{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T19:30:39Z","timestamp":1790796639768,"version":"4.1.0"},"reference-count":33,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2019,11,5]],"date-time":"2019-11-05T00:00:00Z","timestamp":1572912000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Iron deficiency (ID) is the most common nutritional deficiency. ID diagnosis requires ferritin measurement because clinical findings are poor and nonspecific. We studied the diagnostic value of blue sclera, which was scarcely reported as a specific and sensitive sign of ID. We enrolled 74 patients suspected of having ID. Pictures of their eyes were taken using a smartphone under similar daylight conditions. Three independent physicians graded the scleral color, and a computer analysis yielded the blue percentile of the sclera image. Final analysis included 67 patients (mean age 59.9 \u00b1 20.1 years). Fifty-one had ID. Subjective blue scleral color was associated with ID for physician 1 (64.5% vs. 86.1%, p = 0.03). Sensitivity was 60.8% (CI95: 46.1%; 74.2%), specificity 68.8% (CI95: 41.3%; 89%), and positive predictive value 86.1% (CI95: 70.5%; 95.3%). A marginal difference was observed for other physicians (p = 0.05). Computer analysis showed higher blue in the ID group (p = 0.04). The area under the receiver operating characteristic (ROC) curve was 0.7 (0.54; 0.85). Sensitivity was 78.4% (CI95: 63.7%; 88.7%), specificity was 50% (CI95: 24.7%; 75.3%). Assessment of blue sclera was not influenced by iris color, sex, or anemia. We showed that blue sclera has good positive predictive value for ID diagnosis, and computer analysis was correlated to clinical assessment. Improvement of this innovative, non-invasive method could provide an easy handling and inexpensive diagnosis tool for ID.<\/jats:p>","DOI":"10.3390\/jcm8111876","type":"journal-article","created":{"date-parts":[[2019,11,7]],"date-time":"2019-11-07T02:48:31Z","timestamp":1573094911000},"page":"1876","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Computed and Subjective Blue Scleral Color Analysis as a Diagnostic Tool for Iron Deficiency: A Pilot Study"],"prefix":"10.3390","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8511-8432","authenticated-orcid":false,"given":"Herv\u00e9","family":"Lobbes","sequence":"first","affiliation":[{"name":"Internal Medicine Department, University Hospital Clermont-Ferrand, 1 place Lucie et Raymond Aubrac, 63003 Clermont-Ferrand, France"},{"name":"Clermont Auvergne University, CNRS, SIGMA Clermont, Institute Pascal, Campus universitaire des C\u00e9zeaux, 4 Avenue Blaise Pascal, 63178 Aubi\u00e8re, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julien","family":"Dehos","sequence":"additional","affiliation":[{"name":"LISIC Laboratory, C\u00f4te d\u2019Opale University, 50 Rue Ferdinand Buisson, 62228 Calais, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3778-7161","authenticated-orcid":false,"given":"Bruno","family":"Pereira","sequence":"additional","affiliation":[{"name":"University Hospital Clermont-Ferrand, Biostatistics Unit, 58 Rue Montalembert, 63003 Clermont-Ferrand, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7724-4607","authenticated-orcid":false,"given":"Guillaume","family":"Le Guenno","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, University Hospital Clermont-Ferrand, 1 place Lucie et Raymond Aubrac, 63003 Clermont-Ferrand, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2237-0497","authenticated-orcid":false,"given":"Laurent","family":"Sarry","sequence":"additional","affiliation":[{"name":"Clermont Auvergne University, CNRS, SIGMA Clermont, Institute Pascal, Campus universitaire des C\u00e9zeaux, 4 Avenue Blaise Pascal, 63178 Aubi\u00e8re, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Ruivard","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, University Hospital Clermont-Ferrand, 1 place Lucie et Raymond Aubrac, 63003 Clermont-Ferrand, France"},{"name":"Clermont Auvergne University, CNRS, SIGMA Clermont, Institute Pascal, Campus universitaire des C\u00e9zeaux, 4 Avenue Blaise Pascal, 63178 Aubi\u00e8re, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,11,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1017\/S1368980008002401","article-title":"Worldwide prevalence of anaemia, WHO Vitamin and Mineral Nutrition Information System, 1993\u20132005","volume":"12","author":"McLean","year":"2009","journal-title":"Public Health Nutr."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1312","DOI":"10.3945\/ajcn.110.007195","article-title":"Assessment of iron status in US pregnant women from the National Health and Nutrition Examination Survey (NHANES), 1999\u20132006","volume":"93","author":"Mei","year":"2011","journal-title":"Am. 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