Mapping normal lens transparency in adulthood: zone-specific densitometry trends

To establish zone-specific normative values for lens densitometry in a healthy adult population and to evaluate age-related and biometric associations using Scheimpflug imaging.

In this cross-sectional study, 272 eyes from 272 healthy adults aged 18-80 years (mean ± SD, 40.96 ± 15.13 years; 36.0% male) were analysed using the Pentacam HR (Oculus, Germany). Densitometry values (0 = clear; 100 = opaque) were quantified for the central 0-2 mm zone, anterior and posterior cortical regions, and the 2-4 mm and 4-6 mm annuli. Age-group differences were compared, and univariable and multivariable linear regression analyses were performed to evaluate demographic and ocular biometric associations.

Lens densitometry increased progressively with age across nearly all zones. Global density rose from 7.87 ± 0.26 (18-39 years) to 8.58 ± 0.60 (40-59 years) and 9.67 ± 0.45 (60-80 years; p < 0.001). Central 0-2 mm zone density showed the steepest change (7.96 ± 0.31 to 10.08 ± 0.92; p < 0.001), followed by the 2-4 mm annulus (7.89 ± 0.28 to 9.76 ± 0.59; p < 0.001) and 4-6 mm annulus (7.87 ± 0.25 to 9.68 ± 0.46; p < 0.001). Posterior cortical region density did not differ significantly by age (p = 0.724). In univariable regression, age was strongly associated with global density (β = 0.041/year, R² = 0.648, p < 0.001), central 0-2 mm zone density (β = 0.049/year, R² = 0.635, p < 0.001), and annular density (β = 0.043/year for both annuli; R² = 0.584-0.724; both p < 0.001).

Lens densitometry increases significantly with age in a zone-dependent pattern, with the central 0-2 mm zone and mid-peripheral annuli showing the greatest optical changes, while the posterior cortical region remains relatively stable.