Clinical ScienceAutomated Ocular Surface Image Analysis and Health-Related Quality of Life Utility Tool to Measure Blepharokeratoconjunctivitis Activity in ChildrenAl-Hayouti, Huda PhD*; Daniel, Moritz Dr med*,†; Hingorani, Melanie MD FRCOphth‡; Calder, Virginia PhD§; Dahlmann-Noor, Annegret Dr med, PhD, FRCOphth, FRCS(Ed), DipMedEd*,‡Author Information *NIHR Moorfields Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK; †Eye Center, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; ‡Paediatric Service, Moorfields Eye Hospital, London, UK; and §UCL Institute of Ophthalmology, London, UK. Correspondence: Annegret Dahlmann-Noor, Dr med, PhD, FRCOphth, FRCS(Ed), DipMedEd, NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, 162 City Rd, London EC1V 2PD, UK (e-mail: [email protected]). The study was funded by the Moorfields Eye Charity (ST 15 07 J). The research was supported by the National Institute for Health Research (NIHR) Moorfields UCL Institute of Ophthalmology Biomedical Research Centre. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health. Competing interests: In 2017, A. Dahlmann-Noor acted as medical advisor for Santen Inc and Aeries Pharmaceuticals. H. Al-Hayouti, M. Daniel, V. Calder, and M. Hingorani have no interest to declare. Thea contributed to funding for a related project involving tear sample analysis in children with BKC. NeoMatrix contributed to the same related tear sample study, providing a novel sampling technology. None of these had any influence on the work presented here. A. Dahlmann-Noor has been a medical advisor for Santen Inc and Aeries Pharmaceuticals. The remaining authors have no conflicts of interest to declare. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.corneajrnl.com). Cornea: November 2019 - Volume 38 - Issue 11 - p 1418-1423 doi: 10.1097/ICO.0000000000002042 Buy SDC Metrics Abstract Purpose: To explore the tolerability of automated conjunctival hyperemia quantification in children with blepharokeratoconjunctivitis (BKC) and its agreement with clinical activity grading and to explore the Children's Health Utility 9D (CHU9D) as a measure of health-related quality of life in children with BKC. Methods: We enrolled 63 children, 31 with BKC and 32 without ocular surface inflammation, with a median [interquartile range (IQR)] age of 10.6 (7.2–13.9) years for BKC and 11.4 (9.5–13.8) years for healthy volunteers. Two masked observers graded the ocular surface images. The children indicated discomfort during imaging on a 5-point Likert scale. Using nonparametric tests, we explored the interobserver agreement and the agreement of automated redness index (RI) measurements of limbal and bulbar conjunctival hyperemia with clinician assessment. The children also completed the 9-item CHU9D. Results: The children tolerated imaging well: median (IQR) Likert value of 0 (“comfortable”) (0–0) in healthy volunteers and 1 (“a little bit uncomfortable”) (0–2) in mild/moderate BKC. In children with BKC, the median (IQR) bulbar RI was 1.3 (0.8–1.6) and the median limbal RI was 0.7 (0.3–1.1). In healthy volunteers, the median bulbar RI was 0.8 (0.55–1.1; P = 0.162) and the median limbal RI was 0.3 (0.2–0.4; P = 0.02). The agreement between RI and clinical grading was high. There was no significant difference between the mean CHU9D utility score between the 2 groups [0.89 (SD 0.08) vs. 0.92 (SD 0.07); P = 0.15]. Conclusions: Automated conjunctival hyperemia quantification is feasible in children with ocular surface inflammation and may prove useful for long-term monitoring and as an objective outcome measure in clinical trials. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.