Objective quantification of lens nuclear opacities using swept-source anterior segment optical coherence tomography

Area of Science:

• Ophthalmology
• Medical Imaging
• Biomedical Engineering

Background:

• Cataract surgery is a common procedure, with nuclear opacity being a key factor.
• Accurate quantification of lens nuclear opacity is crucial for surgical planning and patient outcomes.
• Existing grading systems like LOCS-III have limitations in objective measurement.

Purpose of the Study:

• To quantify lens nuclear opacity using swept-source anterior segment optical coherence tomography (SS-ASOCT).
• To evaluate the correlation of SS-ASOCT measurements with the Lens Opacities Classification System III (LOCS-III) and surgical parameters.
• To assess the diagnostic performance of SS-ASOCT for hard nuclear cataract detection.

Main Methods:

• A cross-sectional study involving 1222 patients undergoing cataract surgery.
• High-resolution lens images were acquired using SS-ASOCT (CASIA-2).
• Average Nuclear Density (AND) and Maximum Nuclear Density (MND) were measured using custom ImageJ software; Spearman's correlation and ROC analysis were performed.

Main Results:

• SS-ASOCT-derived AND and MND showed significant correlations with LOCS-III nuclear color and opalescence scores (r > 0.65, p < 0.001).
• AND demonstrated strong correlations with preoperative visual acuity, ultrasonic time, and cumulative dissipated energy (r up to 0.4265).
• The method achieved good performance in classifying hard nuclear cataract, with AUCs of 0.859 for AND and 0.796 for MND.

Conclusions:

• SS-ASOCT provides objective and quantitative evaluation of lens nuclear density.
• This technique enables accurate diagnosis of hard nuclear cataract.
• SS-ASOCT measurements correlate well with established grading systems and surgical metrics, offering clinical utility.