Novel Image-Based Analysis for Reduction of Clinician-Dependent Variability in Measurement of the Corneal Ulcer Size

Patel, Tapan P.; Prajna, Namperumalsamy Venkatesh; Farsiu, Sina; Valikodath, Nita; Niziol, Leslie M.; Dudeja, Lakshey; Kim, Kyeong Hwan; Woodward, Maria A.

doi:10.1097/ico.0000000000001488

Cited by 25 publications

(26 citation statements)

References 33 publications

(32 reference statements)

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“…Objective photo-documentation for progressive eye diseases like corneal ulcers or swellings can also help in avoiding errors encountered during manual documentation processes. [ 6 ] The use of screen mirroring with Apple TV (Apple Inc, CA, USA), allows for the images to also be seen with minimal lag, wirelessly on Smart TVs for the education of the patient along with training of residents. With an integrated, holistic, image management software and a HIPPA compliant cloud server, ease of use and data security have been made a priority.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, they can be used for patient education, resident training and photo-documentation for publications and conferences. [ 2 6 ] Instantaneous, objective digital imaging of anterior segment pathologies using commercial digital compact cameras have previously been validated to be at par with the clinical gold standards as well as slit-lamp cameras. [ 1 7 ] A digitized version of imaging brings about the advantage of improved data collection speed, processing power, and ease of storage of electronic data.…”

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confidence: 99%

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A novel approach to anterior segment imaging with smartphones in the COVID-19 era

Dutt

Vadivel

Nagarajan

et al. 2021

Indian Journal of Ophthalmology

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Purpose: To report a novel, telemedicine-friendly, smartphone-based, wireless anterior segment device with instant photo-documentation ability in the COVID-19 era. Methods: Anterior Imaging Module (AIM) was constructed based on a 50/50 beam splitter design, to match the magnification drum optics of slit-lamps with a three-step or higher level of magnification. The design fills the smartphone sensor fully at the lowest magnification and matches the fixed focus of the slit-lamp. It comes with a smartphone for instant photo-documentation, an in-built software application for data-management and secure HIPAA compliant cloud storage, and a Bluetooth trigger for a one-tap image capture. The construction of the device is explained, and the optical resolution measured using U.S. air-force resolution test. AIM’s performance was characterized with traceability to internationally relevant performance standards for digital slit-lamps after image quality assessment through a pilot study. Results: Clinically useful anterior segment images were obtained with both diffuse and slit illumination at different magnification settings with the highest magnification (40X) resolution of 359 lines per cm and the lowest magnification (16X) resolution of 113 lines per cm. Conclusion: AIM is a novel, wireless, telemedicine-enabled design that digitizes existing, analog slit lamps with at least three-step magnification. The settings ensure the focus is determined purely by the position of the slit-lamp. Hence, the image viewed and captured on the smartphone is exactly what the clinician sees through the eyepiece. This helps in maintaining distance from the patient in the ongoing COVID-19 pandemic, as well.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

A novel approach to anterior segment imaging with smartphones in the COVID-19 era

Dutt

Vadivel

Nagarajan

et al. 2021

Indian Journal of Ophthalmology

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“…Nonetheless, it would be helpful to develop image standard references similar to those available for the posterior eye [61]. The introduction of objective image analysis software and other semi-automated image segmentation tools could then be used to further standardise practice [62][63][64]. However, it is hard to envisage current smartphone technology being able to detect corneal pathology such as infiltrates and neovascularisation without accessories.…”

Section: Imagingmentioning

confidence: 99%

Could telehealth help eye care practitioners adapt contact lens services during the COVID-19 pandemic?

Nagra

Vianya-Estopà

Wolffsohn

2020

Contact Lens and Anterior Eye

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The COVID-19 pandemic has necessitated government-imposed restrictions on social interactions and travel. For many, the guidance has led to new ways of working, most notably a shift towards working remotely. While eye care practitioners (ECPs) may continue to provide urgent or emergency eye care, in many cases the travel restrictions present a unique challenge by preventing conventional face-to-face examination. Telephone triage provides a useful starting point for establishing at-risk and emergency patients; but patient examination is central to contact lens patient care.The indeterminate period over which conventional practice will be suspended, and the risk that resumption of 'normal' practice could be impeded by a potential secondary peak in COVID-19 cases, hastens the need for practitioners to adapt their delivery of eyecare. Specifically, it is prudent to reflect upon supportive evidence for more comprehensive approaches to teleoptometry in contact lens practice.Smartphone based ocular imaging is an area which has seen considerable growth, particularly for imaging the posterior eye. Smartphone imaging of the anterior eye requires additional specialised instrumentation unlikely to be available to patients at home. Further, there is only limited evidence for self-administered image capture. In general, digital photographs, are useful for detection of gross anterior eye changes, but subtle changes are less discernible.For the assessment of visual acuity, many electronic test charts have been validated for use by practitioners. Research into self-administered visual acuity measures remains limited.The absence of a comprehensive evidence base for teleoptometry limits ECPs, particularly during this pandemic. Knowledge gaps ought to be addressed to facilitate development of optometry specific evidence-based guidance for telecare. In particular, advances in ocular self-imaging could help move this field forwards.

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“…Image-based and computer-aided methods can reduce clinician-dependent variability and improve reliability of measurements. 19 , 20 Slit-lamp photography (SLP) is a low-cost technology universally available in eye clinics that provides high-resolution digital images of the eye. 21 Semiautomatic and fully automatic segmentation algorithms have been developed for SLP images of MK.…”

Section: Introductionmentioning

confidence: 99%

“… 21 Semiautomatic and fully automatic segmentation algorithms have been developed for SLP images of MK. 19 , 22 – 26 These are promising steps toward developing objective and standardized strategies to aid ophthalmologists in the clinical assessment of MK. However, some key questions that remain to be addressed are (1) how well these image-based measurements correlate with other important clinical measures such as visual function and (2) if these automatic segmentation algorithms can successfully substitute manual measurement methods to aid ophthalmologists in decision making for clinical care.…”

Section: Introductionmentioning

confidence: 99%

Open-Source Automatic Biomarker Measurement on Slit-Lamp Photography to Estimate Visual Acuity in Microbial Keratitis

Loo

Woodward

Prajna

et al. 2021

Trans. Vis. Sci. Tech.

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Purpose To assess clinical applicability of automatic image analysis in microbial keratitis (MK) by evaluating the relationship between biomarker measurements on slit-lamp photography (SLP) and best-corrected visual acuity (BCVA). Methods Seventy-six patients with MK with SLP images and same-day logarithm of the minimum angle of resolution (logMAR) BCVA were evaluated. MK biomarkers (stromal infiltrate, white blood cell infiltration, corneal edema, hypopyon, epithelial defect) were segmented manually by ophthalmologists and automatically by a novel, open-source, deep learning–based segmentation algorithm. Five measurements (presence, maximum width, total area, proportion of the corneal limbus area affected, centrality) were calculated. Correlations between the measurements and BCVA were calculated. An automatic regression model estimated BCVA from the measurements. Differences in performance between using manual and automatic measurements were evaluated using William's test (for correlation) and the paired-sample t -test (for absolute error). Results Measurements had high correlations of 0.86 (manual) and 0.84 (automatic) with true BCVA. Estimated BCVA had average (mean ± SD) absolute errors of 0.39 ± 0.27 logMAR (manual, median: 0.30) and 0.35 ± 0.28 logMAR (automatic, median: 0.30) and high correlations of 0.76 (manual) and 0.80 (automatic) with true BCVA. Differences between using manual and automatic measurements were not statistically significant for correlations of measurements with true BCVA ( P = .66), absolute errors of estimated BCVA ( P = .15), or correlations of estimated BCVA with true BCVA ( P = .60). Conclusions The proposed algorithm measured MK biomarkers as accurately as ophthalmologists. Measurements were highly correlated with and estimative of visual acuity. Translational Relevance This study demonstrates the potential of developing fully automatic objective and standardized strategies to aid ophthalmologists in the clinical assessment of MK.

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Novel Image-Based Analysis for Reduction of Clinician-Dependent Variability in Measurement of the Corneal Ulcer Size

Abstract: Variability exists when measuring corneal ulcers, even among ophthalmologists. Photography and computerized methods for quantifying the ulcer size could reduce variability while remaining accurate and impact quantitative measurement endpoints.

Cited by 25 publications

References 33 publications

A novel approach to anterior segment imaging with smartphones in the COVID-19 era

A novel approach to anterior segment imaging with smartphones in the COVID-19 era

Could telehealth help eye care practitioners adapt contact lens services during the COVID-19 pandemic?

Open-Source Automatic Biomarker Measurement on Slit-Lamp Photography to Estimate Visual Acuity in Microbial Keratitis

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