Quantitative Cataract Grading Based On Blue-Light Autofluorescence Confocal Imaging.

Cataract is a global leading cause of visual loss. Cataract grading is fundamental to optimize the pre-operative planning and to improve surgical outcome. Study aim is to test a novel, quantitative, objective way to perform cataract grading, non-invasively, in vivo.

Clinical practice.

This study is designed as cross-sectional, observational. The cataract-related alterations progressively affect the crystalline lens capability of blue-light absorbance. Based on this assumption, we hypothesized that confocal blue-light autofluorescence represents a novel way to perform cataract grading. We involved patients affected by different cataract stages and we compared our quantitative approach to Lens Opacities Classification System III (LOCS III). Moreover, we evaluated the impact of progressively worse cataract-related opacities on the quality of fundus retinal images. The technique is covered by the patent n. PCT/IB2024/054719.  

We included 40 cataract eyes and 40 controls. Our quantitative analysis objectively documented the progressive reduction of blue-light autofluorescence properties as the cataract becomes even advanced, showing significant correlations with LOCS III grading system (p<0.001). Our approach also showed significant correlations with retinal optical coherence tomography (OCT) and blue-light autofluorescence images quality. As the cataract grade increases, the signal-to-noise significantly decreased both for fundus autofluorescence and OCT images, also showing correlations with our proposed quantitative cataract metrics (p<0.001).

We proposed a novel, objective way to perform cataract grading, non-invasively, in vivo. Our technique, by assessing the biochemical properties of the lens, correlated with LOCS III grading system and the progressive worsening of retinal images quality. Further prospective validation of the approach is warranted to confirm the present findings.