Grading nuclear cataract: reproducibility and validity of a new method.

Aims: To assess the reproducibility and validity of a new instrument for grading nuclear cataract-the laser slit lamp, by comparison with an established method of lens grading-the Lens Opacities Classification System III (LOCS III).

Methods: 62 volunteers (113 eyes) were examined on two occasions. At each visit, a video image of the anterior segment was captured with the laser slit lamp and stored digitally. A measure of lens opacity for each laser slit lamp image was calculated using image analysis software. Each lens was also photographed on both visits for LOCS III grading of nuclear colour and nuclear opalescence.

Results: There was a linear increasing relation between the laser slit lamp measure of nuclear lens opacity and the LOCS III nuclear opalescence scores. The overall reproducibility of the laser slit lamp measurement was comparable with LOCS III (intraclass correlation coefficient of 95% (95% CI 92.9-96.5) for the laser slit lamp method; 97% (95% CI 95. 6-97.9) for the LOCS III method). However, among healthy subjects, the reproducibility was lower (intraclass correlation for the laser slit lamp of 38.6% (95% CI 12.9-59.2) and 76.1% (95% CI 62.3-85.4) for LOCS III.

Conclusion: The laser slit lamp appears to give a valid measurement of nuclear cataract. The reproducibility of the instrument was high and similar to that of LOCS III. Modifications to the design would have to be made to improve its reproducibility among healthy subjects. It is simpler than other objective instruments, and could be useful in large scale studies of cataract.