title: Removal of reflections in the photographic assessment of PCO by fusion of digital retroillumination images.
abstract: OBJECTIVE
  Automated image-analysis systems for objective assessment of posterior capsule opacification (PCO) depend on good image quality. One major drawback is the existence of light-reflection artifacts (Purkinje spots) in retroillumination images of the posterior capsule. Therefore, a software algorithm was developed that removes these artifacts by fusion of two or more digital images from the same eye, photographed in slightly different directions of gaze.
  
  
  METHODS
  The image-fusion process comprises five steps: definition of a primary and a secondary image, automated segmentation of the region of interest and the Purkinje spots, manual selection of three pairs of corresponding points in both images, geometric registration and radiometric calibration of the regions to be inserted from the secondary image into the primary image. The program was tested with an image set of 30 eyes that had various degrees of PCO. A digital image acquisition system with a coaxial optical path was used to take retroillumination images from each eye in at least three different directions of gaze.
  
  
  RESULTS
  In 28 cases all light-reflection artifacts within the capsulorrhexis rim could be removed entirely. In two cases, small parts of single Purkinje spots remained visible, because the reflections were located too closely in the primary and the secondary images.
  
  
  CONCLUSIONS
  Fusion of digital retroillumination images provides high-quality, reflection-free PCO images. This allows objective PCO assessment systems to analyze 100% of the posterior capsule, leading to more accurate results.
authors.affiliation: Department of Ophthalmology, University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria. oliver.findl@akh-wien.ac.at
authors.forename: Oliver
authors.initials: O
authors.lastname: Findl
authors.forename: Wolf
authors.initials: W
authors.lastname: Buehl
authors.forename: Hannes
authors.initials: H
authors.lastname: Siegl
authors.forename: Axel
authors.initials: A
authors.lastname: Pinz
mesh_terms: D000465:Algorithms; D016477:Artifacts; D002138:Calibration; D002386:Cataract / Q000175:diagnosis*; D003941:Diagnostic Techniques, Ophthalmological; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D007903:Lens Capsule, Crystalline / Q000473:pathology*; D008027:Light; D010781:Photography / Q000379:methods*; D012984:Software