May 2008
Volume 49, Issue 13
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:
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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. doi:

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

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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.  

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

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