Skip to main content
SpringerLink
Log in

Anterior segment ultrasound biomicroscopy image analysis using ImageJ software: Intra-observer repeatability and inter-observer agreement

  • Original Paper
  • Published:
International Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

In this novel study, we demonstrate a standardized imaging and measurement protocol of anterior segment (AS) structures with reliability analysis using ultrasound biomicroscopy (UBM) and ImageJ software.

Methods

Ten pediatric and young adult patients undergoing examination under anesthesia for AS pathology were imaged using UBM. Four trained observers analyzed 20 images using ImageJ. Forty-five structural parameters were measured. Those that relied on the trabecular-iris angle (TIA) as a reference landmark were labeled TIA-dependent (TD) and all others were labeled non-TIA dependent (NTD). Intra-observer repeatability (IOR) and inter-observer agreement (IOA) of measurements were determined using coefficient of variation (CV) and intra-class correlation (ICC) followed by assessment of Bland–Altman plots (BAP) for each pair of observers, respectively.

Results

For NTD parameters, non-ciliary body (CB) related measurements showed CV range 0.60–16.22% and ICC range 0.84–0.89, whereas CB-related parameters showed CV range 2.86–23.40% and ICC range 0.29–0.92. For TD parameters, parameters < 2 degrees removed from reference showed CV range 0.02–5.40% and ICC range 0.89–1.00, whereas parameters > 1 degree removed showed CV range 0.63–27.44% and ICC range 0.22–1.00. No systematic proportional bias was detected by BAPs.

Conclusions

Preplaced landmarks yielded good IOR and IOA in quantitative assessment of AS structures that were NTD and non-CB-related or less removed from the reference. CB-related NTD measurements varied greatly in IOR and IOA, indicating protocol modifications or CB qualitative assessments needed to improve accuracy. Variability in TD measurements increased the further removed from the reference, which supports implementation of a reliable reference landmark to minimize variation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Hussein TR, Shalaby SM, Elbakary MA, Elseht RM, Gad RE (2014) Ultrasound biomicroscopy as a diagnostic tool in infants with primary congenital glaucoma. Clin Ophthalmol (Auckland, NZ) 8:1725

    Google Scholar 

  2. Mérula RV, Cronemberger S, Diniz Filho A, Calixto N (2008) New comparative ultrasound biomicroscopic findings between fellow eyes of acute angle closure and glaucomatous eyes with narrow angle. Arquivos Brasileiros de Oftalmologia 71(6):793–798

    Article  PubMed  Google Scholar 

  3. Prata TS, Dorairaj S, De Moraes CG et al (2013) Is preoperative ciliary body and iris anatomical configuration a predictor of malignant glaucoma development? Clin Exp Ophthalmol 41(6):541–545

    Article  PubMed  Google Scholar 

  4. Pavlin CJ, Harasiewicz K, Foster FS (1992) Ultrasound biomicroscopy of anterior segment structures in normal and glaucomatous eyes. Am J Ophthalmol 113(4):381–389

    Article  CAS  PubMed  Google Scholar 

  5. Kobayashi H, Hirose M, Kobayashi K (2000) Ultrasound biomicroscopic analysis of pseudophakic pupillary block glaucoma induced by Soemmering’s ring. Br J Ophthalmol 84(10):1142–1146

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Marigo FA, Finger PT, McCormick SA et al (2000) Iris and ciliary body melanomas: ultrasound biomicroscopy with histopathologic correlation. Arch Ophthalmol 118(11):1515–1521

    Article  CAS  PubMed  Google Scholar 

  7. Pavlin CJ, Harasiewicz K, Sherar MD, Foster FS (1991) Clinical use of ultrasound biomicroscopy. Ophthalmology 98(3):287–295

    Article  CAS  PubMed  Google Scholar 

  8. Pavlin CJ, Foster FS (1992) Ultrasound biomicroscopy in glaucoma. Acta Ophthalmol 70(S204):7–9

    Article  Google Scholar 

  9. Dada T, Sihota R, Gadia R, Aggarwal A, Mandal S, Gupta V (2007) Comparison of anterior segment optical coherence tomography and ultrasound biomicroscopy for assessment of the anterior segment. J Cataract Refract Surg 33(5):837–840

    Article  PubMed  Google Scholar 

  10. Wang Z, Huang J, Lin J, Liang X, Cai X, Ge J (2014) Quantitative measurements of the ciliary body in eyes with malignant glaucoma after trabeculectomy using ultrasound biomicroscopy. Ophthalmology 121(4):862–869

    Article  PubMed  Google Scholar 

  11. Oh J, Shin HH, Kim JH, Kim HM, Song JS (2007) Direct measurement of the ciliary sulcus diameter by 35-megahertz ultrasound biomicroscopy. Ophthalmology 114(9):1685–1688

    Article  PubMed  Google Scholar 

  12. Narayanaswamy A, Sakata LM, He MG et al (2010) Diagnostic performance of anterior chamber angle measurements for detecting eyes with narrow angles: an anterior segment OCT study. Arch Ophthalmol 128(10):1321–1327

    Article  PubMed  Google Scholar 

  13. Tello C, Liebmann J, Potash SD, Cohen H, Ritch R (1994) Measurement of ultrasound biomicroscopy images: intraobserver and interobserver reliability. Invest Ophthalmol Vis Sci 35(9):3549–3552

    CAS  PubMed  Google Scholar 

  14. Nonaka A, Kondo T, Kikuchi M et al (2006) Angle widening and alteration of ciliary process configuration after cataract surgery for primary angle closure. Ophthalmology 113(3):437–441

    Article  PubMed  Google Scholar 

  15. Feizi S, Jafarinasab MR, Karimian F, Hasanpour H, Masudi A (2014) Central and peripheral corneal thickness measurement in normal and keratoconic eyes using three corneal pachymeters. J Ophthalmic Vis Res 9(3):296–304. https://doi.org/10.4103/2008-322x.143356

    Article  PubMed  PubMed Central  Google Scholar 

  16. Kurimoto Y, Park M, Sakaue H, Kondo T (1997) Changes in the anterior chamber configuration after small-incision cataract surgery with posterior chamber intraocular lens implantation. Am J Ophthalmol 124(6):775–780

    Article  CAS  PubMed  Google Scholar 

  17. Kanellopoulos AJ, Asimellis G (2014) Clear-cornea cataract surgery: pupil size and shape changes, along with anterior chamber volume and depth changes. A Scheimpflug imaging study. Clin Ophthalmol (Auckland, NZ) 8:2141

    Article  Google Scholar 

  18. Goldsmith JA, Li Y, Chalita MR, Westphal V, Patil CA, Rollins AM, Izatt JA, Huang D (2005) Anterior chamber width measurement by high-speed optical coherence tomography. Ophthalmology 112(2):238–244

    Article  PubMed  PubMed Central  Google Scholar 

  19. Piñero DP, Plaza Puche AB, Alió JL (2008) Corneal diameter measurements by corneal topography and angle-to-angle measurements by optical coherence tomography: evaluation of equivalence. J Cataract Refract Surg 34(1):126–131. https://doi.org/10.1016/j.jcrs.2007.10.010

    Article  PubMed  Google Scholar 

  20. Chua J, Muen WJ, Reddy A, Brookes J (2012) The masquerades of a childhood ciliary body medulloepithelioma: a case of chronic uveitis, cataract, and secondary glaucoma. Case reports in ophthalmological medicine

  21. Németh J, Csákány B, Pregun T (1996) Ultrasound biomicroscopic morphometry of the anterior eye segment before and after one drop of pilocarpine. Int Ophthalmol 20(1–3):39–42

    PubMed  Google Scholar 

  22. Kobayashi H, Ono H, Kiryu J, Kobayashi K, Kondo T (1999) Ultrasound biomicroscopic measurement of development of anterior chamber angle. Br J Ophthalmol 83:559–562

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Wang D, He M, Wu L, Yaplee S, Singh K, Lin S (2012) Differences in iris structural measurements among American Caucasians, American Chinese, and mainland Chinese. Clin Exp Ophthalmol 40(2):162–169

    Article  CAS  PubMed  Google Scholar 

  24. Lee RY, Huang G, Porco TC, Chen YC, He M, Lin SC (2013) Differences in iris thickness among African Americans, Caucasian Americans, Hispanic Americans, Chinese Americans, and Filipino-Americans. J Glaucoma 22(9):673–678

    Article  PubMed  Google Scholar 

  25. Leung CK, Palmiero PM, Weinreb RN, Li H, Sbeity Z, Dorairaj S, Leung D, Liu S, Liebmann LM, Congdon N, Lam DS, Ritch R (2010) Comparisons of anterior segment biometry between Chinese and Caucasians using anterior segment optical coherence tomography. Br J Ophthalmol 94(9):1184–1189

    Article  CAS  PubMed  Google Scholar 

  26. Mérula RV, Cronemberger S, Diniz Filho A, Calixto N (2008) New comparative ultrasound biomicroscopic findings between fellow eyes of acute angle closure and glaucomatous eyes with narrow angle. Arq Bras Oftalmol 71(6):793–798

    Article  PubMed  Google Scholar 

  27. Hussein TR, Shalaby SM, Elbakary MA, Elseht RM, Gad RE (2014) Ultrasound biomicroscopy as a diagnostic tool in infants with primary congenital glaucoma. Clin Ophthalmol (Auckland, NZ) 8:1725

    Google Scholar 

  28. Kanellopoulos AJ, Asimellis G (2014) Clear-cornea cataract surgery: pupil size and shape changes, along with anterior chamber volume and depth changes. A Scheimpflug imaging study. Clin Ophthalmol (Auckland, NZ) 8:2141

    Article  Google Scholar 

Download references

Acknowledgements

This work was supported by: (1) The Knights Templar Eye Foundation Career Starter Grants for 2015–2016 awarded to Dr. Janet Alexander and (2) The K23 Career Development Award from the National Eye Institute (K23EY025014) awarded to Dr. Osamah Saeedi. We would like to acknowledge Cierra McKoy for contributing to this work.

Author information

Authors and Affiliations

  1. University of Maryland School of Medicine, Baltimore, MD, USA

    Azam Qureshi & Gianna Stoleru

  2. University Hospitals Case Medical Center, Cleveland, OH, USA

    Haoxing Chen

  3. University of Maryland Eye Associates, Baltimore, MD, USA

    Osamah Saeedi, Mona A. Kaleem, Jordan Margo & Janet L. Alexander

  4. Department of Ophthalmology, University of Maryland, Baltimore, MD, USA

    Osamah Saeedi, Mona A. Kaleem, Jordan Margo, Sachin Kalarn & Janet L. Alexander

Authors
  1. Azam Qureshi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Haoxing Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Osamah Saeedi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mona A. Kaleem
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gianna Stoleru
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jordan Margo
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sachin Kalarn
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Janet L. Alexander
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Azam Qureshi.

Ethics declarations

Conflict of interest

No authors report conflict of interest.

Ethical approval

All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. No animals were included in this study.

Informed consent

This work involved human participants in which appropriate informed consent was obtained.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Qureshi, A., Chen, H., Saeedi, O. et al. Anterior segment ultrasound biomicroscopy image analysis using ImageJ software: Intra-observer repeatability and inter-observer agreement. Int Ophthalmol 39, 829–837 (2019). https://doi.org/10.1007/s10792-018-0882-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10792-018-0882-6

Keywords

Search

Navigation