201204312 六、發明說明： 【發明所屬之技術領域】 本發明係關於-種非接觸式淚膜熱影像儀之淚膜熱影 像形態分析方法’尤指—種利用形態學與參數化分析技術 的淚膜熱影像形態分析方法。 【先前技術】 Ο € 人類的眼睛在角膜表面形成有一淚膜，以構成保護; 該淚膜由内而外包括—黏液声、一 鄉欣層、一水液層及—油性層，進 而組成-完整之淚液層；而前述黏液層、水液層及油性層 在功能上係相辅相成’該油性層係用以防止水分蒸發，黏 液層可使淚水均勻分布並緊貼在角膜表面。 ' 正常人在眨眼時，角膜表面的淚液層將由淚點經淚小 管經鼻腔排出而被更新.& 田& & > 士 攸文祈，而所謂的乾眼症患者，係其淚液 的分泌及更新功能較正常人差；冑常乾眼症需要透過一些 接觸式或侵入式的檢驗以協助確立檢驗μ列如石墨氏 (Schi「mer)試驗及淚膜破裂時間（tbut, 丁的「up201204312 VI. Description of the Invention: [Technical Field of the Invention] The present invention relates to a method for analyzing the morphology of a tear film thermal image of a non-contact type tear film thermal imager, especially a tear using a morphology and a parametric analysis technique. Membrane thermal image morphology analysis method. [Prior Art] Ο € The human eye has a tear film formed on the surface of the cornea to protect it; the tear film consists of the mucus sound, the Xiangxin layer, the water layer and the oil layer, and then consists of - The complete tear layer; and the mucus layer, the water layer and the oil layer are functionally complementary to each other'. The oil layer is used to prevent evaporation of water, and the mucus layer can evenly distribute tears and adhere to the corneal surface. When a normal person blinks, the tear layer on the corneal surface will be renewed by the punctum through the lacrimal canal through the nasal cavity. &&&> Gentry, the so-called dry eye patients, their tears The secretion and renewal function is worse than normal; 胄 often dry eye syndrome needs to pass some contact or invasive tests to help establish the test μ column such as graphite (Schi "mer" test and tear film break time (tbut, Ding "up
Time)月者係在眼睛點過三次***之後，將長形濾紙 置於下眼瞼處，經過數分鐘後觀察濾紙的濕潤長度；後者 則肩在患者眼中滴入螢光染齊卜再以裂隙燈觀察張眼後到 第-次破裂產生的時間。由於前述檢驗方式分別以滤紙或 螢光木钟丨彳又入眼目月，對於接受檢驗的患者而言，難免出現 不適的狀況’另，亦存在低可重複性與高變異性等 缺點。 9413 為解決前述問題，申請人先前提出申請第 201204312 號利:工外線熱像儀判斷眼睛疾病之裝置」發明專利案 要疋=紅外線熱像儀拍攝眼疾患者的眼球前表面影 像亚在單位時間内追縱肖膜特定位置的精密溫度變化， 卫依據時序内之溫度變化獲彳m曲料κ值及—降溫溫 差△丁，經由最佳卜夕 z 化之K與△!·的曲線提供醫師作為判斷 -者艮疾之依據。由於前述專利案係、在未接觸的狀態下祿 取患者的眼球影像，經過分析技術後即可確立檢驗，有效Time) After the eye has passed the anesthetic three times, put the long filter paper on the lower eyelid. After a few minutes, observe the wet length of the filter paper; the latter will drop the fluorescent dye into the patient's eye and then use the crack. The time from the observation of the eye to the first rupture. Since the above-mentioned inspection methods are respectively used for filter paper or fluorescent wood clocks, it is inevitable that the patients who are tested will have an uncomfortable situation. In addition, there are disadvantages such as low reproducibility and high variability. 9413 In order to solve the above problems, the applicant has previously filed the application No. 201204312: the device for determining the eye disease by the external thermal imaging camera. The invention patent case 疋 = infrared thermal imaging camera to photograph the anterior surface image of the eye disease patient in the unit time According to the temperature change in the specific position of the film, Weiwei obtains the κ value of the 曲m-curve and the temperature difference △丁 according to the temperature change in the time series, and provides the doctor with the curve of K and △! Judgment - the basis of dysentery. Due to the aforementioned patent system, the patient's eyeball image is taken in an untouched state, and the test can be established after the analysis technique is effective.
L =者在檢驗過程中的不安與恐懼，同時可提高檢驗的 準確性。由於前述裝置相較於既有檢驗方式已具備顯著功 效增進，故已獲准專利並授證（發明專利權第|272931 在前述專利案中，係先取得患者眼球的紅外線執影像 2㈣㈣熱影像分析其溫度變化’供醫師作為診斷之 ⑽=根據臨床經驗，不同的乾眼症患者，其㈣破裂 的二Ρ)的形態及時間長短並不相同，每-種淚膜破裂 睹 別代表不同的症狀與嚴重程度，但在過去關於淚 膜破裂形態的分析，必須完全依 、 顆醫師本身的判斷，而眼 科邊師接受過嚴格的專業醫學訓 fe3. 醫術上的專業性毋庸 置疑，但淚膜破裂的態樣基本上 疋頰似圖案的辨識，由於 淚膜破裂的形狀並不規則，不同 的邊師對相同淚膜的破裂 形狀可能出現不同的辨識結果， 及判斷經驗。 果因而不利於累積臨床病例 【發明内容】 種非接觸式淚膜熱影像儀 因此本發明主要目在提供— 201204312 之淚膜熱影像形態分析方法，主要係利用形態學 影=進行參數化分析，1自動地對患者的淚膜熱影像進： ，態分類，以提供經過形態分類的淚膜熱影像輔 丁 -檢驗結果，藉此可提高檢驗效率’同時可有效 病例及判斷經驗。 床 為達成前述目的採取的主要技術手段係令前述方法包 括： 依序載入數幀先後對同一淚膜擷取的熱影像； 針對每一幀淚膜熱影像的感興趣區域（R〇丨）分別記錄其 溫度的最大值、最小值； 根據前一步驟的記錄内容在淚膜熱影像上劃分一個以 上的溫度區塊，並記錄各溫度區塊的大小、位置及其邊緣 溫度； 分析各溫度區塊的形態及溫度變化； 進行淚膜穩定性分類； 月il述各溫度區塊的形態分析工具包括：似圓性 (Circularity)判斷、馬赛克及溫度梯度（Temperatu「eL = the uneasiness and fear during the test, and can improve the accuracy of the test. Since the aforementioned device has significant improvement in efficiency compared to the existing inspection method, it has been granted a patent and is granted a certificate (Invention Patent No. | 272931 In the aforementioned patent case, the infrared image of the patient's eyeball is first obtained 2 (4) (4) Thermal image analysis Temperature change 'for doctors as a diagnosis (10) = according to clinical experience, different dry eye patients, their (four) ruptured sputum) form and duration are not the same, each tear film rupture represents different symptoms and Severity, but in the past, the analysis of tear film rupture must be based solely on the judgment of the physician itself, and the ophthalmologist has undergone strict professional medical training. 3. The professionalism of medical treatment is unquestionable, but the tear film is broken. The pattern is basically a cheek-like pattern. Because the shape of the tear film is irregular, different side teachers may have different identification results for the same tear film shape and judge the experience. Therefore, it is not conducive to accumulating clinical cases. [Inventive content] A non-contact type of tear film thermal imager. Therefore, the present invention mainly provides a method for analyzing the tear film thermal image morphology of 201204312, mainly by using morphological shadow=parametric analysis. 1 automatically to the patient's tear film thermal image into:, state classification, to provide the shape of the tear film thermal imaging assistant Ding-test results, which can improve the test efficiency 'at the same time can be effective cases and judgment experience. The main technical means for the bed to achieve the above purpose is that the method includes: sequentially loading a plurality of frames of thermal images captured by the same tear film; for each frame of the tear film thermal image (R〇丨) Record the maximum and minimum values of the temperature separately; divide more than one temperature block on the tear film thermal image according to the recorded content of the previous step, and record the size, position and edge temperature of each temperature block; analyze each temperature Morphological and temperature changes of the block; classification of tear film stability; monthly morphological analysis tools for each temperature block include: circularity judgment, mosaic and temperature gradient (Temperatu "e
Gradient)分析等’利用前述分析工具可將淚膜形態分為下 列數類： A _溫度呈同心圓分佈並持續降溫； B_同心圓不十分明顯，呈現均勻分布的灰階； C. 溫度持續下降，出現樹枝狀、龜裂紋或直線條紋 黑影，黑影無上移現象； D. 降溫趨勢不明顯，角膜中央或以上出現一水平橫 紋黑影，並隨時間向上方升高； 5 201204312 报快的下降至最低溫後即不再下 Ε·降溫趨勢快速 降； F.溫度持續下降 龜裂紋或直線條紋f ’一段時間後不明顯，出現樹枝 影且有水平擴張或逐漸上升的趨 狀 勢 其他.不屬於_ # Λ 、則列Α〜F類中任一種的其他類型； 上述的A〜Fgg/十念 顯依序代表淚膜不同程度的穩定性，而患 者的淚膜熱影像極诉二、+· A ΑGradient) analysis and so on. Using the aforementioned analysis tools, the tear film morphology can be divided into the following categories: A _ temperature is concentric circle distribution and continuous cooling; B_ concentric circles are not very obvious, showing uniform distribution of gray scale; C. temperature continues Decline, dendritic, turtle crack or straight stripe black shadow, black shadow does not move up; D. The cooling trend is not obvious, a horizontal horizontal shadow appears in the center or above the cornea, and rises upward with time; 201204312 After the report drops to the lowest temperature, it will not squat again. The cooling trend will drop rapidly. F. The temperature continues to drop. The crack or straight line fringe of the turtle is not obvious after a period of time, and there is a branch shadow and horizontal expansion or gradual rise. Other types that do not belong to _ # Λ, then Α Α F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F F Extreme v. II, +· A Α
乂過則述參數化形態分析後可適當且相對 準確地進行分類，益 藉此可提供醫師作為確立檢驗之參考。 【實施方式】 由於本發明是用以將各種淚膜的形態加以分類，因此 首先由臨床上觀察到的淚膜形態加以分類並說明如后： 。月配合參閲附件一的圖表所示，兩道平行的垂直箭頭 刀別代表眼淚水量，，及，，淚膜穩定性，，，就，，眼淚水量，，方面愈 彺下表不愈少，愈往上表示愈多；又，’淚膜穩定性，，方面愈 往下表不愈差，愈往上表示愈好；當不同的，，眼淚水量，，交 叉對應到不同的”淚膜穩定性”，將出現不同的淚膜形態， 可忐的淚膜形態及特性概如以下所述（所稱的淚膜係由遠紅 外線熱影像儀拍攝接受檢測者閉上眼睛再睁眼後的眼球熱 影像’而遠紅外線影像儀對該熱影像具備溫度分析功能）： Α_睁眼後所拍攝的熱影像（如圖1Α，配合參閱附件二 之熱影像圖片Α)，溫度呈同心圓分佈並持續降溫，尤其角 膜中央在睜眼4〜5秒後’仍可見降溫趨勢，最後在熱影像 的彩色圖上可見四色（或以上）的降溫幅度，且降溫趨勢在 201204312 睜眼6秒後仍清楚可見。 : B.睜眼後所拍攝的熱影像（如圖1B，配合參閱附件二 之熱影像圖片B)’呈現均勻分布的灰階同心圓不十分明顯 ，且呈現一片光壳，熱影像的彩色圖上均勻呈現偏紅/撥色 /黃色，睁眼6秒後沒有太大的變動； C.如圖1C及附件二之熱影像圖片c所示，睁眼後 ，溫度持續下降，且出現樹枝狀、龜裂紋或直線條紋黑影 ，但黑影無上移現象； O D 如圖1 D及附件一之熱影像圖片d所示，睁眼後 降溫趨勢不明顯，角膜中央或以上常出現一道水平橫紋黑 影，並隨時間向上方升高； E. 如圖1E及附件二之熱影像圖片日所示所示，睁眼 後降溫趨勢十分快速，可以是同心圓狀，但通常在3_4秒 内即達到最低溫後即不再下降；且在睁眼後第4〜6秒間不 太有變化。 F. 如圖1 F及附件二之熱影像圖片F所示所示，睁眼 (」後度持續下降，但4〜5秒後不明顯，角膜上出現樹枝狀 、龜裂紋或直線條紋黑影且有水平擴張或逐漸上升的趨勢 〇 其他：不屬於前列A〜F類中任一種的其他類型。 前述形態代碼A〜F分別代表不同程度的淚膜穩定性， 代碼A、B最佳，睁眼超過10秒後才會出現淚膜破裂；代 碼C、D中等，睁眼後5〜10秒間出現淚膜破裂；代碼E、 F最差，睁眼後5秒内即出現淚膜破裂。 由上述可知，就淚膜穩定性的判斷，臨床上大致有前 201204312 列的數種類別；而本發明主要係在利用形態學及參數化分 析技術將取得的淚膜熱影像進行分類’以輔助醫師快速地 苳握患者的淚膜變化，具體的方法請配合參閱圖2所示， 包括有： 依序载入數幀先後對同一淚膜擷取的熱影像（彳〇 ” ； 針對每一幀淚膜熱影像的感興趣區域（RO丨）分別記錄其 溫度的最大值、最小值（1 〇2); 根據前一步驟的記錄内容在淚膜熱影像上劃分一個以 上的溫度區塊’並記錄各溫度區塊的大小、位置及其邊緣 溫度（103); 分析各溫度區塊的形態及溫度變化（彳〇4); 進行淚膜穩定性分類（1 05);其中： ϋ 前述步驟Π01)載人的熱影像是在—段時間内對同一淚 膜拍攝的數幢熱影像’本實施例中，係觀察熱膜在6秒内 的變化’因此前述數幢熱影像係在接受檢測者睁眼後卜6 :間每一秒拍攝一㈣熱影像，因而計載…貞熱影像， 母-巾貞熱影像分別代表接受檢測者其睁眼後第卜2、3、4 、5、6秒的淚膜狀態。 =步驟⑽)係針對每1淚膜熱影像上的感興趣區 =)分別記錄其溫度的最大值、最小值，所稱的感興趣 尤指角膜範圍内；由料紅外線熱像儀本身即能 ^:熱影像的溫度’並以顏色反應出溫度的高低，因而 感興趣區域叫並分別記錄區域内的 /皿度最大值及最小值。 前述步驟(1〇3)係在每-鴨熱影像分別經過步驟(102) 8 201204312 記錄其溫度變化後而在熱影像上劃出一個以上的溫度區塊 ，例如以前述代碼A的淚膜形態為例，可能在角膜上出現 數個呈同心圓排列的環狀溫度區塊，這些呈同心圓排列的 溫度區塊將被 記錄其大小、位置及邊緣的溫度； 前述步驟（1G4)係用以分析各溫度區塊的形態及其溫度 變化.用以分析各溫度區塊形態的工具包括：似圓性 (Ci·丨amy)運算、馬賽克處理及溫度梯度（丁6寧如_ Gradient)分析等；其中似圓性運算公式如下：It can be appropriately and relatively accurately classified after parametric morphological analysis, thereby providing physicians with a reference for establishing tests. [Embodiment] Since the present invention is used to classify the morphology of various tear films, the clinically observed tear film morphology is first classified and described as follows: For the month, see the chart in Annex 1. The two parallel vertical arrow knives represent the amount of tears, and,, tear film stability,,,,,,,,,,,,,,,,,,,,, More and more said more; also, 'Tear film stability, the more the table is not worse, the more up the better; when different, the amount of tears, the cross corresponds to different" tear film stability "Sex", there will be different tear film morphology, the shape and characteristics of the tear film can be as follows (the tear film is called by the far-infrared thermal imager, the eye is closed after the eye is closed and then blinked. The thermal image 'and the far-infrared imager has a temperature analysis function for the thermal image): Α _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Continuous cooling, especially in the center of the cornea after 4 to 5 seconds of blinking, 'the cooling trend is still visible. Finally, the temperature range of four colors (or above) can be seen on the color map of the thermal image, and the cooling trend is still in 201204312. Clearly visible. : B. The thermal image taken after blinking (as shown in Figure 1B, with reference to the thermal image B of Annex II) 'The gray circle concentric circles that are evenly distributed are not very obvious, and present a light shell, color image of the thermal image Evenly showing reddish/picked/yellow, there is not much change after blinking for 6 seconds; C. As shown in the thermal image c of Figure 1C and Annex II, after blinking, the temperature continues to drop and dendrites appear , turtle crack or straight stripe black shadow, but the black shadow does not move up; OD As shown in Figure 1 D and the thermal image picture d of Annex I, the cooling trend after blinking is not obvious, a level often appears in the center or above the cornea Horizontal shading and rising upwards with time; E. As shown in the thermal image picture day of Figure 1E and Annex II, the cooling trend after blinking is very fast, it can be concentric, but usually in 3_4 seconds After reaching the lowest temperature, it does not fall any more; and there is no change between the 4th and 6th second after the blink. F. As shown in the thermal image picture F of Figure 1 F and Annex 2, the blinking (" is continued to decrease, but it is not obvious after 4~5 seconds. There are dendrites, turtle cracks or straight stripe black on the cornea. There is a trend of horizontal expansion or gradual increase. Others: Other types that are not in any of the former A to F categories. The above-mentioned morphological codes A to F represent different degrees of tear film stability, and codes A and B are optimal. Tear film rupture occurs after blinking for more than 10 seconds; code C, D is medium, tear film rupture occurs between 5 and 10 seconds after blinking; code E, F is the worst, and tear film rupture occurs within 5 seconds after blinking. As can be seen from the above, in terms of the determination of the stability of the tear film, there are several categories of the previous 201204312 column in clinical practice; and the present invention mainly uses the morphological and parametric analysis techniques to classify the obtained tear film thermal images to assist The physician quickly grasps the patient's tear film changes. The specific method is shown in Figure 2, including: The sequential loading of several frames of thermal images captured on the same tear film (彳〇); for each frame Region of interest of the tear film thermal image (RO丨) Do not record the maximum and minimum values of temperature (1 〇 2); divide more than one temperature block on the tear film thermal image according to the recorded content of the previous step and record the size, position and edge of each temperature block. Temperature (103); Analyze the shape and temperature change of each temperature block (彳〇4); Perform tear film stability classification (1 05); where: ϋ The above steps Π01) The manned thermal image is in the period of time Several thermal images taken on the same tear film. In this example, the change of the thermal film in 6 seconds is observed. Therefore, the above-mentioned several thermal images are taken every second after receiving the tester's blinking. (4) Thermal image, thus counting the thermal image, the mother-to-smoke thermal image represents the tear film state of the second, third, fourth, fifth, and sixth seconds after the blink of the tester. = Step (10)) The region of interest on each of the tear film thermal images =) records the maximum and minimum values of the temperature, respectively, and the so-called interest, especially in the cornea; the infrared camera itself can: the temperature of the thermal image 'And the color reflects the temperature, so the region of interest is called and remembered separately The maximum value and the minimum value of the dish in the recorded area. The above steps (1〇3) are performed on the thermal image after each of the duck thermal images is recorded in step (102) 8 201204312. The temperature block, for example, taking the tear film morphology of the aforementioned code A as an example, may have several annular temperature blocks arranged in a concentric circle on the cornea, and the temperature blocks arranged in concentric circles will be recorded in size and position. And the temperature of the edge; the foregoing step (1G4) is used to analyze the shape of each temperature block and its temperature change. The tools used to analyze the shape of each temperature block include: circularity (Ci·丨amy) operation, mosaic processing And the temperature gradient (Ding 6 Ningru _ Gradient) analysis, etc.; the circularity formula is as follows:
〇 似圓性係數（Circularity factor) : fcirc = 4 7Γ Α/Ρ 其中：Α是形體面積，ρ則是形體的周長。 所有淚膜熱影像都必 的淚膜形態，其是否呈現 其觀察變化的奇點為低於 須經過似圓性運算，例如代碼A 同心圓即通過似圓性運算得知， 0_3的最小點或下降幅度最大點 又馬賽克（Mosaic):係將熱影像中的多點以單一點表 示（多點之均值或以閥值二值化）矣 G丨表不猎此間化影像資料 ，以利於快速比較判斷；請配合參閱附件三所示，其右上 方所示者為淚膜熱影像，右下方則署 八 π「乃只〗疋將角膜中央出現的溫 度區塊處理成馬赛克的結果；而前述代碼。、d及F淚膜 上所出現樹枝狀、龜殼紋或橫、直 &识且悚双的黑影，即透過馬 赛克處理後而為分析出來。 …再者，所謂的溫度梯度（Tempe「ature G「adient)，是 描述一特定的區域環境内那 X衣兄β那方向上的溫度變化最迅速且 以何種速率變化的物理量’其單位是度/每單位長度(在特 疋的溫度範圍内）。該溫度梯度是用來分析各溫度區塊的形 201204312 狀及位置（如附件四所示）’又如代碼代碼C、D及F淚膜 上所出現的樹枝狀、龜殼紋或橫、直條紋黑影是否在角膜 上移動或朝向那裡移動，亦根據溫度梯度來作判斷。 除前述工具外，由於每-t貞熱影像上的溫度區塊都被 記=其大小、位置及溫度，因此可根據各幢熱影像所記錄 的'皿度，觀察其溫度變化趨勢（或稱降溫幅度△ T/△ t)。 經利用前述工具對熱影像進行形態分析後，即可對淚 膜熱影像進行分類（步驟105)，經過形態分類的淚膜熱影 〇像可辅助醫師更方便地執行確立檢驗，更可累積臨床案例 與判斷經驗。 【圖式簡單說明】 圖1A〜1F係各種淚膜形態示意圖。 圖2係本發明之流程圖。 【主要元件符號說明】 益 【附件簡單說明】 一 眼淚水量與淚膜穩定性對照圖。 二各種（A〜F)淚膜形態的熱影像。 二·對淚膜進行馬赛克處理之操作介面。 四對淚膜進行溫度梯度分析的操作介面Circ Circularity factor: fcirc = 4 7Γ Α/Ρ where: Α is the area of the body, and ρ is the circumference of the body. All tear film thermal images are necessary for the shape of the tear film. Whether it exhibits a singularity of its observed change is lower than the circularity calculation. For example, the code A is concentric, that is, the circular point is calculated, the minimum point of 0_3 or Mosaic is the largest point and mosaic (Mosaic): the multiple points in the thermal image are represented by a single point (the average of multiple points or binarized by the threshold) 矣G丨 table does not hunted this image to facilitate rapid comparison Judging; please refer to the attached figure 3. The upper right side shows the tear film thermal image, and the lower right side is the result of processing the temperature block appearing in the center of the cornea into a mosaic. , d and F tear film appear on the dendritic, turtle shell pattern or horizontal, straight & and the double shadow, that is, through the mosaic treatment for analysis. ... Again, the so-called temperature gradient (Tempe "ature G "adient" is a physical quantity that describes the temperature change in the direction of the X-in-law in a particular regional environment. The unit is the degree/per unit length (in the special Within the temperature range) The temperature gradient is used to analyze the shape and position of each temperature block 201204312 (as shown in Annex IV). Also, the dendritic, turtle shell or horizontal and straight stripes appear on the tear film of code codes C, D and F. Whether the black shadow moves on the cornea or moves toward it, it is also judged according to the temperature gradient. In addition to the above tools, since the temperature block on each-t贞 thermal image is recorded as its size, position and temperature, it can be According to the 'degree of the heat recorded by each thermal image, observe the temperature change trend (or the temperature drop amplitude △ T / △ t). After the morphological analysis of the thermal image using the above tools, the tear film thermal image can be classified. (Step 105), the morphologically classified tear film thermal imaging image can assist the physician to perform the establishment test more conveniently, and can accumulate the clinical case and the judgment experience. [Simplified Schematic] FIG. 1A to FIG. Fig. 2 is a flow chart of the present invention. [Description of main component symbols] Benefits [Simplified description of attachments] A comparison of tear volume and tear film stability. Two thermal images of various (A~F) tear film morphology. Tear film interface mosaic processing operation of Four tear film temperature gradient analysis user interface