Introduction of Deep Learning Based-IR Image Analysis for Marginal Reflex Distance-1 Measurement Method, Simultaneously Capture Images and Compute the Result: Clinical Validation Study

Measuring Marginal Reflex Distance-1 (MRD-1) is a crucial clinical tool used to evaluate the position of the eyelid margin in relation to the cornea. Traditionally, this assessment has been conducted manually by plastic surgeons, ophthalmologists, or trained technicians. However, with the advancements in Artificial Intelligence (AI) technology, there is a growing interest in the development of automated systems capable of accurately measuring MRD-1.In this context, we introduce novel MRD-1 measurement methods based on deep learning algorithms that can simultaneously capture images and compute the results. This prospective observational study involved 154 eyes of 77 patients aged over 18 years who visited Chungnam National University Hospital between September 1, 2023, and July 29, 2023. We collected four different MRD1 da-tasets from patients using three distinct measurement methods, each tailored to the individual patient. The mean MRD1 values, measured through the manual method using a penlight, the deep learning method, ImageJ analysis from RGB eye images, and ImageJ analysis from IR eye images in 56 eyes of 28 patients, were 2.64 ± 1.04 mm, 2.85 ± 1.07 mm, 2.78 ± 1.08 mm, and 3.07 ± 0.95 mm, respectively. Notably, the strongest agreement was observed between MRD1_deep learning (DL) and MRD1_IR (0.822, p < 0.01). In the Bland-Altman plot, the smallest difference was observed between MRD1_DL and MRD1_IR ImageJ, with a mean difference of 0.0611 and △LOA (limits of agreement) of 2.5162, which is the smallest among the other groups. In conclusion, this novel MRD1 measurement method, based on an IR camera and deep learning, demon-strates statistical significance and can be readily applied in clinical settings.