Comparison of Manual and Automated Endothelial Cell Density Analysis in Normal Eyes and DSEK EyesPrice, Marianne O. PhD*; Fairchild, Kelly M. BA*; Price, Francis W. Jr MD†Cornea: May 2013 - Volume 32 - Issue 5 - p 567–573 doi: 10.1097/ICO.0b013e31825de8fa Clinical Science Abstract Author Information Purpose: To compare automated endothelial cell density analysis with manual cell detection methods with 3 imaging devices. Methods: In this prospective study, the corneal endothelium of 54 Descemet stripping endothelial keratoplasty (DSEK) eyes and 28 normal eyes was analyzed with a Nidek Confoscan 4 confocal microscope using a 20× noncontact lens and with Tomey EM-3000 and Konan Noncon Robo SP-8800 specular microscopes. Testing order was randomized. The Confoscan and Robo images were presented in a blinded fashion to an experienced technician for manual cell identification and analysis using the manufacturer's software. A different operator determined endothelial cell density using fully automated software associated with each imaging device. Agreement between methods was assessed by repeated-measures analysis of variance and post hoc Tukey analysis. Results: Manual cell identification on Robo and Confoscan 4 images produced comparable cell density measurements in normal eyes (P = 0.73) and DSEK eyes (P = 0.11). The Confoscan automated cell detection software differed significantly from manual cell detection in both normal and DSEK eyes (P = 0.0003 and P < 0.0001, respectively). The Robo automated cell detection software produced results comparable with manual cell detection in normal eyes (P = 0.082) but significantly overestimated cell density in DSEK eyes (P < 0.0001). The EM-3000 automated cell detection produced results comparable with manual cell detection in normal eyes (P = 0.067) and DSEK eyes (P = 0.49). Conclusions: Only 1 of 3 automated cell detection programs produced cell density readings comparable with those obtained with manual cell identification; the other 2 automated programs significantly overstated endothelial cell density in DSEK eyes. *Cornea Research Foundation of America, Indianapolis, IN †Price Vision Group, Indianapolis, IN. Reprints: Marianne O. Price, Cornea Research Foundation of America, 9002 North Meridian St, Suite 212, Indianapolis, IN 46260 (e-mail: firstname.lastname@example.org). The authors have no funding or conflicts of interest to disclose. Received February 17, 2012 Accepted May 4, 2012 © 2013 by Lippincott Williams & Wilkins.