Age-stratified normative lens densitometry in children: zone-specific reference curves from 4-18 years

Quantitative evaluation of lens transparency may aid the clinical assessment of normal and abnormal lenticular changes during childhood.

Scheimpflug imaging enables objective measurement of crystalline lens light backscatter. While age-related increases in lens densitometry are well documented in adults, normative paediatric data remain limited. Because lens development in childhood differs fundamentally from adult cataractogenesis, age-stratified reference standards are required.

This cross-sectional study included 188 eyes from 188 participants aged 4-18 years. Scheimpflug imaging (Pentacam HR) was used to measure global and zone-specific lens densitometry (nucleus 0-2 mm, anterior cortex, posterior cortex, annulus 2-4 mm, annulus 4-6 mm). Demographic and biometric parameters, including visual acuity, refraction, keratometry, anterior chamber depth, lens thickness, and pupil diameter, were recorded.

The mean age was 12.5 ± 3.6 years (range 4-18), with 53.2% male. Mean global lens density declined from 7.98 ± 0.41 in children aged 4-9 years, to 7.93 ± 0.21 in those aged 10-13 years, and further to 7.72 ± 0.50 in adolescents aged 14-18 years (p < 0.001). Nuclear density showed the steepest decrease, from 8.53 ± 0.57 to 8.23 ± 0.28 and then 7.89 ± 0.29 across the three age groups (p < 0.001). Anterior cortical density increased slightly (7.25 ± 0.77 → 7.20 ± 0.58 → 7.53 ± 0.73, p = 0.028), while posterior cortical density rose modestly (4.63 ± 0.76 → 4.46 ± 0.69 → 4.83 ± 0.65, p = 0.005). Annulus 2-4 mm and 4-6 mm values progressively decreased from childhood to adolescence (p < 0.001 for both).

Lens density decreases across childhood, most markedly in the nucleus, reflecting physiologic maturation.