Methods of Age-related Cataract Diagnosis: from Classic to Innovative Technologies. Literature Review

The literature review focuses on the capabilities of modern high-tech methods for examining the lens, the implementation of which in clinical practice is essential for enhancing the effectiveness of cataract diagnosis. Biomicroscopy with lens image registration, inclu- ding retroillumination for subjective cataract assessment according to the LOCS III classification, remains a widely used method for evaluating lens status. However, despite its versatility, this approach is characterized by significant dependence on the investigator’s experience and qualifications. In an era where contemporary cataract surgery has achieved high standards and shifted emphasis toward patient visual quality, existing subjective diagnostic methods prove inadequate. In recent years, objective methods for lens examination have gained practical significance, enabling the most accurate detection of early age-related lens changes with quantita- tive assessment of opacity severity. One such method is ultrasonic densitometry. The most common technique for quantitative lens evaluation is optical densitometry using Scheimpflug cameras and computer software for objective assessment of opacity localiza- tion and progression dynamics. Other highly informative optical methods for detecting various stages of age-related cataract include wavefront aberration analysis with determination of the light scattering index via double-pass technology, as well as the use of the Shack-Hartmann wavefront sensor. Optical coherence tomography (OCT) with variable wavelength and a high-frequency detector allows high-resolution visualization of lens layer changes, substance degradation, and the presence of vacuoles and lysis zones in cataract. In modern ophthalmology, high-tech methods for quantitative assessment of lens optical density are becoming indispensable not only for determining indications for surgical intervention, selecting optimal phacoemulsification regimens, and preventing intraoperative complications, but also for monitoring cataract progression in clinical trials and evaluating the efficacy of pharmacological correction for initial age-related lens opacities.

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