Comparison of subjective grading of lid wiper epitheliopathy with a semi-objective method


Purpose: To validate a semi-objective method of grading lid wiper epitheliopathy (LWE) compared to subjective assessment. Methods: Twenty upper and 20 lower eyelid margins of patients with LWE were photographed after instillation of fluorescein and lissamine green. The images were graded by two observers using a 0-3 grading scale for height (%) and width (mm) of the lid staining. The images were also processed using custom designed software in MATLAB. After manual delineation of the staining area, width and perpendicular height were automatically measured throughout the selected area. The height as a proportion of the lid margin width and width measures were then categorized into the same bins as in the grading scale. Results: Repeatability of the image analysis system showed a mean difference (95% limits of agreement) between repeats of -0.01mm (0.03 and -0.05mm) for LWE height, 0.04mm (1.16 and -1.08mm) for LWE width, and -0.11mm2 (0.32 and -0.53mm2) for LWE area. The mean difference (95% limits of agreement) between image analysis and human grading for LWE height was -0.84 grades (0.54 and -2.21 grades), for LWE width was 0.31 grades (1.22 and -0.59 grades), and for the final grade (mean height and width) was -0.26 (0.44 and -0.96 grades) (all p <0.001). Conclusion: Human observers tend to overestimate the height and underestimate the width of LWE staining. Lid wiper region is not well defined, thus, it might be a difficult process for human observers to judge the stained region as a proportion of the lid wiper total region.

Publication DOI:
Divisions: College of Health & Life Sciences > School of Optometry > Optometry & Vision Science Research Group (OVSRG)
College of Health & Life Sciences > School of Optometry > Optometry
College of Health & Life Sciences
College of Health & Life Sciences > School of Optometry > Vision, Hearing and Language
Additional Information: © 2017, Elsevier. Licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International Funding: partly supported by Alcon Laboratories Inc.
Uncontrolled Keywords: Accuracy,Grading,Image analysis,Lid wiper epitheliopathy,LWE,Repeatability,Ophthalmology,Optometry
Publication ISSN: 1476-5411
Last Modified: 16 Jul 2024 07:08
Date Deposited: 23 Oct 2017 07:30
Full Text Link:
Related URLs: http://www.scop ... tnerID=8YFLogxK (Scopus URL)
https://www.sci ... 2679?via%3Dihub (Publisher URL)
PURE Output Type: Article
Published Date: 2018-02-01
Published Online Date: 2017-09-21
Accepted Date: 2017-09-09
Authors: Kunnen, Carolina M.E.
Wolffsohn, James S. (ORCID Profile 0000-0003-4673-8927)
Ritchey, Eric R.

Export / Share Citation


Additional statistics for this record