title: Automated Ptosis Measurements From Facial Photographs.
abstract: OBJECTIVE
  Measurements of the margin reflex distances 1 and 2 are crucial for the surgical planning of ptosis repair and blepharoplasty. Facial photographs annotated with automated measurements of eyelid position could provide objective, accurate, and reproducible documentation of these features.
  
  
  OBJECTIVE
  To describe a software algorithm for determining the margin reflex distances 1 and 2 from facial photographs and to evaluate its agreement with manual measurements of the margin reflex distances 1 and 2.
  
  
  METHODS
  Observational study at a single-surgeon oculoplastic private practice among 55 eyes of 28 adult volunteers. The study dates were July 30, 2014, to September 12, 2014. The dates of our analysis were October 12, 2014, to June 18, 2015.
  
  
  METHODS
  Agreement between manual and automated measurements of the margin reflex distances 1 and 2.
  
  
  RESULTS
  Among 55 eyes of 28 participants, automated margin reflex distance 1 measurements were strongly correlated with manual measurements (r = 0.97; 95% CI, r = 0.95 to r = 0.98; P < .001). The bias of automated margin reflex distance 1 measurements was 0.03 mm (95% CI, -0.06 to 0.12 mm), with 95% confidence limits of -0.66 and 0.71 mm. Automated margin reflex distance 2 measurements were strongly correlated with manual measurements (r = 0.96; 95% CI, r = 0.93 to r = 0.98; P < .001). The bias of automated margin reflex distance 2 measurements was 0.13 mm (95% CI, 0.03-0.22 mm), with 95% confidence limits of -0.54 and 0.80 mm.
  
  
  CONCLUSIONS
  Automated ptosis measurements produced by our software algorithm compare favorably with manually performed clinical measurements. An automated, photography-based system could provide an archival and highly reproducible means for obtaining the margin reflex distances 1 and 2 and other facial morphometric data.
authors.affiliation: Department of Ophthalmology, Saint Louis University, St Louis, Missouri.
authors.forename: Zachary M
authors.initials: ZM
authors.lastname: Bodnar
authors.affiliation: Department of Ophthalmology and Visual Sciences, Washington University in St Louis, St Louis, Missouri.
authors.forename: Michael
authors.initials: M
authors.lastname: Neimkin
authors.affiliation: Department of Ophthalmology, Saint Louis University, St Louis, Missouri.
authors.forename: John B
authors.initials: JB
authors.lastname: Holds
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001763:Blepharoptosis / Q000175:diagnosis*; D001767:Blinking; D003941:Diagnostic Techniques, Ophthalmological; D005145:Face; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010781:Photography / Q000379:methods*; D015203:Reproducibility of Results; D012984:Software; D055815:Young Adult