Validation of a semi-automatic protocol for the assessment of the tear meniscus central area based on open-source software

Purpose: Different lower tear meniscus parameters can be clinical assessed on dry eye diagnosis. The aim of this study was to propose and analyse the variability of a semi-automatic method for measuring lower tear meniscus central area (TMCA) by using open source software. Material and methods: On a group of 105 subjects, one video of the lower tear meniscus after fluorescein instillation was generated by a digital camera attached to a slit-lamp. A short light beam (3x5 mm) with moderate illumination in the central portion of the meniscus (6 o’clock) was used. Images were extracted from each video by a masked observer. By using an open source software based on Java (NIH ImageJ), a further observer measured in a masked and randomized order the TMCA in the short light beam illuminated area by two methods: (1) manual method, where TMCA images was “manually” measured; (2) semi-automatic method, where TMCA images were transformed in an 8-bit-binary image, then holes inside this shape were filled and on the isolated shape, the area size was obtained. Finally, both measurements, manual and semi-automatic, were compared. Results: Paired t-test showed no statistical difference between both techniques results (p = 0.102). Pearson correlation between techniques show a significant positive near to perfect correlation (r = 0.99; p < 0.001). Conclusions: This study showed a useful tool to objectively measure the frontal central area of the meniscus in photography by free open source software.