title: Margin Reflex Distance: Differences Based on Camera and Flash Positions.
abstract: OBJECTIVE
  To evaluate the effect of camera flash position on the measurement of photographic margin reflex distances (MRD).
  
  
  METHODS
  Subjects without any ophthalmic disease were prospectively enrolled after institutional review board approval. Clinical measurements of MRD1 and interpalpebral fissure were obtained. Photographs were then taken with a digital single lens reflex with built-in pop-up flash (dSLR-pop), a dSLR with lens-mounted ring flash (dSLR-ring), a point-and-shoot camera, and a smartphone, each in 4 positions: with the camera upright, rotated 90°, 180°, and 270°. The images were analyzed using ImageJ software to measure MRD1, interpalpebral fissure, horizontal white-to-white, and distance from nasal limbus to the corneal light reflex.
  
  
  RESULTS
  Thirty-two eyes of 16 subjects were included (ages 27-65). When using the dSLR-ring, point-and-shoot, and smartphone, the difference between clinical and photographic MRD1 did not reach statistical significance. There was, however, a statistically significant difference in the upright position with dSLR-pop (mean difference 0.703 mm, σ = 0.984 mm, p = 0.0008). For dSLR-pop, photographic MRD1 in upright versus inverted position differed significantly (mean difference -0.562 mm, σ =0.348 mm, p < 0.0001). Photographic MRD1 between dSLR-pop and dSLR-ring showed significant difference in upright position (mean difference -0.572 mm, σ = 0.701 mm, p = 0.0002). There were no statistically significant differences between clinical and photographic interpalpebral fissure, and among white-to-white and nasal limbus to light reflex measurements in any position in all 4 cameras.
  
  
  CONCLUSIONS
  When using photographs for measurement of MRD1, cameras with a near-coaxial light source and aperture have values that are most similar to clinical measurements.
authors.affiliation: *Ophthalmic Plastic Surgery, Massachusetts Eye and Ear Infirmary; and †Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, U.S.A.
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: Choi
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Chou
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Lefebvre
authors.forename: Michael K
authors.initials: MK
authors.lastname: Yoon
mesh_terms: D000328:Adult; D000368:Aged; D001767:Blinking / Q000502:physiology*; D003315:Cornea / Q000503:physiopathology*; D005128:Eye Diseases / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008027:Light; D008297:Male; D008875:Middle Aged; D010775:Photic Stimulation; D010781:Photography / Q000295:instrumentation*; D011446:Prospective Studies; D012984:Software