Evaluation of Fungal Keratitis using a Newly Developed Computer Program, Optscore, for Grading Digital Corneal Photographs

Abstract

Purpose: To validate computer software developed to assess digital corneal photographs of fungal keratitis in clinical research.

Methods: A cornea specialist and five medical students (after training) graded on two occasions 100 corneal photographs of patients with fungal keratitis using Optscore software. Variables assessed were lesion area, location, degree of opacity, percentage of the ulcer lying within a central 4 mm circle of the cornea. Intraclass correlation coefficients (ICCs) were used to assess intragrader reliability, agreement of the students with the corneal specialist, and the reliability of the group mean of the student raters. The area determined using Optscore was compared to the area estimated from slit lamp and to visual acuity.

Results: As a group, medical students achieved an ICC greater than 0.9 for five out of the seven assessed variables. Similar levels of consistency were found after analyzing the graders’ individual results compared to the specialist. The area estimated using slit lamp examination was highly correlated with the mean area determined by Optscore, as was the logarithm of the minimum angle of resolution visual acuity at enrollment.

Conclusions: Non-expert graders using Optscore to assess digital photographs of fungal keratitis are self-consistent, agree with an expert grader both as a group and individually, and measurements of ulcer area obtained from Optscore are highly correlated with measurements of the same patients obtained on clinical examination. These observations support the validity of Optscore for assessing corneal pathology associated with fungal keratitis and make it a promising clinical research tool.

• Corneal ulcer grading
• digital photography
• Mycotic Ulcer Treatment Trial (MUTT)
• Optscore
• Steroids for Corneal Ulcers Trial (SCUT)

Acknowledgements

The authors thank the patients in the Mycotic Ulcer Therapeutic Exploratory Trial and the five medical student graders. They also gratefully acknowledge the assistance of S. Chandra in creating the teaching presentation.