May 2008
Volume 49, Issue 13
Free
ARVO Annual Meeting Abstract  |   May 2008
Digital Photography Assessment of Ocular Surface Vital Dye Staining
Author Affiliations & Notes
  • J. A. Smith
    National Eye Inst/NIH, Potomac, Maryland
    Office of Clin Dir - MSC 1863,
  • S. Vitale
    National Eye Inst/NIH, Potomac, Maryland
    Division of Epidemiology and Clinical Research,
  • K. Martz
    EMMES Corporation, Rockville, Maryland
  • R. Nashwinter
    National Eye Inst/NIH, Potomac, Maryland
    Office of Clinical Director,
  • L. Goodman
    Office of Clinical Director, National Eye Inst/NIH, Bethesda, Maryland
  • D. Cunningham
    Office of Clinical Director, National Eye Inst/NIH, Bethesda, Maryland
  • Footnotes
    Commercial Relationships  J.A. Smith, None; S. Vitale, None; K. Martz, None; R. Nashwinter, None; L. Goodman, None; D. Cunningham, None.
  • Footnotes
    Support  NEI Intramural Research Program/NIH/DHHS
Investigative Ophthalmology & Visual Science May 2008, Vol.49, 2375. doi:https://doi.org/
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    • Get Citation

      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. doi: https://doi.org/.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose:
 

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.

 
Methods:
 

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).

 
Results:
 

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).

 
Conclusions:
 

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.  

 
Keywords: cornea: tears/tear film/dry eye • imaging/image analysis: clinical • cornea: clinical science 
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