Purpose <p>To determine whether a white cataract (WC) with elevated intralenticular pressure (EWC) can be distinguished from one with normal intralenticular pressure (NWC) using an optical biometer based on Swept-Source Optical Coherence Tomography (SS-OCT).</p> Study design <p>Retrospective observational study</p> Methods <p>Patients with a WC who had undergone phacoemulsification and intraocular lens (IOL) implantation at Iwate Medical University Hospital were enrolled. Using surgical videos, WCs with/without leakage of the liquefied cortex or bulging of the swollen cortex were classified as EWC and NWC, respectively. Both groups were compared in terms of age, sex, ocular comorbidities, various parameters, and the presence of characteristic appearances of the liquefied cortex on SS-OCT images. If the parameters were not measured appropriately, remeasurement using SS-OCT images were performed.</p> Results <p>Of the 48 patients with a WC, 26 eyes were classified as having an EWC, and 22 as NWC. There were significant differences in lens thickness (LT), anterior chamber depth (ACD), ΔLT, ΔACD (the differences in LT or ACD between the eyes with a WC and the fellow eyes, respectively), and age between an EWC and an NWC. ROC analysis showed that the AUC values of LT, ΔLT, and ΔACD were higher than 0.970. LT required remeasurement in approximately half of the WC, whereas ACD did not. Image evaluation for detecting an EWC had a sensitivity of 88.5% and a specificity of 90.9%.</p> Conclusions <p>An optical biometer based on SS-OCT may detect an EWC using LT, ΔLT, ΔACD, and SS-OCT images.</p>