Li Zhangliang, Zhang Rui, Wu Xueer, Zhu Zehui, Meng Ziqi, Yang Xing, Wang Dandan, Zhao Yune
Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China.
National Clinical Research Center for Ocular Diseases, Wenzhou, China.
Semin Ophthalmol. 2023 Oct;38(7):617-624. doi: 10.1080/08820538.2023.2176241. Epub 2023 Feb 14.
The dysfunctional lens index (DLI) provided by a ray-tracing aberrometry system is an objective index in cataract assessment. The purpose of this study is to evaluate correlations among Lens Opacities Classification System III (LOCS III) grades, Catquest 9SF scores, and the (DLI) and the DLI's role in surgical decision-making in age-related mixed cataract.
This trial was registered at NIH (clinicaltrial.gov) on January 5, 2021 (NCT04711395). In this prospective cross-sectional study, age-related mixed cataract patients were recruited. One high-volume and two low-volume surgeons made surgical decisions based on corrected distance visual acuity (CDVA), LOCS III graded photographs, and Catquest 9SF scores. Their decision-making agreement was evaluated with Cohen's kappa coefficient. Correlations among the parameters were analyzed. The optimal cut-off DLI was calculated using a receiver operating characteristic curve.
Overall, 106 patients (106 eyes) were included. Very good agreement levels were noted among the high- and low-volume surgeons (Cohen's kappa coefficient, 0.848) (95% CI, 0.748-0.948). The DLI had the strongest correlation with Catquest 9SF scores (R = 0.566), followed by with posterior subcapsular (R = 0.418), nuclear opalescence (R = 0.388), and cortical (R = 0.333, all < .0001) cataract LOCS III grades. Catquest 9SF scores were correlated with cortical (R = 0.249), nuclear opalescence (R = 0.278), and posterior subcapsular (R = 0.235, all < .0001) cataract LOCS III grades. A cut-off DLI of 5.36 was identified as a surgical criterion (specificity, 86.9%; sensitivity, 93.3%).
The DLI is valuable for objectively assessing patient complaints and lens opacity severity. LOCS III remains effective and economical in assessing early cortical cataracts with relatively clear central lenses. A cut-off DLI ≤5.36 could be a criterion for preoperative decision-making.
光线追踪像差测量系统提供的功能障碍晶状体指数（DLI）是白内障评估中的一个客观指标。本研究的目的是评估晶状体混浊分类系统III（LOCS III）分级、Catquest 9SF评分与DLI之间的相关性，以及DLI在年龄相关性混合性白内障手术决策中的作用。
本试验于2021年1月5日在美国国立医学图书馆（clinicaltrial.gov）注册（NCT04711395）。在这项前瞻性横断面研究中，招募了年龄相关性混合性白内障患者。一名高手术量和两名低手术量的外科医生根据矫正远视力（CDVA）、LOCS III分级照片和Catquest 9SF评分做出手术决策。用Cohen's kappa系数评估他们的决策一致性。分析各参数之间的相关性。使用受试者工作特征曲线计算最佳截断DLI。
共纳入106例患者（106只眼）。高手术量和低手术量外科医生之间的一致性水平非常好（Cohen's kappa系数，0.848）（95%CI，0.748 - 0.948）。DLI与Catquest 9SF评分的相关性最强（R = 0.566），其次是与后囊下（R = 0.418）、核混浊（R = 0.388）和皮质（R = 0.333，均P <.0001）白内障的LOCS III分级相关。Catquest 9SF评分与皮质（R = 0.249）、核混浊（R = 0.278）和后囊下（R = 0.235，均P <.0001）白内障的LOCS III分级相关。确定截断DLI为5.36作为手术标准（特异性，86.9%；敏感性，93.3%）。
DLI对于客观评估患者主诉和晶状体混浊严重程度具有重要价值。LOCS III在评估中央晶状体相对清晰的早期皮质性白内障方面仍然有效且经济。截断DLI≤5.36可作为术前决策的标准。
