An automatic diagnosis system of nuclear cataract is presented in this paper. Nuclear cataract is graded according to the severity of opacity using slit-lamp lens images. Anatomical structure in the lens image is detected using a modified active shape model (ASM). Based on the anatomical landmark, local features are extracted according to clinical grading protocol. Support vector machine (SVM) regression is employed to train a grading model for grade prediction. The system is tested using clinical images and clinical ground truth. More than five thousands slit-lamp images were tested. The success rate of feature extraction is 95% and the mean grading difference is 0.36. The automatic diagnosis system can help to improve the grading objectivity and save the workload of ophthalmologists.