Differences between the Results Assessed by Slit Lamp Examination and Anterior Segment Photography in Terms of Cataract Grading

Purpose: We compared the cataract grades with slit lamp examination and anterior segment photography using the Lens Opacities Classification System (LOCS) III criteria. We also explored the effect of a yellow filter on the photographic results.Methods: Eighty eyes with cataracts were examined by three inspectors (1, 2, and 3). Anterior segment photographs taken by inspector 1 were divided into two groups depending on whether cortical opacity or nuclear sclerosis predominated. In each group, the cataract grades determined by inspector 1 on slit lamp examination and anterior segment photography were compared. Also, after randomly assigning the anterior segment photographs taken by inspector 1 to inspectors 2 and 3, the cataract grades of these photographs were compared to the grades of photographs taken by all inspectors using a yellow filter.Results: The average cortical opacity evaluated by inspector 1 on slit lamp examination (3.48 +/- 0.91) was significantly higher than that apparent on anterior segment photographs (2.35 +/- 0.77) ( p < 0.001). In the photographs, the average cortical opacity when a yellow filter was used was significantly higher for both inspectors 1 ( p < 0.001) and 2 ( p = 0.022) than when the filter was absent. The average extent of nuclear sclerosis evaluated by inspector 1 on slit lamp examination (4.08 +/- 0.94) was significantly higher than that of anterior segment photography (3.73 +/- 1.24) ( p = 0.042).Conclusions: Cataract evaluation via anterior segment photography underestimates the extent of damage compared to direct slit lamp examination. However, use of a yellow filter during photography aids cataract evaluation, especially cortical opacity.