Photographic image analysis system of posterior capsule opacification

Purpose: To describe a morphological scoring system of posterior capsule opacification (PCO) that is not based on visual acuity testing. Setting: Department of Ophthalmology, University of Heidelberg, Germany. Methods: Following dilation of the pupil, standardized photographs of the pseudophakic anterior segments were obtained using a photo slitlamp. Posterior capsule opacification was scored by evaluating retroillumination photographs. The individual PCO score was calculated by multiplying the density of the opacification (graded from 0 to 4) by the fraction of capsule area involved behind the intraocular lens (IOL) optic. To evaluate the reliability of the morphological scoring system, six observers examined photographs of five eyes each (Experiment A, interindividual reliability). The same observer scored the PCO in three eyes on five different days (Experiment B, intraindividual reliability). Results: Morphological PCO scores were very reliable. With PCO scoring from 0 to 4, the interindividual reliability showed standard deviations between 0.08 and 0.25. The intraindividual reliability showed standard deviations between 0.06 and 0.19 of the mean individual PCO scores. Standard deviation was 0.12 when different photographs of the same eye were scored. Conclusion: The morphological scoring system evaluates the entire area behind the IOL optic and thus includes a larger area of the posterior capsule than does visual acuity testing. The method revealed high reliability and insignificant investigatordependent variations. When using a standardized photographic setup, systematic errors by the photographic technique were not relevant. This method may be an important tool to accurately test for differences in PCO formation with various IOL styles and surgical methods.