Photographic assessment of eyelid position using a simple measurement tool paired with cell phone photography in a pediatric population

Abstract

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, 2-19years 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.