title: Objective quantification of fluorescence intensity on the corneal surface using a modified slit-lamp technique.
abstract: OBJECTIVE
  To improve the digital quantification of fluorescence intensity of sodium fluorescein instilled on corneal surface by modifying a slit lamp hardware and performing computerized processing of captured digital images.
  
  
  METHODS
  The optics of a slit lamp were modified to remove corneal Purkinje reflection and to expand the illuminated area on the cornea, followed by postexperiment image processing to minimize the influence of uneven illumination. To demonstrate the feasibility and reliability of this new technique, we applied it to objective grading of corneal staining with sodium fluorescein. The results of computerized grading were compared with the results obtained using standard subjective grading of corneal staining. Objective digital grades, staining area, and staining pixel with manually and automatically defined threshold (SP-M and SP-A) were calculated for both original and processed images. Standard subjective grades of the original images were performed by 13 trained observers using National Eye Institute (NEI), Efron, and CCLRU grading scales. A series of linear regression analyses were performed to investigate the correlation between objective and subjective grades.
  
  
  RESULTS
  Digital grades of the captured images were correlated significantly with subjective grades. After minimization of the artifact caused by the nonuniform illumination, correlations between digital and subjective grading were mostly strengthened. In some cases, digital grading of corneal staining was more sensitive than subjective grading methods when differentiating subtle differences of corneal staining.
  
  
  CONCLUSIONS
  Modifications performed on commercial slit-lamp hardware and the proposed digital image-processing technique have improved the quality of captured images for semiautomated quantification of fluorescein intensity on the cornea.
authors: Clinical Research Center, School of Optometry, University of California, Berkeley, CA 94720-2020, USA.
authors: Bo
authors: B
authors: Tan
authors: Yixiu
authors: Y
authors: Zhou
authors: Tatyana
authors: T
authors: Svitova
authors: Meng C
authors: MC
authors: Lin
mesh_terms: D000293:Adolescent; D000328:Adult; D003316:Corneal Diseases / Q000175:diagnosis*; D003941:Diagnostic Techniques, Ophthalmological / Q000295:instrumentation; D005260:Female; D019793:Fluorescein; D005456:Fluorescent Dyes; D006801:Humans; D008297:Male; D055815:Young Adult
chemical_list: D005456:Fluorescent Dyes; D019793:Fluorescein