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Rapid Image Evaluation System for Corneal In Vivo Confocal Microscopy

Sindt, Christine W. OD; Lay, Bruno PhD; Bouchard, Helene; Kern, Jami R. PhD

doi: 10.1097/ICO.0b013e31825ab9e2
Clinical Science

Purpose: To develop rapid image processing techniques for the objective analysis of corneal in vivo confocal micrographs.

Methods: Perpendicular central corneal volume scans from healthy volunteers were obtained via laser in vivo confocal microscopy. The layer in each volume scan that contained the nerve plexus was detected by applying software operators to analyze image features on the basis of their size, shape, and contrast. Dendritic immune cells were detected in the nerve image on the basis of cellular size, lack of elongation, and brightness relative to the nerves. Images that were 20 μm anterior to the best nerve layer images were used for the analysis of epithelial wing cells; wing cell detection was based on extended regional minima and a watershed transformation.

Results: The software successfully detected the best nerve layer images in 15 scans from 15 eyes. Manual and automatic analyses were 81.8% in agreement for dendritic immune cells (for 11 cells in a representative image) and 94.4% in agreement for wing cells (for 466 cells in the image). Within 10 seconds per scan, the software calculated the number, mean length, and mean density of immune cells; the number, mean size, and mean density of wing cells; and the number and mean length of nerves. Factors defining the shape and position of cells and nerves also were available.

Conclusions: The software rapidly and accurately analyzed the in vivo confocal micrographs of the healthy central corneas, yielding quantitative results to describe the nerves, dendritic immune cells, and wing cells.

Supplemental Digital Content is Available in the Text.

*Department of Ophthalmology, University of Iowa, Iowa City, IA

ADCIS, Saint-Contest, France

Alcon Research Ltd, Fort Worth, TX.

Reprints: Christine W. Sindt, Contact Lens Service, Department of Ophthalmology & Visual Science, University of Iowa, 200 Hawkins Dr, Iowa City, IA 52242-1091 (e-mail:

Alcon funded this research and provided the services of a medical writer to assist with the preparation of this manuscript. A patent that resulted from this study names CWS, BL, and JRK as inventors.

The authors have no conflicts of interest to disclose.

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 (

Received December 1, 2011

Accepted April 14, 2012

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.