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Original Investigation |

Automated Ptosis Measurements From Facial Photographs

Zachary M. Bodnar, MD1; Michael Neimkin, MD2; John B. Holds, MD1
[+] Author Affiliations
1Department of Ophthalmology, Saint Louis University, St Louis, Missouri
2Department of Ophthalmology and Visual Sciences, Washington University in St Louis, St Louis, Missouri
JAMA Ophthalmol. 2016;134(2):146-150. doi:10.1001/jamaophthalmol.2015.4614.
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Importance  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.

Objectives  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.

Design, Setting, and Participants  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.

Main Outcomes and Measures  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 and Relevance  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.

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Figure 1.
Image Acquired With the Flash Positioned to the Left of the Camera Lens

The flash positioning results in lateral displacement of the corneal light reflex (in this case to the patient’s right). The effect is asymmetric, with the corneal light reflex of the left eye being more off center than that of the right eye. The numerals in B are in millimeters.

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Figure 2.
Camera Systems Used

A commercially available camera system (D90 camera body with a 60-mm f/2.8G AF-S Micro Nikkor autofocus ED lens at F16; Nikon) was used. Another system (R1C1 wireless close-up Speedlight system for i-TTL single-lens reflex camera; Nikon) was used for illumination.

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Figure 3.
Margin Reflex Distance 1 (MRD1)

Photometric measurements were obtained with the software algorithm. σ Indicates SD; µ, arithmetic mean.

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Figure 4.
Margin Reflex Distance 2 (MRD2)

Photometric measurements were obtained with the software algorithm. σ Indicates SD; µ, arithmetic mean.

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