Utility of photography for trachoma surveys: A systematic review

Naufal, Fahd; West, Sheila K.; Brady, Christopher J.

doi:10.1016/j.survophthal.2021.08.005

Cited by 9 publications

(10 citation statements)

References 24 publications

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“…Previous studies using photography to grade eyelids for trachoma have shown reasonably good correlation with field grading. 4 , 7 – 9 However, some studies have had difficulties with high rates of ungradable images from 11% to 78%. 5 , 9 , 10 Commonly reported factors contributing to images being ungradable included improper focus on the grading area, inadequate coverage of the grading area, excess light reflection, or shadows obscuring the grading area.…”

Section: Discussionmentioning

confidence: 99%

“…The argument that TI cannot be graded reliably, at least for images, was not the case in this study, and agreement on grading TI in the field has also reportedly been very good. 4 …”

Section: Discussionmentioning

confidence: 99%

“…However, there are a number of issues raised by the use of photography. 4 One is concern for the number of ungradable images that can occur, which in some surveys was reported as quite large. 5 As in other ophthalmic uses of photography, this problem can be mitigated by training, certification, and supervision of photographers.…”

Section: Introductionmentioning

confidence: 99%

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The Impact of Image Quality and Trachomatous Inflammation on Using Photography for Trachoma Prevalence Surveys

Odonkor

Naufal

Mkocha³

et al. 2022

Trans. Vis. Sci. Tech.

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Purpose Graded images can be used for trachoma prevalence surveys, but there is concern for mismatch between image and field grades of the upper tarsal conjunctiva. We aimed to determine if poor photograph quality and/or inflammation may contribute to differential grading of trachomatous inflammation—follicular (TF) between field and photograph graders. Methods We developed a simplified and expanded image quality grading tool. Agreement was assessed using kappa statistic. We included 5417 eyes with both field and image grades for TF. Eyes where the field and adjudicated photograph TF grades did not match were identified (mismatched) and assigned an image quality (IQ) score and a potential mismatch reason. We also assigned IQ scores to a stratified random sample of 60 eyes with matching field and photograph TF grades (matched). Results There were 5240 eyes that had matching grades, whereas 177 eyes (3.3%) were mismatched. Overall quality was high, even in mismatched eyes. There was no difference in overall or specific IQ metrics between eyes with matching grades and eyes with mismatched grades ( P = 0.59). Mismatched eyes had worse inflammation compared to matched eyes ( P = 0.048). The primary reason for calling TF in the field but not in the photographs appeared to be the number of follicles observed. Conclusions Image quality did not explain mismatch between field grades and image grades from this prevalence survey. Inflammation made mismatch more likely. Translational Relevance Our quality grading scheme rapidly identifies image quality issues for training. Standardizing TF grading in the presence of inflammation will improve field and photograph grading.

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Section: Discussionmentioning

confidence: 99%

“…The argument that TI cannot be graded reliably, at least for images, was not the case in this study, and agreement on grading TI in the field has also reportedly been very good. 4 …”

Section: Discussionmentioning

confidence: 99%

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The Impact of Image Quality and Trachomatous Inflammation on Using Photography for Trachoma Prevalence Surveys

Odonkor

Naufal

Mkocha³

et al. 2022

Trans. Vis. Sci. Tech.

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“…While photography has often been used as part of randomized controlled trials and in trachoma research generally, data are scarce on the reliability of conjunctival photography within various programmatic surveys. 6 The photographer in this study traveled house-to-house alongside field graders and achieved a high response rate. Within the 10 selected communities, which were scattered across a large geographic area, the team photographed nearly all participants examined for a field grade.…”

Section: Discussionmentioning

confidence: 99%

Photographic grading for trachoma diagnosis within trachoma impact surveys in Amhara region, Ethiopia

Whitson

Nute

Hailemariam

et al. 2022

Transactions of the Royal Society of Tropical Medicine and Hygiene

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Background As countries reach the trachoma elimination threshold and cases of trachomatous inflammation follicular (TF) become rare, it becomes difficult to train survey graders to recognize clinical signs. We assess the use of photography as a grading tool, the efficiency of an in-country grading center and the comparability of field and photographic grading. Methods During January–February 2017 surveys in Amhara, Ethiopia, field graders assessed TF, trachomatous inflammation intense (TI) and trachomatous scarring (TS). Photographs were taken from each conjunctiva and later graded at the Gondar Grading Center (GGC) at the University of Gondar in Amhara. Two trained ophthalmology residents graded each set of photographs and a third grader provided an adjudicating grade when needed. Results A total of 4953 photographs of 2477 conjunctivae from 1241 participants in 10 communities were graded over 5 d at the GGC. Six examined participants were not photographed. Agreement between field and photographic grades were for TF: percent agreement (PA) 96.7%, κ=0.70 (95% confidence interval [CI] 0.64 to 0.77; for TI: PA 94.7%, κ=0.32 (95% CI 0.20 to 0.43); and for TS: PA 83.5%, κ=0.22 (95% CI 0.15 to 0.29). Conclusions Conjunctival photography may be a solution for programs near the elimination threshold where there are few available community cases for training field graders.

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“…However, the precision of TF grading becomes problematic when trachoma prevalence is low. There is tendency to overcall follicles [ 3 ], and there is clearly intergrader variability even when agreement is acceptable [ 4 ]. At the same time, a test of infection for surveillance purposes is also controversial as sensitive commercial tests are expensive, there are no guidelines or standardization on usage, and evidence shows that a low level of infection does not necessarily lead to trachoma re-emergence [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Risk of seroconversion and seroreversion of antibodies to Chlamydia trachomatis pgp3 in a longitudinal cohort of children in a low trachoma prevalence district in Tanzania

Chen¹,

Muñoz²,

Mkocha³

et al. 2022

PLoS Negl Trop Dis

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Background Serologic testing for chlamydial antibodies is one potential tool for trachoma monitoring. Understanding the dynamics of seroconversion and seroreversion in low endemic districts is critical for determining the value of using serology. Methodology/Principal findings We surveyed a random sample of 2536 children aged 1–9 years in Kongwa, Tanzania, over three years; 1719 (67.8%) participants had all three follow-ups. Surveys assessed trachomatous inflammation—follicular (TF), Chlamydia trachomatis infection, and anti-pgp3 antibodies. Mass drug administration occurred immediately after the first and second follow-up surveys. The cohort was classified into trajectories of change in serostatus, and risk factors were evaluated for seroconversion and seroreversion. We found that 86.2% of seropositives remained seropositive throughout the study, whereas 12.1% seroreverted. Seroreverters were younger (Odds Ratio [OR] = 0.88 for every one-year increase in age, 95% CI = 0.79–0.99). 84.5% of seronegatives remained seronegative, and 13.0% seroconverted. Seroconverters were also younger (OR = 0.92, 95% CI = 0.87–0.98). Seroconversion and seroreversion were not explained by indeterminate values for the intensity of antibody response. Less than 1% of the cohort had unstable changes in serostatus, mostly explained by values in the indeterminate range. TF and infection in the cohort declined over time, while seropositivity increased from 31.5% to 36.4%. Conclusions/Significance Antibody status is relatively stable over time. Both seroconversion and seroreversion occurred over the three years in this low endemic district, especially in younger children. Modeling seroreversion is important for accurate determination of seroconversion. The use of serology as a monitoring tool should target the younger aged children as they will most likely capture recent changes in serostatus.

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Utility of photography for trachoma surveys: A systematic review

Cited by 9 publications

References 24 publications

The Impact of Image Quality and Trachomatous Inflammation on Using Photography for Trachoma Prevalence Surveys

The Impact of Image Quality and Trachomatous Inflammation on Using Photography for Trachoma Prevalence Surveys

Photographic grading for trachoma diagnosis within trachoma impact surveys in Amhara region, Ethiopia

Risk of seroconversion and seroreversion of antibodies to Chlamydia trachomatis pgp3 in a longitudinal cohort of children in a low trachoma prevalence district in Tanzania

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