PURPOSE: To obtain estimates of the prevalence of lens opacities in an Indian setting by using photographically acquired lens images. METHODS: In 11 randomly sampled villages from a rural district of Haryana, North India, 1443 people (median age 60 years), 52% women, were identified from enumeration of the > or =50-year age group; 87% attended an eye examination. Digital images of cortical and posterior subcapsular opacities and photographs of nuclear opacities were graded using the Lens Opacity Classification System (LOCS) II. The prevalence of opacities was based on a grade of 2 or higher in the worse eye for nuclear, cortical, or posterior subcapsular opacities. RESULTS: Of the participants, 1071 people had gradable images; a further 163 had undergone surgery or had dense opacities. Nuclear opacities were the most common type, with an overall prevalence of 56.9% (95% CI, 53.0-60.6). Posterior subcapsular opacities occurred in 20.6% (95% CI, 17.9-25.8) and cortical opacities in 21.6% (95% CI, 17.9-25.8). Prevalence rose steeply with age for all opacities and was higher in the women than in the men for cortical opacities (P = 0.03). The prevalence of any type of lens opacity including surgical cases and dense opacities was 75.3% (95% CI, 71.4-78.81). CONCLUSIONS: These results highlight the substantial excess of lens opacities in India compared with Western populations.