The Impact of Image Quality and Trachomatous Inflammation on Using Photography for Trachoma Prevalence Surveys

Michelle Odonkor, Fahd Naufal, Harran Mkocha, Nicodemus Funga, Beatriz Muñoz, Sheila K. West

Research output: Contribution to journalArticlepeer-review


Purpose: Graded images can be used for trachoma prevalence surveys, but there is concern for mismatch between image and field grades of the upper tarsal conjunctiva. We aimed to determine if poor photograph quality and/or inflammation may contribute to differential grading of trachomatous inflammation—follicular (TF) between field and photograph graders. Methods: We developed a simplified and expanded image quality grading tool. Agreement was assessed using kappa statistic. We included 5417 eyes with both field and image grades for TF. Eyes where the field and adjudicated photograph TF grades did not match were identified (mismatched) and assigned an image quality (IQ) score and a potential mismatch reason. We also assigned IQ scores to a stratified random sample of 60 eyes with matching field and photograph TF grades (matched). Results: There were 5240 eyes that had matching grades, whereas 177 eyes (3.3%) were mismatched. Overall quality was high, even in mismatched eyes. There was no difference in overall or specific IQ metrics between eyes with matching grades and eyes with mismatched grades (P = 0.59). Mismatched eyes had worse inflammation compared to matchedeyes(P = 0.048). The primary reason for calling TF in the field but not in the photographs appeared to be the number of follicles observed. Conclusions: Image quality did not explain mismatch between field grades and image grades from this prevalence survey. Inflammation made mismatch more likely. Translational Relevance: Our quality grading scheme rapidly identifies image quality issues for training. Standardizing TF grading in the presence of inflammation will improve field and photograph grading.

Original languageEnglish (US)
Article number11
JournalTranslational Vision Science and Technology
Issue number3
StatePublished - Mar 2022


  • Follicular trachoma
  • Photography
  • Prevalence surveys
  • Quality
  • Trachoma

ASJC Scopus subject areas

  • Ophthalmology
  • Biomedical Engineering


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