Fluorescein CorneoGraphy (FCG): Use of a repurposed fluorescein imaging technique to objectively standardize corneal staining.

Punctate epithelial erosion (PEE) is a corneal sign of dry eye disease (DED), which is observable via staining with fluorescein on slit lamp as a standard of clinical practice and clinical research. There are currently many limitations for detecting PEE, such as lack of optimal excitation with cobalt blue light, difficulty to focus on the whole cornea, observer dependency and no available automatized quantification. We propose to reduce these limitations through repurposing the use of fluorescein angiography mode of optical coherence tomography (OCT, Heidelberg Spectralis II, Germany), as “fluorescein corneography” (FCG) for imaging PEE. A standard methodology was created using 50 patients with corneal staining and 10 healthy volunteers who were imaged on both slit lamp and FCG on two centers. Subsequently, two masked cornea specialists graded slit lamp and FCG images of 15 patients using the National Eye Institute (NEI) scale. FCG showed both a higher interobserver agreement (IOA), and a higher intraclass correlation coefficient (ICC) than slit lamp (0.96 vs 0.86, p<0.001). Light- colored iris patients showed a statistically significant lower mean of epitheliopathy on slit lamp compared to FCG (6.11 vs 8.94; p=0.026), which was not the case with dark-colored iris patients (8.16 vs 8.25; p=0.961) In conclusion we present an OCT-FA system for robust detection of PEE which has major implications in both clinical practice and research endpoints since it is highly sensitive, rigorous, reproducible in different facilities and offers potential for a numerical quantification and automatization of dry-eye corneal staining

Duke Scholars

Author Priyatham S Mettu Ophthalmology, Vitreoretinal Diseases & Surgery

Author Michael John Allingham Ophthalmology, Vitreoretinal Diseases & Surgery

Author Scott William Cousins Ophthalmology, Vitreoretinal Diseases & Surgery