A simple system, based on standard photographs, has been developed to classify lens opacities. The system allows the definition of cataract cases and noncases according to the location of lens opacification (nuclear, cortical, posterior subcapsular) and its extent (early or more advanced). Evaluation of the system has shown good to excellent reproducibility for clinical and photographic classifications. Comparisons of clinical and photograph-derived gradings has shown generally good agreement in classifying the presence and type of cataract; this agreement is highest for nuclear cataract. Photographic gradings of posterior subcapsular and, to a lesser degree, cortical opacities tend to underestimate the extent of opacification found by clinical gradings. The Lens Opacities Case-Control Study system is simple, reproducible, and easy to implement; it is offered for use in case-control and other cross-sectional studies of cataract with compatible classification goals.