Validation of Automated Software for Guttae Quantification in Fuchs Endothelial Corneal Dystrophy

Simran R Sarin; Jérôme Abou Assi; Jessica M Skeie; Pierre Deman; M Bridget Zimmerman; Dustin M McGranahan; Jody M Troyer; Gregory A Schmidt; François Potevin; Mark A Greiner

doi:10.1167/tvst.15.5.8

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Validation of Automated Software for Guttae Quantification in Fuchs Endothelial Corneal Dystrophy

Journal article

Open access

Peer reviewed

Validation of Automated Software for Guttae Quantification in Fuchs Endothelial Corneal Dystrophy

Simran R Sarin, Jérôme Abou Assi, Jessica M Skeie, Pierre Deman, M Bridget Zimmerman, Dustin M McGranahan, Jody M Troyer, Gregory A Schmidt, François Potevin and Mark A Greiner

Translational vision science & technology, Vol.15(5), 8

05/01/2026

DOI: 10.1167/tvst.15.5.8

PMID: 42101417

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https://doi.org/10.1167/tvst.15.5.8View

Published (Version of record) Open Access

Abstract

Corneal guttae are the hallmark pathologic phenotype of Fuchs endothelial corneal dystrophy (FECD). Tools performing quantitative analysis of guttae and their changes over time are needed as medical therapies advance. We developed and validated a novel automated software platform that reports the guttae area ratio (GAR) in FECD specular microscopy images. Patients with FECD with modified Krachmer grade (mKg) 2 to 5 disease and no prior keratoplasty were enrolled and imaged prospectively with one specular microscope unit. In a validation study, expert manual grading and automated software grading of GAR were compared for agreement. Additional images were analyzed to correlate automated GAR with disease grade and subclinical edema by Scheimpflug imaging. Nineteen images were included in the validation study. Mean manual GAR (0.400 ± 0.213) and mean automated GAR (0.395 ± 0.182) demonstrated equivalence (P = 0.003). Additionally, 446 images (109 eyes) demonstrated that automated GAR increases with worsening disease in mKg 2 to 5. Most mKg 4 images (n = 172, 93.5%; 49 eyes) and mKg 5 images (n = 59, 55.1%; 19 eyes) had no evidence of definite subclinical edema. Repeat image analysis demonstrated high repeatability of GAR (intraclass correlation = 0.85; 95% confidence interval, 0.78-0.90). This study validates that automated software for guttae quantification in FECD specular microscopy images is equivalent to manual expert grading. GAR, an objective metric that increases in direct proportion to mKg, may precede development of subclinical edema. This software supports precise quantification of FECD disease secondary to guttae, allowing for objective measurement of disease progression and therapeutic efficacy.

Software

Aged

Cornea - pathology

Female

Fuchs' Endothelial Dystrophy - diagnosis

Fuchs' Endothelial Dystrophy - diagnostic imaging

Fuchs' Endothelial Dystrophy - pathology

Humans

Male

Microscopy - methods

Middle Aged

Prospective Studies

Reproducibility of Results

Details

Title: Subtitle: Validation of Automated Software for Guttae Quantification in Fuchs Endothelial Corneal Dystrophy
Creators: Simran R Sarin - University of Iowa
Jérôme Abou Assi - ADCIS Evolucare Group, Saint-Contest, France
Jessica M Skeie - University of Iowa
Pierre Deman - Labéo
M Bridget Zimmerman - University of Iowa
Dustin M McGranahan - University of Iowa
Jody M Troyer - University of Iowa
Gregory A Schmidt - Lions Eye Bank (Coralville)
François Potevin - Labéo
Mark A Greiner - University of Iowa
Resource Type: Journal article
Publication Details: Translational vision science & technology, Vol.15(5), 8
DOI: 10.1167/tvst.15.5.8
PMID: 42101417
ISSN: 2164-2591
eISSN: 2164-2591
Publisher: ARVO
Language: English
Date published: 05/01/2026
Academic Unit: Pharmaceutical Sciences and Experimental Therapeutics; Biostatistics; Ophthalmology and Visual Sciences
Record Identifier: 9985161448202771

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