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      Objective Assessment of Nuclear and Cortical Cataracts through Scheimpflug Images: Agreement with the LOCS III Scale

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          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Purpose

          To assess nuclear and cortical opacities through the objective analysis of Scheimpflug images, and to check the correlation with the Lens Opacity Classification System III (LOCS III).

          Methods

          Nuclear and cortical opacities were graded according to the LOCS III rules after pupil dilation. The maximum and average pixel intensity values along an elliptical mask within the lens nucleus were taken to analyse nuclear cataracts. A new metric based on the percentage of opaque pixels within a region of interest was used to analyse cortical cataracts. The percentage of opaque pixels was also calculated for half, third and quarter areas from the region of interest’s periphery.

          Results

          The maximum and average intensity values along the nucleus were directly proportional to the LOCS III grade: The larger the LOCS III value, the larger maximum and average intensity ones. These metrics showed a positive and significant correlation with the LOCS grade: The larger the LOCS grade, the higher was percentage of opaque pixels along the cortex within the same mask’s size. This metric showed a significant correlation to the LOCS grade.

          Conclusion

          The metrics used to assess nuclear opacities showed good correlation with the LOCS III. The percentage of opaque pixels showed to be a useful metric to measure objectively the severity of the cortical opacity. These metrics could be implemented in an algorithm to detect and grade lens opacities automatically and objectively.

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          Most cited references 17

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          Correlation of nuclear cataract lens density using Scheimpflug images with Lens Opacities Classification System III and visual function.

          To calculate the average lens density (ALD) and nuclear lens density (NLD) using Scheimpflug images and to determine their correlation with logarithmic minimal angle resolution (logMAR) best-corrected visual acuity (BCVA), contrast sensitivity (CS), and lens grading based on the Lens Opacities Classification System (LOCS) III.
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            Repeatability and agreement of three Scheimpflug-based imaging systems for measuring anterior segment parameters in keratoconus.

            To assess the repeatability and agreement of three rotating Scheimpflug cameras, Pentacam, Galilei, and Sirius, in measuring the mean keratometry (Km), thinnest corneal thickness (TCT), anterior chamber depth (ACD), and mean posterior keratometry (pKm) in keratoconus patients in a prospective study.
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              Correlation of lens density measured using the Pentacam Scheimpflug system with the Lens Opacities Classification System III grading score and visual acuity in age-related nuclear cataract.

              To investigate the relationship between lens density measured with the Pentacam Scheimpflug System and grading score using the Lens Opacities Classification System (LOCS) III as well as that between lens density and visual acuity in age-related nuclear cataract patients. Lens density and grading score were evaluated in 138 cases (180 eyes) with age-related nuclear cataract. LogMAR visual acuity was tested with the Early Treatment Diabetic Retinopathy Study chart. The correlations between lens density value and LOCS III nuclear opacity (NO) and nuclear colour (NC) grading score and that between lens density value and logMAR visual acuity were analysed. There was a linear increasing relationship between lens density value and LOCS III grading score in nuclear cataract patients. Lens density value had a stronger significant correlation with LOCS III NO score than that with NC score. The correlation between the nuclear lens density value and logMAR visual acuity was stronger than that between NO score and logMAR visual acuity or between NC score and logMAR visual acuity. Lens density as a quantitative and objective parameter can present the degree of NO and associated visual impairment due to nuclear cataract. The LOCS III criterion as an economic cataract grading system provides data that are in satisfactory concordance with the results obtained using the Pentacam Scheimpflug system.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                18 February 2016
                2016
                : 11
                : 2
                Affiliations
                [1 ]Optometry Research Group, Department of Optics and Optometry and Vision Science, University of Valencia, Burjasot, Comunidad Valenciana, Spain
                [2 ]Unit of Optometry, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
                [3 ]St. Erik Eye Hospital, Stockholm, Sweden
                Rush University Medical Center, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: UB LCG MN RB. Performed the experiments: UB LCG. Analyzed the data: ADV UB MN RB. Contributed reagents/materials/analysis tools: ADV UB LCG MN RB. Wrote the paper: ADV UB RB.

                Article
                PONE-D-15-49320
                10.1371/journal.pone.0149249
                4758745
                26890694
                © 2016 Domínguez-Vicent et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                Page count
                Figures: 5, Tables: 3, Pages: 12
                Product
                Funding
                This research was founded by an “Atracció de talent” research scholarship (Universidad de Valencia) awarded to Alberto Domínguez-Vicent (UV-INV-PREDOC13-110412), and the funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Physical Sciences
                Materials Science
                Material Properties
                Optical Properties
                Opacity
                Medicine and Health Sciences
                Ophthalmology
                Lens Disorders
                Cataracts
                Biology and Life Sciences
                Anatomy
                Head
                Eyes
                Medicine and Health Sciences
                Anatomy
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                Biology and Life Sciences
                Anatomy
                Ocular System
                Eyes
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                Anatomy
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                Anatomy
                Ocular System
                Ocular Anatomy
                Lens (Anatomy)
                Medicine and Health Sciences
                Anatomy
                Ocular System
                Ocular Anatomy
                Lens (Anatomy)
                Engineering and Technology
                Equipment
                Optical Equipment
                Optical Lenses
                Medicine and Health Sciences
                Surgical and Invasive Medical Procedures
                Ophthalmic Procedures
                Cataract Surgery
                Research and Analysis Methods
                Imaging Techniques
                Image Analysis
                Physical Sciences
                Mathematics
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                Machine Learning Algorithms
                Research and Analysis Methods
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                Biology and Life Sciences
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                All relevant data are within the paper and its Supporting Information files.

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