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J. A. Smith, S. Vitale, K. Martz, R. Nashwinter, L. Goodman, D. Cunningham; Digital Photography Assessment of Ocular Surface Vital Dye Staining. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2375.
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Ocular surface (OSF) vital dye staining is an essential measure of OSF damage. Current grading schemes require real-time observation of dye staining patterns and are hampered by the need to refer to standard diagrams, limited observation time, and inherent observer subjectivity. We studied 2 methods to assess OSF staining via digital imaging: masked human grading and automated assessment.
In eyes of patients with ocular surface disease, sodium fluorescein and lissamine green dyes were used via standardized procedures (volume, duration, photographic techniques). Simultaneous slit lamp clinical grading, Oxford scale (range, 0-5) of temporal (T), nasal (N) conjunctiva, and cornea (K) staining and digital photographs (OIS WinStation) were obtained and repeated 1 week later. Subsequent masked reviews of the digital images were done by the original clinical grader and 2 other graders. Digital images were also analyzed using an automated image processing segmentation algorithm consisting of 3 methods to identify area of staining intensity (StInt) for red (R), green (G), and blue (B) channels: 1) RGB: average R StInt/average G StInt; 2) RGB all:ratios (R/G, B/G, and B/R StInt); and 3) levels of HSB (Hue/Saturation/Brightness).
Data from 107 eyes of 41 subjects (93% female, 31-85 yrs, median 54.3 yrs, 80% White, 10% African American, 10% Asian) were analyzed. Agreement between digital and clinical grades are reported in the Table. StInt scores based on automated image processing increased significantly with increasing clinical grade: RGB, p=0.0001 (T), 0.0009 (N); RGB all, p=0.0001 (T), 0.0016 (N); HSB hue, p=0.0001 (T), 0.003 (N).
Agreement of masked digital photo grading with gold standard clinical grading was moderate to good. Automated digital OSF staining assessment may provide useful endpoints for future clinical trials.
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