Consideration of canny edge detection for eye redness image processing: a review

Eye redness can be taken as a sign of inflammation which may suggest severity and progression of a specific disease. In image processing, there is apportioning a digital image into relevant features in sets of pixels where is called image segmentation. The image that consists of numerous parts of different colors and textures need to be distinguished in this process. In each digital image, the transformation of images into edges was using edge detection techniques. It represents the contour of the image which could be helpful to recognize the image as an object with its detected edges. The Canny edge detector is a standard edge detection algorithm for many years among the present edge detection algorithms. This paper focuses on important canny edge detection for detecting a region of interest (ROI) in eye redness images

Management of allergic conjunctivitis and dry eye

Ocular allergy is a common eye condition encountered in clinical practice. However, little is known how seasonal allergic conjunctivitis (SAC), the most common subtype, is managed in clinical practice. Further, dry eye, another common eye condition, may be misdiagnosed as SAC and vice-versa as they share similar signs and symptoms. In addition, despite the frequent recommendation of non-pharmacological treatments for SAC, evidenceto support their use has not been identified in the scientific literature. The aim of this thesis was therefore to determine the actual diagnosis and management of SAC and dry eye in clinical practice and investigate the efficacy of non-pharmacological treatments for these conditions. The diagnostic and management strategies for SAC and dry eye employed by pharmacy staff are found to be inconsistent with current guidelines and scientific evidence based upon a mystery shopper design. Cluster analysis of tear film metrics in normal and dry eye patients identified several clinically relevant groups of patients that may allow for targeted treatment recommendations. Using a novel environmental chamber model of SAC, the use of artificial tears and cold compresses, either alone or combined is an effective treatment modality for acute and symptomatic SAC, on a par with topical anti-allergic medication, and has been demonstrated for the first time. In addition, eyelid warming therapy with a simple, readily available, seed filled device is an effective method of treating meibomian gland dysfunction (MGD) related evaporative dry eye, perhaps the most common dry eye subtype. A greater focus on ophthalmology must be implemented as part of the formal education and training of pharmacy staff, while greater professional communication between community pharmacists, optometrists and the population they serve is required. Artificial tears and cold compresses may be considered as front line agents for acute SAC by pharmacy staff and optometrists, to whom pharmacological treatment options are limited

Dendritic cells in ocular allergy

Background: The prevalence of ocular allergy is increasing, and dendritic cells (DC) are responsible for the initiation of the allergic response. Although it has been established that DC density increases in vernal keratoconjunctivitis, this is yet to be explored in other more prevalent forms of allergic conjunctivitis. A subclinical state termed “minimal persistent inflammation” has been described in some allergic diseases (e.g., rhinitis, asthma, vernal keratoconjunctivitis) where subjects maintain a base level of subclinical inflammation when not in contact with allergens but display increased susceptibility to developing symptoms in the presence of allergens, this even at subthreshold doses. Minimal persistent inflammation may similarly be a feature of allergic eye disease. Furthermore, most human studies have focused on characterising central corneal DC with little attention to the topographical characteristics of corneal and conjunctival DC or to DC morphology, both of which are important factors to consider in understanding DC activation and migration. This thesis aims to assess corneal and conjunctival epithelial DC (distribution, density, and morphology) in ocular allergy during the active and asymptomatic phases of allergy in humans. Methods: A retrospective study of ocular surface DC density and morphology in participants with systemic allergies, characterised by a positive skin prick test to common allergens compared with those negative to a skin prick test, was undertaken. To enable in vivo confocal microscopy (IVCM) images of DC to be reliably assessed in a clinical setting, a grading system for DC morphology at the ocular surface was developed and validated. Diurnal and topographical changes in DC density and morphology were assessed. Inter and intra-rater repeatability of corneal and conjunctival DC density and morphology was also described. A series of cross-sectional studies in the active and asymptomatic phases of allergic conjunctivitis based in Australia and in the active phase of allergic conjunctivitis and vernal keratoconjunctivitis based in Iran were conducted. Topographical characteristics of corneal and conjunctival DC density and morphology were assessed using IVCM. Results: Longer DC dendrites were observed in systemic allergic participants despite reduced DC density, suggesting an immune response at the ocular surface. A morphology grading system involving cell body size, presence of dendrites, and presence of long and thick dendrites was repeatable and could provide a user-friendly pictorial reference in a clinical setting. Diurnal variation was not observed in ocular surface DC density and morphology, and they could be reliably measured using IVCM. Both allergic conjunctivitis and vernal keratoconjunctivitis were associated with an increase in DC density and changes in morphology, indicating immune activation at the ocular surface. DC with larger cell bodies and a higher proportion of long dendrites at the corneal locations of people with allergic conjunctivitis were suggestive of increased antigen capture capacity of DC. Elevated DC density persisted at all corneal locations in the asymptomatic phase of allergic conjunctivitis but not in the conjunctiva, an indication of persistent inflammation. However, morphology analysis suggested these cells were not activated for antigen capture. In vernal keratoconjunctivitis, compared to non-allergic participants, DC bodies were larger, and more DC with long dendrites were observed at corneal locations. Participants with vernal keratoconjunctivitis had higher DC density at the corneal limbus and larger DC bodies at the corneal centre and periphery compared to those with allergic conjunctivitis. Conclusion: This research established the reliability of assessing ocular surface DC density and morphology using IVCM. Changes observed in DC density and morphology at the ocular surface might serve as biomarkers for the diagnosis and management of active inflammation in ocular allergy. The presence of corneal inflammation during the asymptomatic phase of allergy may have relevance for practitioners aiming to optimise treatment outcomes for their ocular allergy patients. The applicability of the morphology grading system should be explored in different ocular surface inflammatory and immune diseases

Development of Novel Techniques for Measuring Bulbar Conjunctival Red Blood Cell Velocity, Oximetry and Redness

Introduction The ocular surface provides a unique opportunity to study hemodynamics since the vessels can be visualized directly, without treatment and non-invasively. The availability of instruments to measure various hemodynamic parameters on the ocular surface in an objective manner are lacking. The quantification of red blood cell velocity, blood oxygen saturation and conjunctival redness on the ocular surface using novel, validated techniques has the potential of providing useful information about vascular physiology. The specific aims of each chapter are as follows: Chapter 3: The objective was to design, develop and validate a system that would non-invasively quantify the red blood cell velocity in the conjunctival vessels. A tool was developed to automatically analyze video sequences of conjunctival vessels, digitally imaged with high enough magnification to resolve movement of the blood within the vessel. Chapter 4: The objective was to: a) design and develop a method in order to non-invasively quantify the changes in blood oxygen saturation (SO2) in the conjunctival vessels and demonstrate reliability of the measures and, b) demonstrate the application of the method by showing a response to an isocapnic hyperoxic provocation and compare those values to the results from a valid instrument. Chapter 5: The aim of this experiment was to examine variations in ocular redness levels, red blood cell velocities and oxygen saturation levels over time in clinically healthy participants and also to compare differences between two age groups. Chapter 6: The aim of this experiment was to examine the ocular redness levels, red blood cell velocities and oxygen saturation levels in clinically healthy participants when a topical ophthalmic decongestant was instilled onto the eye and to demonstrate the validity of the use of two novel techniques. Chapter 7: The aim of this experiment was to examine ocular redness, red blood cell velocity and oxygen saturation in participants who were habitual soft contact lens wearers (study) compared to those that did not (control) and also to compare differences in silicone (SH) and non-silicone hydrogel wearers. Methods Chapter 3: Simulations representing moving RBCs within a vessel and the random variation of each cell in terms of speed, shape and intensity were created in order to evaluate the performance of the algorithm. For each vessel, a signal that correlated to blood cell position was extracted from each frame, and the inter-frame displacement was estimated through a modified dynamic time warping (DTW) algorithm. This provided the red blood cell velocity over time in each point of the vessels. Thus, from these estimates, the mean red blood cell velocity for each vessel was easily evaluated. The true mean velocity from the simulation with the one estimated by the algorithm was compared and the system accuracy was determined. Chapter 4: a) Conjunctival vessels were imaged with two narrow-band interference filters with O2-sensitive and O2-insensitive peak transmissions using a Zeiss slit lamp at 32x magnification. Optical densities were calculated from vascular segments using the average reflected intensities inside and outside the vessels. Optical density ratios were used to calculate relative oxygen saturation values. Video images of the bulbar conjunctiva were recorded at three times of the day. Measurement repeatability was assessed over location at each time and across consecutive frames. b) Subjects initially breathed air for 10 minutes followed by pure oxygen (O2) for 20 minutes, and then air for a final 10 minute period using a sequential re-breathing circuit. Simultaneously, SO2 values measured with a pulse oximeter ear clip and finger clip were recorded. The validity of the dual wavelength method was demonstrated by comparing the values to those from the ear clip pulse oximeter. Chapter 5: Participants attended eight separate visits over the course of a day. Levels of bulbar conjunctival redness, red blood cell velocity and blood oxygen saturation were measured on a vessel of interest. Chapter 6: Participants attended three separate visits during an allotted 60 minute session. Bulbar conjunctival redness, red blood cell velocity and blood oxygen saturation were measured on a vessel of interest, pre-insertion, just after insertion and, 10 minutes after insertion of a topical ocular decongestant. Significant differences between the three measures were assessed and correlations between the three parameters were reported. Chapter 7: Participants were measured 8 times over the course of a day with their contact lenses in place. Bulbar conjunctival redness, red blood cell velocity and blood oxygen saturation were measured. Results Chapter 3: Results for the simulated videos demonstrated a very good concordance between the estimated and actual velocities supporting its validity. The mean relative error for the modified Dynamic Time Warping (DTW) method is 6%. Chapter 4: The intraclass correlations (ICCs) between the three locations at each time point were 0.93, 0.56 and 0.86 respectively. Measurements across 5 consecutive frames showed no significant difference for all subjects (ICC = 0.96). The ICCs between the two methods at each time point were 0.45, 0.10 and 0.11 respectively. a) There was no significant difference in SO2 between the three locations measured using the dual wavelength method for all subjects. There was also no significant difference between the three locations at any of the time points for the dual wavelength method. b) In response to isocapnic hyperoxic provocation using the dual wavelength method, blood oxygen saturation was increased from control values and subsequently recovered after withdrawal of hyperoxia. Blood oxygen saturation values recorded from the ear clip and finger clip of the pulse oximeter also showed an increase from control values and subsequently recovered after withdrawal of hyperoxia. SO2 comparison between the dual wavelength method and the ear-clip pulse oximeter method did not show a significant difference. The interaction between the two methods and time on SO2 was not significant. Chapter 5: From baseline, the group mean redness and oxygen saturation did not change significantly over time. There was a significant difference in the group mean red blood cell velocity values over time. There was no significant difference between age strata for all three measures. Chapter 6: After drop instillation redness values decreased significantly. There was no change in red blood cell velocity and oxygen saturation over time. There was a moderate significant correlation between SO2 and red blood cell velocity just after drop insertion. Chapter 7: When comparing the study and control groups, no significant difference in redness or SO2 over time was found. RBC velocity over time was found to be significantly different between groups. When comparing the two study groups (SH vs. hydrogel) no significant difference across either measure over time was found. Conclusions Chapter 3: Signal displacement estimation through the DTW algorithm can be used to estimate mean red blood cell velocity. Successful application of the algorithm in the estimation of RBC velocity in conjunctival vessels was demonstrated. Chapter 4: The application of the dual wavelength method was demonstrated and optical density ratios can be used in a reliable manner for relative oxygen saturation measurements. This valid method promises to enable the study of conjunctival O2 saturation under various experimental and physiological conditions. Chapter 5: The results of this study support the theory of metabolic regulation. The lack of any significant change across time for redness and oxygen saturation along with significant changes in red blood cell velocity substantiates this notion. Chapter 6: This study supports the literature regarding metabolic regulation of the microvasculature during the use of various stimuli. The results demonstrated that oxygen saturation levels remain stable even when a significant decrease in ocular redness is measured. The novel techniques used in this experiment demonstrated the expected action of the decongestant further contributing to their application and validity. Chapter 7: In summary, the participants in the study group were habitual contact lens wearers that had lower RBC velocities when compared to the control group supporting the notion that contact lenses initiate a hypoxic response. The lack of change in SO2 in either group supports the theory of metabolic regulation

Histamine-Induced Conjunctivitis and Breakdown of Blood–Tear Barrier in Dogs: A Model for Ocular Pharmacology and Therapeutics

Conjunctival inflammation disturbs the blood–tear barrier and thus affects the tear film stability and composition. We aimed to develop a non-invasive and reliable method to induce conjunctivitis in dogs, a large animal model for translational work on ocular surface disease in humans. Six beagle dogs underwent a randomized, vehicle-controlled, balanced crossover trial—on six separate days, one eye received topical artificial tears (vehicle), while the other eye received one of six concentrations of histamine solution (0.005–500 mg/ml). At sequential times after eyedrop administration, a conjunctivitis score was given to each eye based on the degree of palpebral and bulbar conjunctival hyperemia and chemosis, ocular pruritus, and discharge. Total protein content (TPC) and serum albumin were quantified in tear fluid at baseline and 20 min. Additionally, 13 dogs presenting for various ophthalmic diseases with associated conjunctivitis were examined. Experimentally induced conjunctivitis developed rapidly (\u3c1 min) following topical histamine administration and lasted for 1–3 h (four lowest doses) to 6–8 h (two highest doses). The severity of conjunctivitis was dose-dependent. Histamine was overall well tolerated, although transient blepharitis, aqueous flare, and ocular hypertension occurred in a few dogs receiving histamine ≥375 mg/ml. TPC and serum albumin levels increased in tears of eyes receiving histamine ≥1.0 mg/ml, being significantly higher than vehicle and baseline in eyes receiving histamine ≥375 mg/ml. Lacrimal albumin levels were also increased in 13 dogs with naturally acquired conjunctivitis, up 2.7–14.9 fold compared to contralateral healthy eyes. Histamine-induced conjunctivitis represents a robust model for translational work on the ocular surface given the low cost, non-invasiveness, self-resolving nature, ability to adjust the duration and severity of the disease, and shared features with naturally occurring ocular diseases. Histamine solutions of 1, 10, and 375 mg/ml induce mild, moderate, and severe conjunctivitis in dogs, respectively. Leakage of serum albumin in tear fluid of eyes with conjunctivitis suggests a breakdown of the blood–tear barrier

An eye on the dog as the scientist\u27s best friend for translational research in ophthalmology: Focus on the ocular surface

Preclinical animal studies provide valuable opportunities to better understand human diseases and contribute to major advances in medicine. This review provides a comprehensive overview of ocular parameters in humans and selected animals, with a focus on the ocular surface, detailing species differences in ocular surface anatomy, physiology, tear film dynamics and tear film composition. We describe major pitfalls that tremendously limit the translational potential of traditional laboratory animals (i.e., rabbits, mice, and rats) in ophthalmic research, and highlight the benefits of integrating companion dogs with clinical analogues to human diseases into preclinical pharmacology studies. This One Health approach can help accelerate and improve the framework in which ophthalmic research is translated to the human clinic. Studies can be conducted in canine subjects with naturally occurring or noninvasively induced ocular surface disorders (e.g., dry eye disease, conjunctivitis), reviewed herein, and tear fluid can be easily retrieved from canine eyes for various bioanalytical purposes. In this review, we discuss common tear collection methods, including capillary tubes and Schirmer tear strips, and provide guidelines for tear sampling and extraction to improve the reliability of analyte quantification (drugs, proteins, others)

Diagnosis, Management, and Treatment of Vernal Keratoconjunctivitis in Asia: Recommendations From the Management of Vernal Keratoconjunctivitis in Asia Expert Working Group

Vernal keratoconjunctivitis (VKC) is an underdiagnosed and underrecognized ocular surface disease with limited epidemiological data in Asia. It is more prevalent in warm, dry, and windy climates, and often has a substantial impact on a patient's quality of life. In rare cases, VKC can be associated with vision loss, either through corticosteroid overuse or inadequate treatment of persistent inflammation. As a potentially severe and complex disease, there is variability with how VKC is managed across Asia and among the various allergic eye diseases. Diagnosis and treatment of patients with VKC is a challenge for many ophthalmologists, since no precise diagnostic criteria have been established, the pathogenesis of the disease is unclear, and anti-allergic treatments are often ineffective in patients with moderate or severe disease. In addition, the choice of treatment and management strategies used for patients varies greatly from country to country and physician to physician. This may be because of a lack of well-defined, standardized guidelines. In response, the Management of Vernal Keratoconjunctivitis in Asia (MOVIA) Expert Working Group (13 experts) completed a consensus program to evaluate, review, and develop best-practice recommendations for the assessment, diagnosis, and management of VKC in Asia. The expert-led recommendations are summarized in this article and based on the currently available evidence alongside the clinical expertise of ophthalmologists from across Asia with specialism and interest in the ocular surface, VKC, and pediatric ophthalmology.ope

An eye on the dog as a translational model for ocular pharmacology

Today’s high failure rate in ophthalmic clinical trials can be largely explained by two major shortcomings: (i) the animals routinely studied (rabbits, mice, rats) are not representative of the affected population due to apparent anatomical and physiological differences with humans; and (ii) studies conducted in healthy eyes do not account for physiological disturbances in ocular homeostasis present in diseased eyes. Unlike traditional laboratory animals, diseases in dogs better reflect the complex genetic, environmental, and physiological variation present in humans; however, the translational potential of canine research is currently limited by scarce information on normative data specific to dogs, and the limited means to mimic ocular disease in a reliable and non-invasive manner in this species. The work conducted in the dissertation provides a deeper understanding of the canine ocular surface in health and disease states, investigating laboratory Beagle dogs and canine patients of varied breeds and cephalic conformations. Tear fluid was collected from canine eyes in successive experiments – primarily via Schirmer tear strips but also capillary glass tubes and absorbent sponges – and subsequent bioanalytical tools included fluorophotometry (tear film fluorescence), infrared spectroscopy (total protein content), immunoassays (serum albumin, cytokines, chemokines) and liquid chromatography-mass spectrometry (corticosteroids). Data analysis combined conventional statistical tests with nonlinear mixed-effects mathematical modeling to improve the robustness of the predictions. The main research outcomes of the dissertation work are the following: (i) Normative data were established for canine tear film dynamics, including tear volume (65.3 µL), basal tear turnover rate (12.2%/min) and reflex tear turnover rate (50%/min). In both clinical and research settings, successive lacrimal tests should be spaced by ≥ 10 min in dogs to provide sufficient time for the tear film to replenish. (ii) The volumetric capacity of the canine palpebral fissure was 31.3 µL, approximating the volume of a single eyedrop. Kinetic studies confirmed that a single drop is sufficient for topical administration in dogs, any excess being lost predominantly by blinking and spillage over the periocular skin. (iii) Topical histamine solutions of 1, 10, and 375 mg/mL induced mild, moderate, and severe conjunctivitis in dogs, respectively. The resulting disruption of the blood-tear barrier promoted leakage of plasma compounds (eg., albumin) into the tear film, a finding confirmed in dogs with naturally acquired ocular diseases. This ‘large animal’ model was robust, non-invasive, and self-resolving, providing a unique opportunity to investigate the ocular surface in health and disease. (iv) Acute conjunctivitis increased tear quantity and decreases tear stability, although ocular surface homeostasis was rapidly restored. (v) Corticosteroid levels in the tear film did not change significantly between healthy vs. diseased eyes following oral prednisone administration, although findings may differ for drugs with other physicochemical properties. (vi) Albumin in tears lowered the ocular bioavailability of topically administered drugs, as shown for tropicamide and (to a lesser extent) latanoprost in dogs. The thesis concludes with a comprehensive review of key ocular parameters in humans, dogs, and traditional laboratory species (rabbits, mice, rats), detailing species differences in ocular surface anatomy, physiology, tear film dynamics and tear film composition, and highlighting the benefits of integrating dogs into preclinical studies given striking resemblances between the canine and human eyes (One Health approach)

International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis.

BACKGROUND: Critical examination of the quality and validity of available allergic rhinitis (AR) literature is necessary to improve understanding and to appropriately translate this knowledge to clinical care of the AR patient. To evaluate the existing AR literature, international multidisciplinary experts with an interest in AR have produced the International Consensus statement on Allergy and Rhinology: Allergic Rhinitis (ICAR:AR). METHODS: Using previously described methodology, specific topics were developed relating to AR. Each topic was assigned a literature review, evidence-based review (EBR), or evidence-based review with recommendations (EBRR) format as dictated by available evidence and purpose within the ICAR:AR document. Following iterative reviews of each topic, the ICAR:AR document was synthesized and reviewed by all authors for consensus. RESULTS: The ICAR:AR document addresses over 100 individual topics related to AR, including diagnosis, pathophysiology, epidemiology, disease burden, risk factors for the development of AR, allergy testing modalities, treatment, and other conditions/comorbidities associated with AR. CONCLUSION: This critical review of the AR literature has identified several strengths; providers can be confident that treatment decisions are supported by rigorous studies. However, there are also substantial gaps in the AR literature. These knowledge gaps should be viewed as opportunities for improvement, as often the things that we teach and the medicine that we practice are not based on the best quality evidence. This document aims to highlight the strengths and weaknesses of the AR literature to identify areas for future AR research and improved understanding

Comparative toxicological-hygienic assessment, structural-morphological, physicochemical characteristics, and virucidal properties of new nanopowder materials TiO2 and TiO2@Ag

In order to address safety concerns related to the acquisition and utilization of TiO2 and TiO2@Ag nanomaterials, as well as to investigate their disinfectant and biological effects, the structural-morphological, morpho­metry, toxicological, cytotoxic, and virucidal properties of these specified nanomaterials have been studied through experiments conducted on laboratory animals and in vitro. It has been demonstrated that the TiO2@Ag nanocomposite exhibited distinct physicochemical characteristics: it consisted of TiO2 nanoparticles ranging in size from 13 nm to 20 nm and Ag nanoparticles ranging from 35 nm to 40 nm with 4.0 wt% of silver localized on the surface of titanium dioxide. The purity of the modification of synthesized nano-TiO2 and nano-TiO2@Ag has been confirmed. Acute intraperitoneal administration of nanopowders revealed LD50 values of 4783.30 mg/kg for nano-TiO2 and 724.44 mg/kg for nano-TiO2@Ag. A slight accumulation was observed upon repeated (28-fold) intragastric administration of nano-TiO2. The cumulative dose administered, which equated to 15.9 multiples of the LD50 (76040 mg/kg), did not result in animal mortality but led to retardation in body weight gain. TiO2 and TiO2@Ag nanopowders do not irritate the skin, induce mild conjunctival irritation, and may exhibit a weak sensitizing effect. Nano-TiO2 and nano-TiO2@Ag powders accumulate in the tissues of internal organs and cause damage to the liver, kidneys, and lungs of laboratory animals upon intraperitoneal administration. The most characteristic morphological signs of the toxic effect of nano-TiO2 on liver tissue were observed at a level of 67.7% (cytoplasmic vacuolization in hepatocytes), while in the case of nano-TiO2@Ag initial necrotic changes were at a level of 70.0% (hepatocytes with pyknotic nuclei). Immunoassay analysis has demonstrated that TiO2@Ag and TiO2 nanomaterials at concentrations of 30 µg/ml can enhance the functional activity of peripheral blood mononuclear cells in vitro by increasing the production of cytokines IL-1, IL-6, TNF-α, and IL-4 in donors (p<0.05). This indicates the potential for chronic inflammation and allergic reactions among synthesis operators. In the study of the impact of nanomaterials on murine germ cells, it has been established that they affect the activity of mitochondrial enzymes and exert a damaging effect on mitochondrial membranes and overall cell integrity. Estimated approximate safe exposure levels in the workplace air are 0.3 mg/m3 for nano-TiO2 and 0.2 mg/m3 for nano-TiO2@Ag. Nano-TiO2@Ag and nano-TiO2 at a concentration of 100 µg/ml exhibit pronounced extracellular virucidal activity against human adenovirus serotype 2. The TiO2@Ag nanocomposite has a less damaging effect on Нер-2 cells compared to nano-TiO2