Correlations of Straylight, Aberrometry, and Lens Scattering in Cataract Patients

1. Correlations of Straylight, Aberrometry, and Lens Scattering in Cataract Patients Bruno Valbon, MD Frederico Guerra, MD; Daniela Jardim, MD; Fernanda Fonyat, MD; Renato Ambrosio Jr., MD, PhD Dr. Ambrósio is a consultant for Oculus and is on the speaker bureau for Reichert, Allergan, Alcon and Moria.

2. Introduction • Cataract is a major cause of visual decline in older people. • The deterioration in visual function in these patients cannot be entirely explained by spherical or cylindrical refractive errors. • Nuclear cataract can also decrease visual function by affecting contrast sensitivity. Deterioration in contrast sensitivity can be explained • in terms of scatter and increased higher-order aberrations (HOAs) • Quality of vision loss because of eye media disturbances is limited not only to visual acuity effects, but also to other effects such as caused by straylight • Straylight increases with age in the perfectly healthy eye, but much more so with disturbances to the optical media, such as cataract. • The present study sought to take the next step by evaluating changes in the density and optical properties of the crystalline lens in eyes with grades of nuclear cataract on LOCS III to establish the correlation between the widespread subjective clinical classification and other objective methods of quantifying nuclear lens opacification.

3. Purpose • To correlate straylight levels, lens scattering, lens opacity and total and intraocular aberrometry in patients with cataract. SETTING : INSTITUTO DE OLHOS RENATO AMBROSIO, RIO DE JANEIRO, BRASIL

4. Methods • Retrospective Study • Inclusion criteria: diagnosis of cataract • Exclusion criteria: corneal disease (other than up to mild guttata); retinal or optic nerve disease and previous ocular surgery • Ocular straylight was evaluated using the C-Quant (Oculus) • Lens scattering was evaluated using the Scheimpflug Anterior Segment Tomography (Pentacam , Oculus), using the new software PNS • Total wavefront was measured by ray tracing (iTrace), intraocular aberrations were calculated by the integration of the Placido topography (Vista, Tracy Technologies) • Dilated slit lamp evaluation was performed and lens opacity was classified according to LOCS scale • This is study analyzed was Kolmogorov-Smirnov for Normaliy • Correlation tests were performed. • Either variables with Normal Distribution: Pearson • One of the variables with no Normal Distribution: Spearman

5. Example 1: Early Cataract PNS 1 ; HOA t 1,949 C-quant : log(s) 1,16 est0,08 q 0,82

6. Example 2 – PNS 2 ; HOA t 0,508 C-quant : log(s) 2,7 est 0,64 q -0,13 C-quant : log(s) 2,7est 0,64q -0,13

7. Example 3 – PNS 3 ; HOA t 0,508 C-quant : log(s) 1,27 est 0,05 q 2

8. Example 4 – PNS 4 ; HOA total 0,986 C-quant : log(s) 1,85 est 0,06 q -0,13

9. Example 5 – PNS 5 ; HOA total 0,887 C-quant : log(s) 1,74 est 0,06 q 0,63

10. RESULTS • 30 eyes of 19 consecutive patients with nuclear opacity between N01 and NO6 on the Lens Opacities Classification System III

11. RESULTS • rho

12. RESULTS • Graphics LOCS x PNS, Log(s) x PNS, Log(s) x LOCS

13. CONCLUSION • New mehtods for diagnosing cataract have been introduced • C-Quant measurement of the straylight (glare disability) is an important new functional parameter • The Scheimpflug Tomography by the Pentacam calculates the PNS scale which has a very high correlation with the slit lamp biomicroscopy exam. • Optical analysis with aberrometry also has weak correlation