ISOS: Conjunctival Hyperemia Quantization
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Purpose of the application
To describe a slit lamp-based imaging system and software that objectively and automatically quantifies conjunctival hyperemia. Conjunctival hyperemia is an important indicator of several ocular conditions including ocular surface inflammation, ocular irritation, and systemic disease. It is associated with increased blood volume in the anterior scleral, bulbar conjunctival and limbal vessels. Since conjunctival hyperemia is a consistent clinical sign of the ocular response to physiological and pathological stimuli, it has been considered an important endpoint in efficacy and safety trials for contact lenses, medications, as well as for evaluation of ocular toxicity of drugs, chemicals and pollutants. Thus, assessing the progression of conjunctival hyperemia is critically important for the treatment of patients with ocular disease.
The Imaging System for the Ocular Surface (ISOS) consisting of hardware and software components was developed to capture images and perform automated image analysis of conjunctival blood vessel morphology. It is a joint development between Novartis and ADCIS. A pilot study was conducted to obtain and analyze conjunctival images from patients with allergic conjunctivitis following allergen challenge. Manual image grading was performed on sets of images that were subsequently processed by image analysis. A statistical correlation of grading and image analysis results was performed, and a machine learning-based automatic hyperemia grading system was integrated in ISOS.
Automatic image analysis using ISOS resulted in the ability to evaluate changes in a variety of morphological parameters of vessels that were not quantifiable to clinical observers (e.g. vessel dimensions such as diameter, total length, density), and correlate them with human grading. A machine learning-based system was developed in ISOS to mimic human grading and automatically quantify hyperemia from 35 morphological parameters. The automatic grading provided by ISOS was robust, highly correlated to manual image grading, and provided an objective hyperemia grade within a few seconds.
Manual grades between 0 (no redness and 4)
This pilot study demonstrated that the ISOS suite represents a valuable tool for objective assessment of conjunctival hyperemia. ISOS minimized grading variations across images and provided clinically meaningful measurement of conjunctival hyperemia and insights into the progression of ocular hyperemia. ISOS was fast, reliable, accurate, and most importantly, eliminated human bias in assessing conjunctival hyperemia.
Three types of users can interact with ISOS: Graders, Viewers and Reviewers.
The ISOS software product has the following capabilities:
ISOS is a stand-alone, software product that can be installed on any personal computer running Windows® XP or higher.
Video tutorialsISOS Grader