Evaluating a new objective grading software for conjunctival hyperaemia

Abstract

Background/ Aims: Standardised numeric grading scales are used in ophthalmic practice to improve consistency between clinicians in recording the severity of ocular conditions and to facilitate the monitoring of such changes. We investigated the intraand inter-observer grading reliability and the agreement between subjective Cornea and Contact Lens Research Unit (CCLRU) and Efron grading scales as well as a new Advanced Ophthalmic Systems (AOS) software which uses an objective approach to grading conjunctival hyperaemia. Methods: One experienced observer graded n=30 bulbar and n=26 palpebral conjunctival hyperaemia images to 0.1 increments. Masked grading of randomised images was undertaken for all three methods, on two separate occasions. The agreement within and between the grading methods was assessed between sessions, and compared to the results of a novice observer. Results: There were no statistically significant differences (P > 0.05) between test and retest values. However, repeatability in the grading estimates of both bulbar and palpebral conjunctival hyperaemia was improved using the AOS grading method (R 2 =0.998; Coefficient of Repeatability CoR 0.10-0.13), compared to Efron (R 2 = 0.926; CoR 0.62) and CCLRU (R 2 = 0.885-0.911; CoR 0.50-0.78). Intraclass coefficient correlations (ICC) improved inter-observer agreement using objective (> 0.995) versus subjective methods (0.853-0.959). Conclusion: These subjective and objective grading methods are not interchangeable. Due to the excellent repeatability and improved agreement between experienced and novice observers, the objective grading method provides a 2 more consistent approach when grading ocular abnormalities and may achieve greater reliability in record keeping and clinical monitoring in the future.

Optimising subjective anterior eye grading precision

“…In addition, the results of this new technology might not be interchangeable with results obtained using subjective grading scales. [18][19] Thus, it is important to continue to support clinicians using grading scales optimally, although, digital photography can allow direct comparison at subsequent visits and is preferable to grading.…”

BCLA CLEAR - Effect of contact lens materials and designs on the anatomy and physiology of the eye

“…The clinician can use visual scales to grade hyperaemia severity and to monitor treatment effect [105]. Significant efforts have been made to develop standardised grading scales that are easy to use by the clinician or that rely on computer analysis [106][107][108][109][110][111][112].…”

BCLA CLEAR - Evidence-based contact lens practice

“…Objective grading from digital images has the potential to decrease the variability of subjective rating, but relies on good quality imaging [150][151][152]. Although anterior eye digital imaging (from a digital slit lamp or even a smartphone) is not commonly utilised in clinical practices [138], the resulting images or movie clips can accurately reflect anterior eye characteristics.…”