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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 |
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