The Ocular Redness Index: A Novel Automated Method for Measuring Ocular Injection

Amparo, Francisco; Wang, Haobing; Emami-Naeini, Parisa; Karimian, Parisa; Dana, Reza

doi:10.1167/iovs.13-12217

Cited by 46 publications

(56 citation statements)

References 19 publications

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“…5A, Table 1). OR arises as a consequence of reactive dilation of conjunctival blood vessels (conjunctival hyperemia) and is a frequent response to diverse pathologic stimuli333435. When all controls and patients were considered, we detected a positive linear correlation between OR scores and conjunctival CD4 + T CM (r = 0.5; P < 0.0001) and CD8 + T CM (r = 0.54; P < 0.0001), and an inverse correlation with conjunctival CD8 + T EM (r = −0.4; P = 0.0057) and T EMRA cells (r = −0.5; P = 0.002) (Fig.…”

Section: Resultsmentioning

confidence: 99%

Tissue resident memory T cells in the human conjunctiva and immune signatures in human dry eye disease

Bose

Lee

Hou

et al. 2017

Sci Rep

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Non-recirculating resident memory (TRM) and recirculating T cells mount vigorous immune responses to both self and foreign antigens in barrier tissues like the skin, lung and gastrointestinal tract. Using impression cytology followed by flow cytometry we identified two TRM subsets and four recirculating T-subsets in the healthy human ocular surface. In dry eye disease, principal component analysis (PCA) revealed two clusters of patients with distinct T-cell signatures. Increased conjunctival central memory and naïve T cells characterized Cluster-1 patients, and increased CD8+ TRMs and CD4+ recirculating memory T cells characterized Cluster-2 patients. Interestingly these T-cell signatures are associated with different clinical features: the first signature correlated with increased ocular redness, and the second with reduced tear break up times. These findings open the door to immune-based characterization of dry eye disease and T-subset specific immunotherapies to suppress T-subsets involved in disease. They may also help with patient stratification during clinical trials of immunomodulators.

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Section: Resultsmentioning

confidence: 99%

Tissue resident memory T cells in the human conjunctiva and immune signatures in human dry eye disease

Bose

Lee

Hou

et al. 2017

Sci Rep

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“…9 In order to overcome the limits of qualitative measurements, several (semi-) automated techniques have been described. Most of them are based on a combination of color quantification, [10][11][12][13] edge detection, 11 and fractal analysis.…”

Section: Posmentioning

confidence: 99%

“…Eyelids were held open to reveal the entire cornea and the maximum amount of bulbar conjunctiva. 10 Slit-lamp parameters were set as follows: white light with application of the diffuser, magnification 310, maximum slit width, angle of slit-lamp arm of 458, and maximum light intensity at one-half. Room lights were switched on.…”

Section: Questionnairesmentioning

confidence: 99%

“…Many studies, including ours, have tried to minimize variability in image acquisition by setting fixed slitlamp parameters. 10,11,13 In addition, Amparo et al 10 proposed an elegant white-balance correction algorithm to balance differences in lightening conditions. With regard to conjunctival ROIs selection, small interoperator differences should be unimportant given the large amount of total conjunctiva and the fact that the indices do not depend on the number of pixels.…”

Section: Figurementioning

confidence: 99%

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Quantifying Ocular Surface Inflammation and Correlating It With Inflammatory Cell Infiltration In Vivo: A Novel Method

Ferrari

Rabiolo

Bignami

et al. 2015

Invest. Ophthalmol. Vis. Sci.

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PURPOSE. The purpose of this study was to develop a novel, objective, and semiautomated method to quantify conjunctival redness by correlating measured redness with standard clinical redness and symptom scales and inflammatory cell infiltration. METHODS.Eleven outpatients presenting with mild to severe conjunctival hyperemia were included in the study. Clinical examination included patient history; visual analogue score (VAS) for ocular symptoms; 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ 25) for quality of life/vision; photographs of the anterior segment graded for conjunctival hyperemia, using Efron, relative redness of image (RRI), and edge feature (EF) scales; and conjunctival impression cytology analyzed by flow cytometry. Differences between affected and unaffected eyes were evaluated, and correlations among questionnaire scores, ocular hyperemia grading scores, and assessment of biological markers were performed.RESULTS. Visual analogue score (P < 0.0001), Efron scale (P ¼ 0.0003), RRI scores (P ¼ 0.0004), and EF scores (P < 0.0001) and the percentage of granulocytes (defined as cluster of differentiation [CD] 45 dim ; P ¼ 0.0080) were significantly higher in affected eyes. Conversely, the percentage of CD45 bright leukocytes was reduced in affected eyes (P ¼ 0.0054). Both the RRIs and EFs were positively correlated with VAS, Efron scale, percentages of conjunctival granulocytes, and CD45 bright CD3 neg cells, whereas they were negatively correlated with the percentage of CD45 bright CD3 pos cells. Edge feature and RRI were correlated (Spearman r ¼ 0.78, P < 0.0001).CONCLUSIONS. Ocular redness is a cardinal sign driving clinical judgment in highly prevalent ocular disorders; hence, we suggest that our semiautomated and reproducible method may represent a helpful tool in the follow-up of these patients.Keywords: conjunctival hyperemia, grading score, image processing, impression cytology, ocular redness SCOPO. Sviluppare un nuovo metodo quantitativo e semiautomatico per quantificare l'iperemia congiuntivale e correlarla con parametri clinici e biologici.METODI. Undici pazienti ambulatoriali con iperemia congiuntivale da lieve a severa sono stati inclusi nello studio. I pazienti arruolati sono stati valutati al basale e 20 6 8 giorni dopo. L'esame clinico includeva: storia del paziente; questionario Visual Analogue Score (VAS) al fine di valutare la sintomatologia oculare; questionario 25-Item National Eye Institute Visual Function Questionnaire (NEI-VFQ 25) al fine di valutare la qualità della vita e della visione; fotografie del segmento anteriore analizzate con scala di Efron, Relative Redness of Image (RRI) e Edge Feature (EF); citologia ad impressione congiuntivale processata tramite citometria a flusso. Sono state indagate le differenze tra occhi affetti e non-affetti e le correlazioni tra punteggi ottenuti ai questionari, grado di iperemia congiuntivale e parametri biologici.RISULTATI. Le seguenti misure: VAS (P < 0.0001), scala di Efron (P ¼ 0.0003), RRI (P ¼ 0.0004), EF (...

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“…10 Additionally, the photographs evaluated in our initial study did not include a reference mark that allowed for color-balance standardization. The current study was designed to overcome the limitations described in our previous report, and to specifically validate the ability of the ORI to assess changes in ocular redness in a real clinical setting, where patients are evaluated prospectively.…”

Section: Introductionmentioning

confidence: 99%

Evaluating Changes in Ocular Redness Using a Novel Automated Method

Amparo

Yin

Zazzo

et al. 2017

Trans. Vis. Sci. Tech.

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PurposeTo evaluate interobserver concordance in measured ocular redness among a group of raters using an objective computer-assisted method (ocular redness index [ORI]) and a group of clinicians using an ordinal comparative scale.MethodsWe conducted a prospective study to evaluate ocular redness in clinical photographs of 12 patients undergoing pterygium surgery. Photographs were acquired preoperatively, and at 1 week and 1 month postoperatively. One group of clinicians graded conjunctival redness in the photographs using an image-based comparative scale. A second group applied the ORI to measure redness in the same photographs. We evaluated redness change between time points, level of agreement among raters, and assessed redness score differences among observers within each group.ResultsInterobserver agreement using the image-based redness scale was 0.458 (P < 0.001). Interobserver agreement with the ORI was 0.997 (P < 0.001). We observed statistically significant differences among clinicians' measurements obtained with the image-based redness scale (P < 0.001). There were no significant differences among measurements obtained with the ORI (P = 0.27). We observed a significant change in redness between baseline and follow-up visits with all scoring methods. Detailed analysis of redness change was performed only in the ORI group due to availability of continuous scores.ConclusionOur findings suggest that the ORI scores provide higher consistency among raters than ordinal scales, and can discriminate redness changes that clinical observers often can miss.Translational RelevanceThe ORI may be a reliable alternative to measure ocular redness objectively in the clinic and in clinical trials.

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The Ocular Redness Index: A Novel Automated Method for Measuring Ocular Injection

Cited by 46 publications

References 19 publications

Tissue resident memory T cells in the human conjunctiva and immune signatures in human dry eye disease

Tissue resident memory T cells in the human conjunctiva and immune signatures in human dry eye disease

Quantifying Ocular Surface Inflammation and Correlating It With Inflammatory Cell Infiltration In Vivo: A Novel Method

Evaluating Changes in Ocular Redness Using a Novel Automated Method

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