.41-4.86) and any (OR, 2.27; 95% CI, 1.14-4.51) cataract, and women using antidyslipidemia medication had an increased risk of cortical (OR, 2.18; 95% CI, 1.12-4.24) and any (OR, 2.21; 95% CI, 1.14-4.26) cataract. Metabolic syndrome and its components, such as abdominal obesity, high blood pressure, and impaired fasting glucose, are associated with age-related cataract formation in the Korean population.

Relationship between Corneal Guttae and Quality of Vision in Patients with Mild Fuchs' Endothelial Corneal Dystrophy

To investigate the effect of the severity of corneal guttae on quality of vision (QOV) in patients with mild Fuchs' endothelial corneal dystrophy (FECD). Cross-sectional study. Twenty-three eyes of 14 patients with mild FECD without corneal edema on slit-lamp examination (5 pseudophakic eyes and 18 phakic eyes with mild lens opacity; grade 1.0-2.0 nuclear opalescence, grade 1.0-2.0 nuclear color, grade 1.0 cortical cataract, and grade 1.0 posterior subcapsular cataract on the Lens Opacities Classification System, version III). The area ratio of the corneal guttae (ARCG) in the endothelial cells was measured by multifocal specular microscopy. The QOV parameters, that is, corrected distance visual acuity (CDVA), letter contrast sensitivity (LCS), and intraocular straylight, also were measured. The correlations were assessed between the ARCG and QOV parameters and between the straylight and CDVA and LCS. The ARCG, logarithm of the minimum angle of resolution CDVA, LCS, and straylight. Univariate analysis showed that the ARCG was correlated significantly with the CDVA, LCS, and straylight (R(2) = 0.41, P = 0.001; R(2) = 0.55, P = 0.001; and R(2) = 0.39, P = 0.002, respectively). Univariate analysis also showed that straylight was correlated significantly with the CDVA and LCS (R(2) = 0.47, P = 0.001 and R(2) = 0.41, P = 0.001, respectively). Corneal guttae without edema caused the QOV to deteriorate in eyes with FECD. Patients with higher straylight had worse CDVA or LCS. Intraocular forward light scatter caused by corneal guttae may result in visual disturbances. Quantification of corneal guttae can be useful to evaluate the effect of guttae on the QOV and determine the surgical indications of endothelial keratoplasty for eyes with mild FECD.

Protracted low-dose radiation exposure and cataract in a cohort of Chinese industry radiographers

ObjectivesThe aim of this study was to assess the risk of cataract following protracted low doses of radiation exposure among industry radiographers and comparison groups of unexposed workers.MethodsA cohort of...

Investigation of phacoemulsification on exfoliation syndrome combined cataract with different nuclear hardness.

We investigated the clinical staging and management of cataracts to decrease the incidence of complications of phacoemulsification and improve the postoperative visual function of patients with exfoliation syndrome (XFS) with cataract. Cataracts with XFS were divided into early, middle, and late stages using the Emery-Little lens opacities classification system. Phacoemulsification and intraocular lens (IOL) implantation were performed in all eyes. The incidences of intraoperative and early postoperative complications of phacoemulsification were compared, and differences in the outcomes of phacoemulsification were evaluated. There were 23, 31, and 34 eyes with early-, middle- and late-stage XFS, respectively. The mean ultrasound time, cumulative dissipated energy, and incidence of moderate to severe corneal edema and wound burn in the late-stage group were significantly higher than in the early- and middle-stage groups (p&lt;0.05). The incidence of zonular dehiscence, capsular rupture, vitreous loss, and iritis were not significant among the 3 groups (p&gt;0.05). Intraocular pressure rise in the early postoperative period and the level of optic atrophy in the late-stage group were significantly higher than in the other 2 groups (p&lt;0.05). The gain in visual acuity in the early- and middle-stage groups after surgery was better than in the late-stage group of XFS, and the difference was statistically significant (p&lt;0.05). The clinical staging of cataract with XFS contributed to the choice of operation time and its management. Phacoemulsification and IOL implantation in early- and middle-stage XFS induced fewer complications and led to better recovery of visual function after surgery.

Results of endocapsular phacofracture debulking of hard cataracts.

Purpose/aim of the studyTo present a phacoemulsification technique for hard cataracts and compare postoperative results using two different ultrasonic tip motions during quadrant removal.Materials and methodsA phacoemulsification technique which employs in situ fracture and endocapsular debulking for hard cataracts is presented. The prospective study included 56 consecutive cases of hard cataract (LOCS III NC [Lens Opacification Classification System III, nuclear color], average 4.26), which were operated using the Infiniti machine and the Partial Kelman tip. Longitudinal tip movement was used for sculpting for all cases which were randomized to receive longitudinal or torsional/interjected longitudinal (Intelligent Phaco [IP]) strategies for quadrant removal. Measurements included cumulative dissipated energy (CDE), 3 months postoperative surgically induced astigmatism (SIA), and corneal endothelial cell density (ECD) losses.ResultsNo complications were recorded in any of the cases. Respective overall and longitudinal vs IP means were as follows: CDE, 51.6±15.6 and 55.7±15.5 vs 48.6±15.1; SIA, 0.36±0.2 D and 0.4±0.2 D vs 0.3±0.2 D; and mean ECD loss, 4.1%±10.8% and 5.9%±13.4% vs 2.7%±7.8%. The differences between longitudinal and IP were not significant for any of the three categories.ConclusionThe endocapsular phacofracture debulking technique is safe and effective for phacoemulsification of hard cataracts using longitudinal or torsional IP strategies for quadrant removal with the Infiniti machine and Partial Kelman tip.

Axial Length Measurement Failure Rates with the IOLMaster and Lenstar LS 900 in Eyes with Cataract

PurposeTo evaluate axial length (AL) measurement failure rate with the IOLMaster (Carl Zeiss AG, Germany) and Lenstar LS 900 (Haag-Streit AG, Switzerland) in eyes with cataract.MethodsTwo hundred and ninety-six eyes of 170 patients with cataract were enrolled. Cataract type and severity were graded using the Lens Opacities Classification System III (LOCS III) and AL measurements were attempted with IOLMaster (version 5.4) and Lenstar LS 900 (version 1.1). Chi-squared analysis was used to assess if the difference in AL measurement acquisition rate was statistically significant between the two devices. The association of the different cataract types and severity with the AL measurement acquisition rate was evaluated with logistic regression analysis.ResultsAL measurements were obtained in 184 eyes (62.16%) using the IOLMaster and 191 eyes (64.53%) using the Lenstar, which corresponds to a failure rate of 37.84% and 35.47% respectively. Chi-square analysis indicated no significant difference between the Lenstar and IOLMaster for AL measurement failure rate (x2 = 0.356, P = 0.550). Logistic regression analysis indicated no association between acquisition rates and cortical or nuclear cataracts with either device. There was a statistically significant association between acquisition rates and increasing severity of posterior subcapsular cataracts with the IOLMaster (β = -1.491, P<0.001) and Lenstar LS 900 (β = -1.507, P<0.001).ConclusionThe IOLMaster and Lenstar LS 900 have similar AL measurement failure rates (35–38%) for Chinese public hospital cataract patients. Increasing severity of posterior subcapsular cataracts was problematic for both devices.

Frequency of pseudoexfoliation among patients scheduled for cataract surgery

To assess the frequency of pseudoexfoliation syndrome (PXF) in patients scheduled for cataract surgery and to evaluate its association with pupil dilation, lens nucleus hardness, intraocular pressure (IOP), glaucoma, age, and sex. Ourense University Hospital, Ourense, Spain. Cross-sectional study. This study evaluated eyes scheduled for cataract surgery between January 2013 and July 2013. Pseudoexfoliation was diagnosed in phakic eyes that showed central and/or peripheral white deposits on the lens surface, pupillary margin, or both. Dilated pupils were evaluated with a portable pupil chart. Nucleus hardness was assessed according to the Lens Opacities Classification System III. Diagnosis of glaucoma was based on International Society Geographical and Epidemiological Ophthalmology criteria. Of the 1763 eyes (1093 patients) evaluated, 381 (21.6%) were diagnosed with PXF. The frequency of PXF increased with age from 6.0% in people between 50 year and 60 years to 31.66% in those older than 80 years. In PXF eyes, nuclear cataracts were significantly harder than in non-PXF eyes (P < .001). The mean IOP was significantly higher in PXF eyes than in non-PXF eyes (P = .002). The frequency of glaucoma was higher in PXF eyes (17.4%) than in non-PXF eyes (9.4%), with a statistically significant difference (P < .001). In PXF eyes, the pupil was significantly smaller than in non-PXF eyes (P < .001). The frequency of PXF was high in the study population and increased with age. Eyes with PXF were associated with significantly harder nuclear cataracts, smaller pupils, and glaucoma. No author has a financial or proprietary interest in any material or method mentioned.

Relationship between socioeconomic and lifestyle factors and cataracts in Koreans: the Korea National Health and Nutrition Examination Survey 2008-2011.

Cataracts are the leading cause of visual impairment and blindness, and therefore early identification and modification of the risk factors for cataracts are meaningful. This study aimed to investigate the relationship between socioeconomic status (SES) and lifestyle factors, and age-related cataracts in South Korea. This cross-sectional study was based on data collected in the 2008-2011 Korea National Health and Nutrition Examination Survey. A total of 15 866 subjects, aged ≥40 years, were included. SES was defined using household income and education level. Sociodemographic, lifestyle, and other associated factors were assessed by health interviews and examinations. Cataracts were diagnosed via slit-lamp examination using the Lens Opacities Classification System III. The prevalence of any cataract was 38.9% in men and 42.3% in women (P<0.001). In women, the risk of cataracts increased with decreases in household income (P-value for trend=0.016 and 0.041 in any, and cortical cataract, respectively) and education level (P-value for trend=0.009, 0.027, and 0.016 in any, nuclear, and cortical cataract, respectively) after adjusting for confounding factors. Current smoking was correlated with nuclear cataracts in men (OR 1.21; 95% CI: 1.00, 1.46 in age-adjusted analysis) and cataract surgery in women (OR 2.25; 95% CI: 1.00, 5.04 in multivariate-adjusted analysis). Socioeconomic disparities in cataract prevalence were observed in women; current smoking increased the risk of nuclear cataracts in men and surgery in women. Public health interventions focusing on gender differences are warranted to prevent and treat cataracts.

Macular pigment optical density in a healthy Chinese population.

To measure the macular pigment optical density (MPOD) values in a healthy Chinese population using the one-wavelength reflectometry method and to investigate the relationships of MPOD with age, sex, body mass index (BMI), smoking and lens opacities. A total of 441 healthy participants, aged 3-81 years old (242 male and 199 female subjects), were enrolled in this study. Demographic and lifestyle data were recorded based on physical examinations and questionnaires. Lens opacities were measured according to the Lens Opacities Classification System III (LOCS III). MPOD values were measured at 7° of eccentricity, using the one-wavelength reflectometry method (Visucam 200; Carl Zeiss Meditec). MPOD values were reported in parameters including 'max' and 'mean' optical density (OD). The original MPOD values without automated correction were used for analysis. The average values were 0.303 ± 0.097 d.u. (initials of density units) for the max OD and 0.109 ± 0.031 d.u. for the mean OD. A significant inverse relationship was found between age and MPOD (for max OD, β = -0.716, p < 0.001; for mean OD, β = -0.669, p < 0.001). Participants with no lens opacities had higher MPOD values than those with moderate lens opacities (p < 0.001). The MPOD values were not associated with sex, BMI or smoking status. MPOD within 7° of eccentricity, as measured by one-wavelength reflectometry, was found to decrease with increasing age in a healthy Chinese population, and lens opacities had an impact on these measurements. These results provide a reference value for future studies in the Chinese population.

Monthly microperimetry (MP1) measurement of macular sensitivity after dexamethasone implantation (Ozurdex) in retinal vein occlusions.

To evaluate changes in macular sensitivity as measured via microperimetry (MP) in patients with macular edema (ME) secondary to retinal vein occlusion (RVO) after dexamethasone implantation (DEX implantation, Ozurdex), in comparison to distance visual acuity, reading ability, and spectral domain optical coherence tomography (SD-OCT). Twenty-three patients with ME secondary to RVO were treated with a DEX implantation in this prospective, observational case study. Patients were controlled at baseline and then monthly with microperimetry and assessment of distance visual acuity, reading ability, and SD- OCT. Side effects of the DEX implant were monitored by measuring the intraocular pressure (IOP) and lens grading with Lens Opacities Classification System (LOCS) charts. The 23 patients with RVO included 16 patients with branch retinal vein occlusion (BRVO) and 7 patients with central retinal vein occlusion (CRVO). Improvement in distance visual acuity, reading ability, and in central 8-points microperimetry showed statistical significance from month 1 to 3, whereas the 40-points microperimetry improved with statistical significance from month 1 to 2. The reduction of central retinal thickness measured with SD-OCT remained statistically significant until month 4. Subgroup analysis of patients with BRVO and CRVO confirmed the best test results observed at month two after DEX implantation. The highest macular sensitivity was measured two months after DEX implantation. This corresponds to the best test results for distance visual acuity, reading ability, and SD-OCT observed two months after treatment.

Migration study of lens opacities in Bangladeshi adults in London and Bangladesh: a pilot study

BackgroundLens opacities (LO) occur at an earlier age and have a higher prevalence in developing countries. In this pilot study, we assessed the feasibility and practical challenges of conducting a...

Association between refractive errors and senile cataract in rural area of western Maharashtra

Purpose: To study the association between refractive errors and senile cataract in rural area of western MaharashtraMaterials & Methods: It is a prospective cross sectional study carried out on 420 eyes of 210 patients with senile cataract was included in the study. The age and sex of the patient, grade and the refractive status of the cataract of the eyes were recorded. The grade of the cataract was recorded by the LOCS III (Lens Opacities Classification System, version III). Refractive status was measured subjectively using retinoscope and refractive error for each eye was converted into spherical equivalent units. Results: The age variation in the study was between 60-85 years.The maximum number of patients was in the age group of 60-65 years.The spherical equivalent ranged between -3.0 D to +4.25D.45.95% of the study population had a spherical equivalent between - 2 to -1.73.81 % of the study population had a myopic refraction.20% had a hypermetropic refraction. Percentage of patients with a score of nuclear opalescence and colour between 1.0-2.0 was 41.90%, between 2.1-3.0 was 26.67% and above 3.0 was 31.43%.Percentage of patients with a score of cortical cataract between 0.1-1.0 was 69.76% and with a grade between 2.1-3.0 was 26.91 %. Percentage of patients with a score of posterior subcapsular cataract between 0.1-1.0 was 53.57% and with a grade between 2.1-3.0 was 39.05%. Conclusion: The myopic refraction was associated with nuclear, cortical and posterior subcapsular cataract and this refractive error was stastically significant with nuclear, cortical and posterior subcapsular cataract.

Risk factors for nuclear and cortical cataracts: A hospital based study

Purpose:To evaluate risk factors associated with nuclear and cortical cataracts among a hospital based sample of subjects in Southern India.Methods:In this hospital-based study, 3,549 subjects including 2,090 male and 1,459 female individuals aged 45 years and over were randomly screened for nuclear and cortical cataracts. Lens opacity was graded and classified after pupil dilation using the lens opacities classification system (LOCS) III at the slit lamp. Furthermore, participants were interviewed for lifestyle variables and dietary intake of carotenoids using a structured food frequency questionnaire.Results:Demographic risk factors for cataracts included older age and lower socioeconomic status. Nuclear cataracts were associated with diabetes (OR = 6.34; 95% CI: 2.34-8.92%), tobacco chewing (moderate, OR = 3.04; heavy, OR = 4.62), cigarette smoking (moderate, OR = 1.58; heavy, OR = 1.87) and hypertension (OR = 1.56; 95% CI: 1.25-2.78%). Cortical cataracts were associated with diabetes (OR = 15.03; 95% CI: 7.72-29.2%), tobacco chewing (moderate, OR = 2.16; heavy, OR = 2.32) and cigarette smoking (moderate, OR = 2.20; heavy, OR = 2.97). Higher dietary intake of lutein/zeaxanthin (L/Z) and β-carotene was associated (P < 0.001) with a lower risk of nuclear and cortical cataracts.Conclusion:Higher dietary intake of carotenoids is associated with a lower risk of cataracts. Nuclear and cortical cataracts are associated with various risk factors such as diabetes, hypertension, cigarette smoking and tobacco, similar to studies conducted in other Asian and European populations, irrespective of ethnic origin.

Effect of standardized fruit extract of Luffa cylindrica on oxidative stress markers in hydrogen peroxide induced cataract.

Objective:The ability of Luffa cylindrica Roem fruit extract (LCE) to modulate biochemical parameters was investigated by in vitro studies for its role in hydrogen peroxide induced cataract on isolated goat lenses which were incubated for 72 h at 37°C.Materials and Methods:Test groups contained 5, 10, 15, 20, 25, and 30 µg/ml of LCE along with 1 ml of H2O2 (0.5 mM) as cataract inducer. Lenses were examined for morphological variation and transparency periodically during the incubation. Biochemical parameters such as superoxide dismutase (SOD), reduced glutathione (GSH), total protein content (TPC), and malondialdehyde (MDA) were estimated.Results:SOD, GSH, and TPC levels were found to increase proportionally with the concentration of LCE. However, MDA levels were found to be inversely proportional to the concentration of LCE. Opacity was graded as per “lens opacities classification system III.” Morphological examination suggested that LCE (25 µg/ml) maintained a vision for 44 h. No lens in LCE dose groups developed dense nuclear opacity after 24 h as opposed to 80% in negative control.Conclusion:The results suggest that LCE can delay the onset and/or prevent the progression of cataract which can be attributed to the presence of adequate phenolics, flavonoids, and Vitamin A and its high nutritional value. This preliminary study can be further synergized by testing LCE against other in vivo and in vitro models of cataract.

A study of morphology of cataract in western India

Background: Population-based studies of lens opacity have suggested that the distribution of lens opacity types may differ between races. We report the prevalence of the different types of age-related cataract based on the LOCS III (Lens opacification classification system III) grading cataract among adults in the western Indian state of Maharashtra. Materials and Methods: Cataract was classified on examination of eyes with dilated pupils. Demographic data included age, sex, occupation, dietary habits (vegetarian or non-vegetarian), and tobacco use. Results: A total of 198 patients were included in the present study. The highest prevalence was that of nuclear sclerosis (NS), in its pure form (45.5%) or as mixed occurrence [3% NS+CC (cortical cataract) and 11.1% NS+PSCC (posterior sub-capsular cataract)]. The prevalence of NS was significantly higher (57.4%) in higher age group as compared to that in lower age group (33.7%). On the other hand, prevalence of NS+PSCC cases was more than double (26.5%) in lower ( 65 years) age group (11.1%). The type of occupation was significantly associated with type of cataract (χ2 = 11.64, P = 0.003); majority (50%) of the CC type and NS+PSCC type (41.2%) were farmers, whereas 50.8% of NS type were housewives. Majority of the diabetic patients (71.1%) belonged to NS type. Among the tobacco users 56.8% had the nuclear sclerosis type of cataract. Conclusions: Nuclear sclerosis was the most prevalent morphology of cataract in the study group.

Short-term influence of cataract surgery on circadian biological rhythm and related health outcomes (CLOCK-IOL trial): study protocol for a randomized controlled trial.

BackgroundLight information is the most important cue of circadian rhythm which synchronizes biological rhythm with external environment. Circadian misalignment of biological rhythm and external environment is associated with increased risk of depression, insomnia, obesity, diabetes, cardiovascular disease, and cancer.Increased light transmission by cataract surgery may improve circadian misalignment and related health outcomes. Although some observational studies have shown improvement of depression and insomnia after cataract surgery, randomized controlled trials are lacking. We will conduct a parallel-group, assessor-blinded, simple randomized controlled study comparing a cataract surgery group at three months after surgery with a control group to determine whether cataract surgery improves depressive symptoms, sleep quality, body mass regulation, and glucose and lipid metabolism.Methods/DesignWe will recruit patients who are aged 60 years and over, scheduled to receive their first cataract surgery, and have grade 2 or higher nuclear opacification as defined by the lens opacities classification system III. Exclusion criteria will be patients with major depression, severe corneal opacity, severe glaucoma, vitreous haemorrhage, proliferative diabetic retinopathy, macular oedema, age-related macular degeneration, and patients needing immediate or combined cataract surgery. After baseline participants will be randomized to two groups. Outcomes will be measured at three months after surgery among the intervention group, and three months after baseline among the control group. We will assess depressive symptoms as a primary outcome, using the short version geriatric depression scale (GDS-15). Secondary outcomes will be subjective and actigraph-measured sleep quality, sleepiness, glycated haemoglobin, fasting plasma glucose and triglyceride, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, body mass index, abdominal circumference, circadian rhythms of physical activity and wrist skin temperature, and urinary melatonin metabolite. Chronotype and visual function will be assessed using the ‘morningness-eveningness’ questionnaire, the Munich chronotype questionnaire, and the National Eye Institute Visual Function Questionnaire.DiscussionAlthough there are potential limitations due to the difference in duration from baseline survey to outcome measurements between two groups, any seasonal effect on the outcome measurement will be balanced as a result of continuous inclusion of participants through the year, and outcomes will be adjusted for day length at outcome measurements at analysis.Trial registrationUMIN000014559, UMIN Clinical Trials Registry, registered on 15 July 2014.

Correlation Among Lens Opacities Classification System III Grading, Visual Function Index-14, Pentacam Nucleus Staging, and Objective Scatter Index for Cataract Assessment

To investigate the relationship among Lens Opacities Classification System III (LOCS III) grading score, Visual Function Index-14 (VF-14) score, average lens density by the Pentacam Nucleus Staging system, and the objective scatter index measured by the Optical Quality Analysis System in age-related cataract patients. Prospective, single-center, cross-sectional study. Thirty-six subjects (60 eyes) with age-related cataract were recruited. Subjects with any corneal anomaly potentially affecting intraocular scatter were excluded. The best-corrected visual acuity (BCVA), LOCS III nuclear opalescence score and cortical cataract score, VF-14 score, average lens density, and objective scatter index were obtained. Correlations among these parameters were analyzed. The LOCS III nuclear opalescence score was correlated with the BCVA (r = 0.438; P = .001), objective scatter index (r = 0.543; P < .001), and average lens density (r = 0.621; P < .001). The objective scatter index was also correlated with the BCVA (r = 0.779; P < .001) and the average lens density (r = 0.320; P = .013). The VF-14 score had the strongest correlation with the objective scatter index (r = -0.712; P < .001). The difference between groups with objective scatter index<3.0 and ≥3.0 was significant with regard to BCVA, average lens density, LOCS III nuclear opalescence score, and VF-14 score. LOCS III grading remains an economical and effective method to assess lens opacities, especially in the formation of early cortex cataracts. The objective scatter index can be a useful parameter to objectively analyze the correlation between ocular examination findings and patient concerns. Furthermore, the objective scatter index scores ≥3.0 can be a possible objective cut-off for preoperative decision making.

Cataract and quality of life in patients with glaucoma.

To assess the impact of cataract on quality of life (QoL) for patients with glaucoma. Cross-sectional study. Two hundred forty-two patients with mild (n = 67), moderate (n = 80) or severe (n = 45) glaucoma and 50 controls (glaucoma suspects). Patients with cataract of any severity were included. The following data were collected: sociodemographic information, phakic/pseudophakic status, cataract grade according to the Lens Opacities Classification System (LOCS) III, visual acuity and visual field test parameters. Glaucoma severity was stratified according to binocular visual field loss. Visually significant cataract was defined as: LOCS III criteria nuclear cataract ≥3/6.9, cortical cataract ≥3/5.9 or posterior subcapsular cataract ≥2/5.9. Patients' QoL was measured using Rasch-transformed scores from the Glaucoma Activity Limitation-9 (GAL-9) questionnaire. Multiple linear regression models were used to determine the association between cataract and GAL-9 (logit) score. Fifty-six (23.1%) patients had at least one visually significant cataract. At least one visually significant cataract (standardized coefficient [β] 1.19, 95% confidence interval 1.04-1.34, P = 0.011) and poor visual field index (better eye) (β 1.47, 95% confidence interval 1.36-1.88, P < 0.001) were independently associated with worse GAL-9 score. Cataract influences glaucoma-related QoL among glaucoma patients of all severity levels and is an important cause of potentially reversible visual impairment among glaucoma patients. The Rasch-analysed GAL-9 questionnaire is a useful metric to quantify visual disability related to cataract in glaucoma patients.

Autofluorescence imaging of macular pigment: influence and correction of ocular media opacities.

The healthy adult human retina contains in its macular region a high concentration of blue-light absorbing carotenoid compounds, known as macular pigment (MP). Consisting of the carotenoids lutein, zeaxanthin, and meso-zeaxanthin, the MP is thought to shield the vulnerable tissue layers in the retina from lightinduced damage through its function as an optical attenuator and to protect the tissue cells within its immediate vicinity through its function as a potent antioxidant. Autofluorescence imaging (AFI) is emerging as a viable optical method for MP screening of large subject populations, for tracking of MP changes over time, and for monitoring MP uptake in response to dietary supplementation. To investigate the influence of ocular media opacities on AFI-based MP measurements, in particular, the influence of lens cataracts, we conducted a clinical trial with a large subject population (93 subjects) measured before and after cataract surgery. General AFI image contrast, retinal blood vessel contrast, and presurgery lens opacity scores [Lens Opacities Classification System III (LOCS III)] were investigated as potential predictors for image degradation. These clinical results show that lens cataracts can severely degrade the achievable pixel contrasts in the AFI images, which results in nominal MP optical density levels that are artifactually reduced. While LOCS III scores and blood vessel contrast are found to be only a weak predictor for this effect, a strong correlation exists between the reduction factor and the image contrast, which can be quantified via pixel intensity histogram parameters. Choosing the base width of the histogram, the presence or absence of ocular media opacities can be determined and, if needed, the nominal MP levels can be corrected with factors depending on the strength of the opacity.