Objective Grading of The Anterior Eye

Peterson, Rachael C.; Wolffsohn, James S.

doi:10.1097/opx.0b013e3181981976

Cited by 56 publications

(41 citation statements)

References 8 publications

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“…Staining can also be spread across several sections on the eyelid, and 'interpreting' (and mentally adding) those areas together to assess the overall LWE width may be a challenging subjective task. Even improving on grading by averaging relative height and width 'bins' rather than making them a combined integer, the 95% confidence interval compared to subjective grading is nearly 1 unit of the 4-point scale (25%) [21] compared to just 10.7% with repeated image analysis for width, 13.8% for height, and 13.0% for area measures. It is also interesting to note the quadratic fit of subjectively grading LWE compared to objective image analysis, which has been observed before with some grading scales [22], caused in this case by the increasing width bands (2mm between grades 1 and 2; 3mm between grades 2 and 3; 5mm between grades 3 and 4) with increasing grade.…”

Section: Discussionmentioning

confidence: 99%

Comparison of subjective grading of lid wiper epitheliopathy with a semi-objective method

Kunnen

Wolffsohn

Ritchey

2018

Contact Lens and Anterior Eye

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Purpose: To validate a semi-objective method of grading lid wiper epitheliopathy (LWE) compared to subjective assessment. Methods:Twenty upper and 20 lower eyelid margins of patients with LWE were photographed after instillation of fluorescein and lissamine green. The images were graded by two observers using a 0-3 grading scale for height (%) and width (mm) of the lid staining. The images were also processed using custom designed software in MATLAB. After manual delineation of the staining area, width and perpendicular height were automatically measured throughout the selected area. The height as a proportion of the lid margin width and width measures were then categorized into the same bins as in the grading scale.Results: Repeatability of the image analysis system showed a mean difference (95% limits of agreement) between repeats of -0.01mm (0.03 and -0.05mm) for LWE height, 0.04mm (1.16 and -1.08mm) for LWE width, and -0. Conclusion:Human observers tend to overestimate the height and underestimate the width of LWE staining. Lid wiper region is not well defined, thus, it might be a difficult process for human observers to judge the stained region as a proportion of the lid wiper total region.

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Section: Discussionmentioning

confidence: 99%

Comparison of subjective grading of lid wiper epitheliopathy with a semi-objective method

Kunnen

Wolffsohn

Ritchey

2018

Contact Lens and Anterior Eye

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“…1 Sketching can be useful in visually indicating proportions and locations, but eye care practitioners differ in their artistic ability and prowess. However, it could still be considered the best method to represent anterior eye staining if photography is not available, as it is difficult otherwise to capture multiple locations, shapes and sizes of features such as staining, 2 although depth description may need noting with wordings. However, only about one third of optometrists used sketching and just 2% indicated they would photograph in a recent study.…”

Section: Introductionmentioning

confidence: 99%

Anterior eye health recording

Wolffsohn

Naroo

Christie

et al. 2015

Contact Lens and Anterior Eye

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This is the accepted version of the paper.This version of the publication may differ from the final published version. Permanent repository link AbstractAims: To survey eye care practitioners from around the world regarding their current practice for anterior eye health recording to inform guidelines on best practice. Methods:The on-line survey examined the reported use of: word descriptions, sketching, grading scales or photographs; paper or computerised record cards and whether these were guided by proforma headings; grading scale choice, signs graded, level of precision, regional grading; and how much time eye care practitioners spent on average on anterior eye health recording. Results:Eight hundred and nine eye care practitioners from across the world completed the survey. Word description (p<0.001), sketches (p=0.002) and grading scales (p<0.001) were used more for recording the anterior eye health of contact lens patients than other patients, but photography was used similarly (p = 0.132). Of the respondents, 84.5% used a grading scale, 13.5% using two, with the original Efron (51.6%) and CCLRU/BrienHolden-Vision-Institute (48.5%) being the most popular. The median features graded was 11 (range 1 to 23), frequency from 91.6% (bulbar hyperaemia) to 19.6% (endothelial blebs), with most practitioners grading to the nearest unit (47.4%) and just 14.7% to one decimal place. The average time taken to report anterior eye health was reported to be 6.8±5.7 minutes, with the maximum time available 14.0±11 minutes. Conclusions:Developed practice and research evidence allows best practice guidelines for anterior eye health recording to be recommended.

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“…The current literature describes several achievements in digital image analysis of conjunctival vessels, which are reported to be more sensitive than subjective ratings [19,20,27,28,29,30,31,32,33,34,35,36]. Combinations of different techniques are described, such as threshold-setting, edge-detection, color extraction, smoothing, fractal analysis or densitometry [28,33].…”

Section: Introductionmentioning

confidence: 99%

Objectifying the Conjunctival Provocation Test: Photography-Based Rating and Digital Analysis

Dogan

Astvatsatourov

Deserno

et al. 2013

Int Arch Allergy Immunol

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Background: Patients with allergic rhinoconjunctivitis are susceptible to both nasal and ocular symptoms. The conjunctival provocation test (CPT) is an established diagnostic procedure used in allergic rhinoconjunctivitis, particularly to document a patient's current reactivity to allergens. To date, there are no international guidelines defining the CPT. No approved evaluation method exists for interpreting CPT results. This paper aims to establish the digital analysis of macroimages as an objective, validated and standardized method for interpreting CPT results. Methods: In a clinical immunotherapy trial with 155 patients, treatment progress was documented based on the CPT. Local investigators used a symptom score to grade tearing, reddening and the patients' subjective perception of symptoms (mucosal irritation). A central observer rated conjunctival hyperemia via digital photography. Digital image analysis software was utilized to determine conjunctival hyperemia. Results: Spearman's correlation between the local investigators' and the central observer's ratings was r = 0.729 (p < 0.001); the percentage of total agreement was 48% (based on 739 photos). Digital image analysis (based on 48 photos) had a high percentage of total agreement with the central observer's ratings (69%) but a low percentage of total agreement with the investigators' ratings (38%). The corresponding correlations were r = 0.264 and 0.064, respectively. Conclusion: Photography-based rating by a central observer may represent a valuable supplement to the local investigator's assessment for making an objective evaluation of CPT results. Digital image analysis possesses the potential of being an objective evaluation method compared to the wide-spread subjective evaluation by the investigators.

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Objective Grading of The Anterior Eye

Cited by 56 publications

References 8 publications

Comparison of subjective grading of lid wiper epitheliopathy with a semi-objective method

Comparison of subjective grading of lid wiper epitheliopathy with a semi-objective method

Anterior eye health recording

Objectifying the Conjunctival Provocation Test: Photography-Based Rating and Digital Analysis

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