RT Journal Article SR Electronic T1 Objective quantification of lens nuclear opacities using swept-source anterior segment optical coherence tomography JF British Journal of Ophthalmology JO Br J Ophthalmol FD BMJ Publishing Group Ltd. SP 790 OP 794 DO 10.1136/bjophthalmol-2020-318334 VO 106 IS 6 A1 Wang, Wei A1 Zhang, Jiaqing A1 Gu, Xiaoxun A1 Ruan, Xiaoting A1 Chen, Xiaoyun A1 Tan, Xuhua A1 Jin, Guangming A1 Wang, Lanhua A1 He, Mingguang A1 Congdon, Nathan A1 Liu, Zhenzhen A1 Luo, Lixia A1 Liu, Yizhi YR 2022 UL http://bjo.bmj.com/content/106/6/790.abstract AB Background/aims The primary objective is to quantify the lens nuclear opacity using swept-source anterior segment optical coherence tomography (SS-ASOCT) and to evaluate its correlations with Lens Opacities Classification System III (LOCS-III) system and surgical parameters. The secondary objective is to assess the diagnostic performance for hard nuclear cataract.Methods This cross-sectional study included 1222 patients eligible for cataract surgery (1222 eyes). The latest SS-ASOCT (CASIA-2) was used to obtain high-resolution lens images, and the average nuclear density (AND) and maximum nuclear density (MND) were measured by a custom ImageJ software. Spearman’s correlations analysis was used to assess associations of AND/MND with LOCS-III nuclear scores, visual acuity and surgical parameters. The subjects were then split randomly (9:1) into the training dataset and validating dataset. Receiver operating characteristic curves and calibration curves were constructed for the classification on hard nuclear cataract.Results The AND and MND from SS-ASOCT images were significantly correlated with nuclear colour scores (AND: r=0.716; MND: r=0.660; p<0.001) and nuclear opalescence scores (AND: r=0.712; MND: r=0.655; p<0.001). The AND by SS-ASOCT images had the highest values of Spearman’s r for preoperative corrected distance visual acuity (r=0.3131), total ultrasonic time (r=0.3481) and cumulative dissipated energy (r=0.4265). The nuclear density had good performance in classifying hard nuclear cataract, with area under the curves of 0.859 (0.831–0.886) for AND and 0.796 (0.768–0.823) for MND.Conclusion Objective and quantitative evaluation of the lens nuclear density using SS-ASOCT images enable accurate diagnosis of hard nuclear cataract.All data relevant to the study are included in the article or uploaded as supplemental information.