title: Anterior segment measurements using digital photography: a simple technique.
abstract: OBJECTIVE
  The purpose of this study is to describe a simple method of measuring anterior segment lesions from digital slit lamp images and confirm reliability of the technique.
  
  
  METHODS
  Ten reference photos were taken of a PD ruler, refocusing on the ruler for each photo. Using Adobe Photoshop, the number of pixels per millimeter squared (area) and 1 mm (linear) were recorded for each photo. An Excel spreadsheet was set up to convert pixels to millimeters and millimeters squared. Interrater reliability was determined by two observers who independently calculated the area of 69 epithelial defects. A Bland and Altman plot was used to demonstrate the agreement between the two doctors.
  
  
  RESULTS
  Interrater reliability was excellent as measured by an intraclass correlation coefficient (ICC 2,1) = 0.99. From the Bland and Altman plot it was determined that in 95% of cases, the area of the epithelial defect measured by provider 2 may be as much as 1.17 mm less than or 1.09 mm greater than that measured by provider 1.
  
  
  CONCLUSIONS
  This simple method, which allows accurate measurements from digital images using common off-the-shelf software, is a valuable tool for clinical documentation as well as for research purposes.
authors.affiliation: Center for Refractive Surgery, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA. ronald.vanroekel1@na.amedd.army.mil
authors.forename: R Cameron
authors.initials: RC
authors.lastname: VanRoekel
authors.forename: Kraig S
authors.initials: KS
authors.lastname: Bower
authors.forename: Jenna M
authors.initials: JM
authors.lastname: Burka
authors.forename: Robin S
authors.initials: RS
authors.lastname: Howard
mesh_terms: D000869:Anterior Eye Segment / Q000033:anatomy & histology*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D010781:Photography / Q000379:methods*; D015203:Reproducibility of Results