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We tested an instrument to measure the line spread function (LSF) of the eye in order to assess objectively retinal image degradation due to cataract. Optical aberrations from 62 eyes with early to moderate cataract were assessed by measuring the extent of blurring of a best-focused fine line image (LSF) projected onto a subject's retina. The instrument consisted of a slitlamp equipped with a Hruby lens to project the line and a computer-coupled CCD camera to record and measure the blurred image. We hypothesized that the width of the blurred line image (called WSCAT) due to light scattering in the cataractous lens would be affected most by nuclear and subcapsular cataracts. The WSCAT results were compared to the data from two other tests: (1) Snellen acuity and (2) LOCS II cataract classification. Grouping eyes by Snellen acuity we found that WSCAT from the group with 6/4.5 (20/15) or 6/6 (20/20) acuity was distinguishable from the group with 6/9 (20/30) or worse acuity (95% confidence interval). Data also were analyzed using a regression model which corrects for the intraclass correlation between the two eyes of an individual. Results show a significant association between WSCAT and minimum angular resolution (MAR) derived from Snellen visual acuity (regression coefficient of 5.45, p = 0.008). WSCAT also is correlated with both LOCS II nuclear opalescence (NO) and posterior subcapsular (P) categories with regression coefficients of 3.03 (p = 0.004) and 2.07 (p = 0.054), respectively. Results from measurement of LSF indicate the potential for this instrument to assess retinal image degradation associated with nuclear and posterior subcapsular cataract objectively.

The Lens Opacities Classification Systems (LOCS III) was developed and standardized using photograding. The purpose of this study was to assess the validity of LOCS III at the slitlamp and to compare slitlamp with photograding. To do so, two independent observers graded cataract at the slitlamp and in photographs from two sets of patients; the first set consisted of 205 eyes (193 acceptable photographs) and the second set of 51 eyes (51 photographs). The 95% tolerance limits (TL) for grading at the slitlamp ranged from 0.9 to 1.8 for the first set and 0.6 to 1.2 for the second (intraclass correlation coefficients 0.79 to 0.91 vs. 0.70 to 0.97, respectively). Specifically, there was a significant decrease in 95% TL for cortical and nuclear color. For the first set of photograding, the 95% TL were 0.3 to 0.6 between the two observers and 0.6 to 0.8 for the same observer at two different sessions. Similar results were found for photograding the second set. The 95% TL for comparing slitlamp and photograding were generally > 1.0. The results suggest that (1) LOCS III at the slitlamp has 95% TL only slightly worse than those for LOCS III photogradings; (2) LOCS III slitlamp grading for cortical and nuclear color improves with practice; and (3) the slitlamp and photographic gradings cannot be used interchangeably.