Purpose: To evaluate objective cataract grading with double-pass image technique.

Methods: Cataract grading was performed with lens opacities classification system III and HD analyzer, and quality of vision questionnaire was conducted. Patients were divided by preoperative best-corrected visual acuity into two groups; those with visual acuity less than 20/30 to group A, and those with visual acuity better than 20/30 to group B. The correlation of HD Analyzer parameters including objective scatter index (OSI) and preoperative visual acuity was investigated.

Results: Among a total of 50 eyes of 37 patients, group B consisted of 20 eyes (40%) of 10 patients. OSI score was 5.8 ± 2.8 (1.9-10.6), and cases with score over 5 consisted 68%, and 52% among group B. OSI showed significant positive relationship to preoperative best-corrected visual acuity (p=0.012), but cases with good visual acuity and relatively high OSI score resulted in weaker relationship between OSI and visual acuity. OSI score was related to focus item in questionnaire.

Conclusions: Cataract surgery decision based on best-corrected visual acuity can overlook the discomfort of patients with good visual acuity and subjectively decreased quality of vision. OSI measurement via HD Analyzer could be expected to act as an objective method to evaluate cataract grade and help in deciding early surgery, especially in patients with good visual acuity and subjective discomfort.