Comparison of automated vs manual analysis of corneal endothelial cell density and morphology in normal and corneal endothelial dystrophy‐affected dogs

Objective To determine the efficacy of automated imaging software of the Nidek ConfoScan 4 confocal biomicroscope at analyzing canine corneal endothelial cell density and morphology in health and disease, by comparing to a manual analysis method. Animal studied Nineteen eyes of 10 dogs were evaluated and include three Beagles, three Jack Russell Terriers, and four miscellaneous breeds. Twelve clinically normal and seven eyes affected with corneal endothelial dystrophy (CED) were scanned and analyzed. Procedures Endothelial cell density (ECD), mean and standard deviation (SD) of cell area, percent polymegathism, mean and SD of the number of cell sides, and percent pleomorphism were calculated using automated and manual methods for each scan. Results The automated analysis showed significantly greater ECD in comparison with the manual frame method due to misidentification of cell domains in CED‐affected dogs. No significant differences in ECD were observed between normal and CED‐affected dogs in automated analysis, while CED‐affected dogs showed significantly lower ECD in manual frame method and planimetry. Using both automated and manual methods, CED‐affected dogs showed greater variability of cell area or the number of cell sides than normal dogs. Conclusion The automated imaging software is unable to accurately identify cell borders in CED‐affected dogs resulting in inaccurate estimates of ECD. Thus, manual analysis is recommended for use in clinical trials assessing adverse events associated with novel medical treatments and/or surgical procedures.