J Korean Ophthalmol Soc.  2023 Nov;64(11):1009-1013. 10.3341/jkos.2023.64.11.1009.

Differences between the Results Assessed by Slit Lamp Examination and Anterior Segment Photography in Terms of Cataract Grading

• Kim W
• Yoon S
• Kim DH
• Eom Y
• Song JS

• KMID: 2547863
• DOI: http://doi.org/10.3341/jkos.2023.64.11.1009

Abstract

Purpose
We compared the cataract grades with slit lamp examination and anterior segment photography using the Lens Opacities Classification System (LOCS) III criteria. We also explored the effect of a yellow filter on the photographic results.
Methods
Eighty eyes with cataracts were examined by three inspectors (1, 2, and 3). Anterior segment photographs taken by inspector 1 were divided into two groups depending on whether cortical opacity or nuclear sclerosis predominated. In each group, the cataract grades determined by inspector 1 on slit lamp examination and anterior segment photography were compared. Also, after randomly assigning the anterior segment photographs taken by inspector 1 to inspectors 2 and 3, the cataract grades of these photographs were compared to the grades of photographs taken by all inspectors using a yellow filter.
Results
The average cortical opacity evaluated by inspector 1 on slit lamp examination (3.48 ± 0.91) was significantly higher than that apparent on anterior segment photographs (2.35 ± 0.77) (p < 0.001). In the photographs, the average cortical opacity when a yellow filter was used was significantly higher for both inspectors 1 (p < 0.001) and 2 (p = 0.022) than when the filter was absent. The average extent of nuclear sclerosis evaluated by inspector 1 on slit lamp examination (4.08 ± 0.94) was significantly higher than that of anterior segment photography (3.73 ± 1.24) (p = 0.042).
Conclusions
Cataract evaluation via anterior segment photography underestimates the extent of damage compared to direct slit lamp examination. However, use of a yellow filter during photography aids cataract evaluation, especially cortical opacity.

Keyword

Anterior segment photograph, Cataract grading, Slit lamp exam, Yellow filter