Abstract

The sclera is arguably a better site than the skin to measure jaundice–especially in dark-skinned patients–since it is free of skin pigment (melanin), a major confounding factor. This work aims to show how the yellowness of the sclera can be quantified by digital photography in color spaces including the native RGB and CIE XYZ. We also introduce a new color metric we call “Jaundice Eye Color Index” (JECI) which allows the yellowness of jaundiced sclerae to be predicted for a specific total serum bilirubin level in the neonatal population.

Published by The Optical Society under the terms of the Creative Commons Attribution 4.0 License. Further distribution of this work must maintain attribution to the author(s) and the published article's title, journal citation, and DOI.

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References

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  1. V. K. Bhutani, G. R. Gourley, S. Adler, B. Kreamer, C. Dalin, and L. H. Johnson, “Noninvasive measurement of total serum bilirubin in a multiracial predischarge newborn population to assess the risk of severe hyperbilirubinemia,” Pediatrics 106(2), E17 (2000).
    [Crossref] [PubMed]
  2. A. Riskin, A. Tamir, A. Kugelman, M. Hemo, and D. Bader, “Is visual assessment of jaundice reliable as a screening tool to detect significant neonatal hyperbilirubinemia?” The Journal of Pediatrics 152, 782–787 (2008).
    [Crossref]
  3. L. I. Kramer, “Advancement of dermal icterus in the jaundiced newborn,” Am. J. Dis. Child. 118(3), 454–458 (1969).
    [PubMed]
  4. R. Keren, K. Tremont, X. Luan, and A. Cnaan, “Visual assessment of jaundice in term and late preterm infants,” Arch. Dis. Child. Fetal Neonatal Ed. 94(5), F317–F322 (2009).
    [Crossref] [PubMed]
  5. A. Azzuqa and J. F. Watchko, “Bilirubin Concentrations in Jaundiced Neonates with Conjunctival Icterus,” J. Pediatr. 167(4), 840–844 (2015).
    [Crossref] [PubMed]
  6. T. Smith and J. Guild, “The C.I.E. colorimetric standards and their use,” Trans. Opt. Soc. 33(3), 73–134 (1931).
    [Crossref]
  7. T. S. Leung, K. Kapur, A. Guilliam, J. Okell, B. Lim, L. W. MacDonald, and J. Meek, “Screening neonatal jaundice based on the sclera color of the eye using digital photography,” Biomed. Opt. Express 6(11), 4529–4538 (2015).
    [Crossref] [PubMed]
  8. A. Mariakakis, M. A. Banks, L. Phillipi, L. Yu, J. Taylor, and S. N. Patel, “BiliScreen: Smartphone-Based Scleral Jaundice Monitoring for Liver and Pancreatic Disorders,” Proc. ACM Interact. Mob. Wearable Ubiquitous Technol. 1, 1–26 (2017).
    [Crossref]
  9. L. d. Greef, M. Goel, M. J. Seo, E. C. Larson, J. W. Stout, J. A. Taylor, and S. N. Patel, “BiliCam: Using Mobile Phones to Monitor Newborn Jaundice,” in Proceedings of the 2014 ACM International Joint Conference on Pervasive and Ubiquitous Computing (2014), pp. 331–342.

2015 (2)

2009 (1)

R. Keren, K. Tremont, X. Luan, and A. Cnaan, “Visual assessment of jaundice in term and late preterm infants,” Arch. Dis. Child. Fetal Neonatal Ed. 94(5), F317–F322 (2009).
[Crossref] [PubMed]

2000 (1)

V. K. Bhutani, G. R. Gourley, S. Adler, B. Kreamer, C. Dalin, and L. H. Johnson, “Noninvasive measurement of total serum bilirubin in a multiracial predischarge newborn population to assess the risk of severe hyperbilirubinemia,” Pediatrics 106(2), E17 (2000).
[Crossref] [PubMed]

1969 (1)

L. I. Kramer, “Advancement of dermal icterus in the jaundiced newborn,” Am. J. Dis. Child. 118(3), 454–458 (1969).
[PubMed]

1931 (1)

T. Smith and J. Guild, “The C.I.E. colorimetric standards and their use,” Trans. Opt. Soc. 33(3), 73–134 (1931).
[Crossref]

Adler, S.

V. K. Bhutani, G. R. Gourley, S. Adler, B. Kreamer, C. Dalin, and L. H. Johnson, “Noninvasive measurement of total serum bilirubin in a multiracial predischarge newborn population to assess the risk of severe hyperbilirubinemia,” Pediatrics 106(2), E17 (2000).
[Crossref] [PubMed]

Azzuqa, A.

A. Azzuqa and J. F. Watchko, “Bilirubin Concentrations in Jaundiced Neonates with Conjunctival Icterus,” J. Pediatr. 167(4), 840–844 (2015).
[Crossref] [PubMed]

Bhutani, V. K.

V. K. Bhutani, G. R. Gourley, S. Adler, B. Kreamer, C. Dalin, and L. H. Johnson, “Noninvasive measurement of total serum bilirubin in a multiracial predischarge newborn population to assess the risk of severe hyperbilirubinemia,” Pediatrics 106(2), E17 (2000).
[Crossref] [PubMed]

Cnaan, A.

R. Keren, K. Tremont, X. Luan, and A. Cnaan, “Visual assessment of jaundice in term and late preterm infants,” Arch. Dis. Child. Fetal Neonatal Ed. 94(5), F317–F322 (2009).
[Crossref] [PubMed]

Dalin, C.

V. K. Bhutani, G. R. Gourley, S. Adler, B. Kreamer, C. Dalin, and L. H. Johnson, “Noninvasive measurement of total serum bilirubin in a multiracial predischarge newborn population to assess the risk of severe hyperbilirubinemia,” Pediatrics 106(2), E17 (2000).
[Crossref] [PubMed]

Goel, M.

L. d. Greef, M. Goel, M. J. Seo, E. C. Larson, J. W. Stout, J. A. Taylor, and S. N. Patel, “BiliCam: Using Mobile Phones to Monitor Newborn Jaundice,” in Proceedings of the 2014 ACM International Joint Conference on Pervasive and Ubiquitous Computing (2014), pp. 331–342.

Gourley, G. R.

V. K. Bhutani, G. R. Gourley, S. Adler, B. Kreamer, C. Dalin, and L. H. Johnson, “Noninvasive measurement of total serum bilirubin in a multiracial predischarge newborn population to assess the risk of severe hyperbilirubinemia,” Pediatrics 106(2), E17 (2000).
[Crossref] [PubMed]

Greef, L. d.

L. d. Greef, M. Goel, M. J. Seo, E. C. Larson, J. W. Stout, J. A. Taylor, and S. N. Patel, “BiliCam: Using Mobile Phones to Monitor Newborn Jaundice,” in Proceedings of the 2014 ACM International Joint Conference on Pervasive and Ubiquitous Computing (2014), pp. 331–342.

Guild, J.

T. Smith and J. Guild, “The C.I.E. colorimetric standards and their use,” Trans. Opt. Soc. 33(3), 73–134 (1931).
[Crossref]

Guilliam, A.

Johnson, L. H.

V. K. Bhutani, G. R. Gourley, S. Adler, B. Kreamer, C. Dalin, and L. H. Johnson, “Noninvasive measurement of total serum bilirubin in a multiracial predischarge newborn population to assess the risk of severe hyperbilirubinemia,” Pediatrics 106(2), E17 (2000).
[Crossref] [PubMed]

Kapur, K.

Keren, R.

R. Keren, K. Tremont, X. Luan, and A. Cnaan, “Visual assessment of jaundice in term and late preterm infants,” Arch. Dis. Child. Fetal Neonatal Ed. 94(5), F317–F322 (2009).
[Crossref] [PubMed]

Kramer, L. I.

L. I. Kramer, “Advancement of dermal icterus in the jaundiced newborn,” Am. J. Dis. Child. 118(3), 454–458 (1969).
[PubMed]

Kreamer, B.

V. K. Bhutani, G. R. Gourley, S. Adler, B. Kreamer, C. Dalin, and L. H. Johnson, “Noninvasive measurement of total serum bilirubin in a multiracial predischarge newborn population to assess the risk of severe hyperbilirubinemia,” Pediatrics 106(2), E17 (2000).
[Crossref] [PubMed]

Larson, E. C.

L. d. Greef, M. Goel, M. J. Seo, E. C. Larson, J. W. Stout, J. A. Taylor, and S. N. Patel, “BiliCam: Using Mobile Phones to Monitor Newborn Jaundice,” in Proceedings of the 2014 ACM International Joint Conference on Pervasive and Ubiquitous Computing (2014), pp. 331–342.

Leung, T. S.

Lim, B.

Luan, X.

R. Keren, K. Tremont, X. Luan, and A. Cnaan, “Visual assessment of jaundice in term and late preterm infants,” Arch. Dis. Child. Fetal Neonatal Ed. 94(5), F317–F322 (2009).
[Crossref] [PubMed]

MacDonald, L. W.

Meek, J.

Okell, J.

Patel, S. N.

L. d. Greef, M. Goel, M. J. Seo, E. C. Larson, J. W. Stout, J. A. Taylor, and S. N. Patel, “BiliCam: Using Mobile Phones to Monitor Newborn Jaundice,” in Proceedings of the 2014 ACM International Joint Conference on Pervasive and Ubiquitous Computing (2014), pp. 331–342.

Seo, M. J.

L. d. Greef, M. Goel, M. J. Seo, E. C. Larson, J. W. Stout, J. A. Taylor, and S. N. Patel, “BiliCam: Using Mobile Phones to Monitor Newborn Jaundice,” in Proceedings of the 2014 ACM International Joint Conference on Pervasive and Ubiquitous Computing (2014), pp. 331–342.

Smith, T.

T. Smith and J. Guild, “The C.I.E. colorimetric standards and their use,” Trans. Opt. Soc. 33(3), 73–134 (1931).
[Crossref]

Stout, J. W.

L. d. Greef, M. Goel, M. J. Seo, E. C. Larson, J. W. Stout, J. A. Taylor, and S. N. Patel, “BiliCam: Using Mobile Phones to Monitor Newborn Jaundice,” in Proceedings of the 2014 ACM International Joint Conference on Pervasive and Ubiquitous Computing (2014), pp. 331–342.

Taylor, J. A.

L. d. Greef, M. Goel, M. J. Seo, E. C. Larson, J. W. Stout, J. A. Taylor, and S. N. Patel, “BiliCam: Using Mobile Phones to Monitor Newborn Jaundice,” in Proceedings of the 2014 ACM International Joint Conference on Pervasive and Ubiquitous Computing (2014), pp. 331–342.

Tremont, K.

R. Keren, K. Tremont, X. Luan, and A. Cnaan, “Visual assessment of jaundice in term and late preterm infants,” Arch. Dis. Child. Fetal Neonatal Ed. 94(5), F317–F322 (2009).
[Crossref] [PubMed]

Watchko, J. F.

A. Azzuqa and J. F. Watchko, “Bilirubin Concentrations in Jaundiced Neonates with Conjunctival Icterus,” J. Pediatr. 167(4), 840–844 (2015).
[Crossref] [PubMed]

Am. J. Dis. Child. (1)

L. I. Kramer, “Advancement of dermal icterus in the jaundiced newborn,” Am. J. Dis. Child. 118(3), 454–458 (1969).
[PubMed]

Arch. Dis. Child. Fetal Neonatal Ed. (1)

R. Keren, K. Tremont, X. Luan, and A. Cnaan, “Visual assessment of jaundice in term and late preterm infants,” Arch. Dis. Child. Fetal Neonatal Ed. 94(5), F317–F322 (2009).
[Crossref] [PubMed]

Biomed. Opt. Express (1)

J. Pediatr. (1)

A. Azzuqa and J. F. Watchko, “Bilirubin Concentrations in Jaundiced Neonates with Conjunctival Icterus,” J. Pediatr. 167(4), 840–844 (2015).
[Crossref] [PubMed]

Pediatrics (1)

V. K. Bhutani, G. R. Gourley, S. Adler, B. Kreamer, C. Dalin, and L. H. Johnson, “Noninvasive measurement of total serum bilirubin in a multiracial predischarge newborn population to assess the risk of severe hyperbilirubinemia,” Pediatrics 106(2), E17 (2000).
[Crossref] [PubMed]

Trans. Opt. Soc. (1)

T. Smith and J. Guild, “The C.I.E. colorimetric standards and their use,” Trans. Opt. Soc. 33(3), 73–134 (1931).
[Crossref]

Other (3)

A. Mariakakis, M. A. Banks, L. Phillipi, L. Yu, J. Taylor, and S. N. Patel, “BiliScreen: Smartphone-Based Scleral Jaundice Monitoring for Liver and Pancreatic Disorders,” Proc. ACM Interact. Mob. Wearable Ubiquitous Technol. 1, 1–26 (2017).
[Crossref]

L. d. Greef, M. Goel, M. J. Seo, E. C. Larson, J. W. Stout, J. A. Taylor, and S. N. Patel, “BiliCam: Using Mobile Phones to Monitor Newborn Jaundice,” in Proceedings of the 2014 ACM International Joint Conference on Pervasive and Ubiquitous Computing (2014), pp. 331–342.

A. Riskin, A. Tamir, A. Kugelman, M. Hemo, and D. Bader, “Is visual assessment of jaundice reliable as a screening tool to detect significant neonatal hyperbilirubinemia?” The Journal of Pediatrics 152, 782–787 (2008).
[Crossref]

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Figures (4)

Fig. 1
Fig. 1 (a) Original image in RGB. Grayscale images of (b) blue pixel values, and (c) blue chromaticity values. The intensity profiles in (d) show that blue pixel values (solid lines) vary over a much greater range for a given ball than blue chromaticity values (dashed lines). The difference can also be seen in (e), which profiles the percentage deviation from each ball median.
Fig. 2
Fig. 2 Sclera colors for 87 newborns plotted on the CIE XYZ chromaticity diagram. The blue line is the axis for the Jaundice Eye Color Index. The TSB of each newborn is color-coded.
Fig. 3
Fig. 3 Mean blue chromaticity values versus total serum bilirubin in newborn sclera (n = 87).
Fig. 4
Fig. 4 The Jaundice Eye Color Index (JECI) versus TSB. The horizontal color bar displays the yellowness of sclera corresponding to a specific TSB under D65 illuminant.

Equations (1)

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JECI= z D65 z=( z D65 1 )+x+y

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