Clinical performance of an objective methodology to categorize tear film lipid layer patterns

Purpose: To validate the performance of a new objective application designated iDEAS (Dry Eye Assessment System) to categorize different zones of lipid layer patterns (LLPs) in one image. Material and methods: Using the Tearscopeplus and a digital camera attached to a slit-lamp, 50 images were captured and analyzed by 4 experienced optometrists. In each image the observers outlined tear film zones that they clearly identified as a specific LLP. Further, the categorization made by the 4 optometrists (called observer 1, 2, 3 and 4) was compared with the automatic system included in iDEAS (5th observer). Results: In general, observer 3 classified worse than all observers (observers 1, 2, 4 and automatic application, Wilcoxon test, <0.05). The automatic system behaved similar to the remaining three observers (observer 1, 2 and 4) showing differences only for Open meshwork LLP when comparing with observer 4 (Wilcoxon test, p=0.02). For the remaining two observers (observer 1 and 2) there was not found statistical differences (Wilcoxon test, >0.05). Furthermore, we obtained a set of photographs per LLP category for which all optometrists showed agreement by using the new tool. After examining them, we detected the more characteristic features for each LLP to enhance the description of the patterns implemented by Guillon. Conclusions: The automatic application included in the iDEAS framework is able to provide zones similar to the annotations made by experienced optometrists. Thus, the manual process done by experts can be automated with the benefits of being unaffected by subjective factors.