Skip to main content
Log in

A novel method to measure margin reflex distance using the autorefractometer

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

Abstract

Purpose

To determine the margin reflex distance (MRD) in healthy subjects using autorefractometer front monitor images (ARFMI) and validate the accuracy of this method by comparing it with conventional methods.

Methods

One hundred eyes of 50 healthy subjects aged 20–59 years were included in the study. Autorefractometer front monitor images were video-recorded using a smartphone camera, and screenshots were taken to analyze the MRD. The results were compared with those from conventional methods to determine the reliability of the method. To evaluate the repeatability and reproducibility of all measurement methods, we performed two different visits by two observers.

Results

The mean MRD-1 of the autorefractometer image measurement was 4.29 ± 0.90 mm, mean MRD-1 of the of the digital photography image measurement was 3.78 ± 1.03 mm, and mean MRD-1 of the manual measurement was 4.02 ± 1.09 mm. The mean difference (MD) of MRD-1 was analyzed and it was found that MD of the autorefractometer image was significantly higher than the MD of other groups (p < 0.001). The best repeatability was found in the autorefractometer image measurement [intraclass correlation coefficients (ICC): 0.960], and substantial to excellent repeatability was found in the manual (ICC: 0.903) and digital photography image measurements (ICC: 0.843). The mean inter-eye difference of MRD-1 measured by the three methods was analyzed, and there was a statistically significant difference in the autorefractometer and digital image groups (p: 0.001, p: 0.002, respectively).

Conclusion

Margin reflex distance measurement using ARFMI analysis is a novel, simple, accurate, reliable, and objective method. The autorefractometer device is readily available and can be found in any ophthalmic clinic. Therefore, ophthalmologists can easily measure and record MRD values and use the accurate and reliable results for follow-up and medicolegal issues.

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

Access this article

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

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Rubin PA (2005) Eyelid position measurement. Ophthalmology. https://doi.org/10.1016/j.ophtha.2004.12.015

    Article  PubMed  Google Scholar 

  2. Dailey RA, Wobig JL (1992) Eyelid anatomy. J Dermatol Surg Oncol 18:1023–1027. https://doi.org/10.1111/j.1524-4725.1992.tb02779.x

    Article  CAS  PubMed  Google Scholar 

  3. Nair AG, Santhanam A (2016) Clinical photography for periorbital and facial aesthetic practice. J Cutan Aesth Surg. https://doi.org/10.4103/0974-2077.184047

    Article  Google Scholar 

  4. Coombes AG, Sethi CS, Kirkpatrick WN, Waterhouse N, Kelly MH, Joshi N (2007) A standardized digital photography system with computerized eyelid measurement analysis. Plast Reconstr Surg 120:647–656. https://doi.org/10.1097/01.prs.0000270315.53241.10

    Article  CAS  PubMed  Google Scholar 

  5. Bajaj MS, Pushker N, Mahindrakar A, Balasubramanya R (2003) Standardised clinical photography in ophthalmic plastic surgery. Br J Ophthalmol 87:375–376. https://doi.org/10.1136/bjo.87.3.375-b

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Kovacic Z, Ivanisevic M, Plestina-Borjan I, Capkun V (1998) Automatic refractometry, reliability of the determination of type and degree of refraction anomalies. Lijec Vjesn 120:162–164

    CAS  PubMed  Google Scholar 

  7. Jorge J, Queiros A, Almeida JB, Parafita MA (2005) Retinoscopy/autorefraction: which is the best starting point for a noncycloplegic refraction? Optom Vis Sci 82:64–68

    PubMed  Google Scholar 

  8. Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1:307–310

    Article  CAS  Google Scholar 

  9. Boboridis K, Assi A, Indar A, Bunce C, Tyers AG (2001) Repeatability and reproducibility of upper eyelid measurements. Br J Ophthalmol 85:99–101. https://doi.org/10.1136/bjo.85.1.99

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Nemet AY (2015) Accuracy of marginal reflex distance measurements in eyelid surgery. J Craniofac Surg 26:e569–e571. https://doi.org/10.1097/SCS.0000000000001304

    Article  PubMed  Google Scholar 

  11. Nishihira T, Ohjimi H, Eto A (2014) A new digital image analysis system for measuring blepharoptosis patients’ upper eyelid and eyebrow positions. Ann Plast Surg 72:209–213. https://doi.org/10.1097/SAP.0b013e31825b8fb7

    Article  CAS  PubMed  Google Scholar 

  12. Choi CJ, Chou JC, Lefebvre DR, Yoon MK (2016) Margin reflex distance: differences based on camera and flash positions. Ophthalmic Plast Reconstr Surg 32:199–203. https://doi.org/10.1097/IOP.0000000000000456

    Article  PubMed  Google Scholar 

  13. Zheng X, Kakizaki H, Goto T, Shiraishi A (2016) Digital analysis of eyelid features and eyebrow position following CO2 laser-assisted blepharoptosis surgery. Plast Reconstr Surg Glob Open 4:e1063. https://doi.org/10.1097/GOX.0000000000001063

    Article  PubMed  PubMed Central  Google Scholar 

  14. Koushan K, Skibell BC, Harvey JT, Jankowski HK, Deangelis DD, Oestreicher JH (2008) Digital photography as a novel technique of measuring ocular surface dimensions. Orbit 27:259–265. https://doi.org/10.1080/01676830802222811

    Article  PubMed  Google Scholar 

  15. Hogarty DT, Hogarty JP, Hewitt AW (2020) Smartphone use in ophthalmology: what is their place in clinical practice? Surv Ophthalmol 65:250–262. https://doi.org/10.1016/j.survophthal.2019.09.001

    Article  PubMed  Google Scholar 

  16. Danesh J, Ugradar S, Goldberg R, Rootman DB (2018) A novel technique for the measurement of eyelid contour to compare outcomes following Muller’s muscle-conjunctival resection and external levator resection surgery. Eye Lond. https://doi.org/10.1038/s41433-018-0105-4

    Article  PubMed  PubMed Central  Google Scholar 

  17. Sinha KR, Yeganeh A, Goldberg RA, Rootman DB (2018) Assessing the accuracy of eyelid measurements utilizing the volk eye check system and clinical measurements. Ophthalmic Plast Reconstr Surg 34:346–350. https://doi.org/10.1097/IOP.0000000000000991

    Article  PubMed  Google Scholar 

  18. Bodnar ZM, Neimkin M, Holds JB (2016) Automated ptosis measurements from facial photographs. JAMA Ophthalmol 134:146–150. https://doi.org/10.1001/jamaophthalmol.2015.4614

    Article  PubMed  Google Scholar 

  19. Chun YS, Park HH, Park IK, Moon NJ, Park SJ, Lee JK (2017) Topographic analysis of eyelid position using digital image processing software. Acta Ophthalmol 95:e625–e632. https://doi.org/10.1111/aos.13437

    Article  PubMed  Google Scholar 

  20. Choi CJ, Lefebvre DR, Yoon MK (2016) Validation of the facial assessment by computer evaluation (FACE) program for software-aided eyelid measurements. Orbit 35:117–120. https://doi.org/10.3109/01676830.2016.1139595

    Article  PubMed  Google Scholar 

  21. Zheng X, Goto T, Shiraishi A, Nakaoka Y (2019) New method to analyze sagittal images of upper eyelid obtained by anterior segment optical coherence tomography. Orbit 38:446–452. https://doi.org/10.1080/01676830.2018.1563200

    Article  PubMed  Google Scholar 

  22. Timlin HM, Keane PA, Day AC, Salam T, Abdullah M, Rose GE et al (2016) Characterizing the lacrimal punctal region using anterior segment optical coherence tomography. Acta Ophthalmol 94:154–159. https://doi.org/10.1111/aos.12906

    Article  PubMed  Google Scholar 

  23. Ogasawara K (2020) Application of Second-Generation Swept-Source Anterior Segment-OCT in the Measurement of Marginal Reflex Distance-1 (MRD-1). Clini Ophthalmol 14:635–642

    Article  Google Scholar 

  24. Rufer F, Schroder A, Erb C (2005) White-to-white corneal diameter: normal values in healthy humans obtained with the Orbscan II topography system. Cornea 24:259–261. https://doi.org/10.1097/01.ico.0000148312.01805.53

    Article  PubMed  Google Scholar 

Download references

Funding

The authors of this study have not receive any financial support for this submission.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Demet Yolcu.

Ethics declarations

Conflicts of interest

The author declare that have no conflict of interest.

Ethics approval

The study was approved by the Ethics Committee of the University of Health Sciences, Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey, and the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yolcu, D., Ozdogan, S. A novel method to measure margin reflex distance using the autorefractometer. Int Ophthalmol 42, 1241–1247 (2022). https://doi.org/10.1007/s10792-021-02110-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10792-021-02110-7

Keywords

Navigation