Department of Ophthalmology, Duke University, Durham, North Carolina; Department of Pediatrics, Duke University, Durham, North Carolina.
Massachusetts Eye and Ear, Boston, Massachusetts; Department of Ophthalmology, Harvard School of Medicine, Boston, Massachusetts.
J AAPOS. 2021 Oct;25(5):289.e1-289.e6. doi: 10.1016/j.jaapos.2021.05.020. Epub 2021 Oct 14.
This proof-of-concept study evaluates the ability to assess eyelid measurements and the reproducibility of eyelid measurements using a simple measurement tool paired with digital cell phone photography in children.
Seventy consecutive patients and their siblings, 2-19 years of age, were prospectively enrolled. Participants underwent clinical examination and cell phone photography with a simple measurement tool. An ophthalmologist and nonophthalmologist assessed photographs for interpalpebral fissure distance (IPFD), margin reflex distance-1 (MRD1), and levator function (LF). Clinical examinations and photographs were repeated on the same day in a random sample (n = 20). The agreement of grading photographs compared to clinical examination was assessed using Bland-Altman plots. Intra-grader repeatability of the clinical examination, repeatability of photographic technique, and interobserver reproducibility of photographic assessment was evaluated with intraclass correlation coefficients (ICC).
Of photographs acquired, both graders considered quality good/fair in 100% to assess IPFD and MRD1, and 70% to assess LF. The mean difference (limits of agreement) in mm between clinical examination and photographic assessment was 1.1 (-1.5 to 3.8) for IPFD, 0.7 (-1.8 to 3.1) for MRD1, and 1.1 (-3.5 to 5.7) for LF. Intraobserver repeatability on clinical examination was excellent for IPFD (ICC = 0.81), MRD1 (ICC = 0.88), and LF (ICC = 0.94). Repeatability of photographic technique was fair for IPFD (ICC = 0.44) and good for MRD1 (ICC = 0.74) and LF (ICC = 0.77). Interobserver photographic assessment repeatability was excellent for IPFD (ICC = 0.94), MRD1 (ICC = 0.96), and LF (ICC = 0.92).
Photographic assessment of eyelid measurements in children is possible, highly reproducible between graders, and enables documentation for future comparison.
本验证性研究旨在评估在儿童中使用简单测量工具和数字手机摄影评估眼睑测量值的能力及其重复性。
连续纳入 70 例患者及其 2-19 岁的兄弟姐妹，参与者接受临床检查和使用简单测量工具的手机摄影。一名眼科医生和非眼科医生评估照片的睑裂距离（IPFD）、MRD1 和提上睑肌功能（LF）。在随机样本（n=20）中，同一天重复临床检查和照片。使用 Bland-Altman 图评估照片分级与临床检查的一致性。使用组内相关系数（ICC）评估临床检查的内部分级重复性、摄影技术的重复性以及摄影评估的观察者间可重复性。
评估 IPFD 和 MRD1 时，两位分级者均认为 100%的照片质量良好/尚可，评估 LF 时则认为 70%的照片质量良好/尚可。临床检查和摄影评估之间的平均差值（mm）为 IPFD 为 1.1（-1.5 至 3.8），MRD1 为 0.7（-1.8 至 3.1），LF 为 1.1（-3.5 至 5.7）。IPFD（ICC=0.81）、MRD1（ICC=0.88）和 LF（ICC=0.94）的临床检查内观察者重复性极好。IPFD（ICC=0.44）的摄影技术重复性良好，MRD1（ICC=0.74）和 LF（ICC=0.77）的摄影技术重复性极好。IPFD（ICC=0.94）、MRD1（ICC=0.96）和 LF（ICC=0.92）的观察者间摄影评估重复性极好。
在儿童中，通过摄影评估眼睑测量值是可行的，分级者之间具有高度可重复性，并能够记录下来以备将来比较。
