Novel Subclassification of Presbyopia Based on Lens Functional and Structural Features.

Area of Science:

• Ophthalmology
• Biomedical Engineering

Background:

• Presbyopia classification is crucial for effective surgical decision-making.
• Existing methods may not fully capture the functional and structural changes of the lens in presbyopia.

Purpose of the Study:

• To develop a novel classification system for presbyopia based on objective lens functional and structural parameters.
• To aid in surgical decision-making for presbyopia correction.

Main Methods:

• A cross-sectional observational study involving 176 patients (352 eyes) with presbyopia.
• Lens function assessed via dysfunction lens index (DLI); lens density measured using Pentacam (LD-P) and swept-source OCT (LD-S).
• Principal component analysis (PCA) and k-means clustering used to classify eyes into non-lens surgery (NLS) and lens surgery (LS) groups; a diagnostic scoring system and website were developed.

Main Results:

• 268 eyes (76.1%) were diagnosed with presbyopia.
• PCA excluded the top 5.2% of highly variable cases.
• 138 eyes (51.5%) were classified into the NLS group and 116 eyes (43.3%) into the LS group.
• The LS group showed significantly lower DLI and higher lens density (P < 0.001).
• Optimal cutoff values determined: DLI = 7.75, LD-P = 8.75, LD-S = 60.05.
• Combining DLI and LD-P yielded the highest diagnostic efficacy.

Conclusions:

• A novel classification of presbyopia using lens functional (DLI) and structural (density) features has been proposed.
• This classification provides a valuable diagnostic tool to guide surgical interventions for presbyopia.