The Repeatability of Discrete and Continuous Anterior Segment Grading Scales

Purpose To investigate the repeatability of three anterior segment clinical grading scales: 1) verbal descriptors scale (VDS), 2) photographic matching scale (PS), and 3) continuous matching scale (CS). Methods Five optometrists graded 30 slides each of 3-9-o’clock staining, bulbar redness, and palpebral conjunctival roughness twice, separated by at least a day. VDS and PS were five-point scales (0–4) with half grades permitted. The CS was a 5-second, 240-frame video movie generated using morphing software. PS and CS grading was done with references presented on a computer screen. Results Averaged across observers, the test-retest intraclass correlation, correlation coefficient of concordance, and Pearson’s r ranged from 0.95 to 0.99 (all p < 0.001). Coefficients of repeatability using CS to grade all three ocular conditions ranged between 0.31 and 0.49. The corresponding PS and VDS coefficients of repeatability ranged between 0.37 and 0.49; PS generally had better repeatability than VDS. Conclusions Each of the clinical grading scales was reliable. The coefficients of repeatability showed that bulbar redness and palpebral conjunctival roughness were graded with higher precision using CS.

[1]  M. Bullimore,et al.  Considerations in the subjective assessment of cataract. , 1993, Optometry and vision science : official publication of the American Academy of Optometry.

[2]  C. Nickerson.  A note on a concordance correlation coefficient to evaluate reproducibility , 1997 .

[3]  F W Fitzke,et al.  A new computer assisted objective method for quantifying vascular changes of the bulbar conjunctivae. , 1996, Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians.

[4]  J J Bartko,et al.  Measures of agreement: a single procedure. , 1994, Statistics in medicine.

[5]  D. Altman,et al.  STATISTICAL METHODS FOR ASSESSING AGREEMENT BETWEEN TWO METHODS OF CLINICAL MEASUREMENT , 1986, The Lancet.

[6]  H. Solan,et al.  Effect of Luminance on Visual Evoked Potential Amplitudes in Normal and Disabled Readers , 1998, Optometry and vision science : official publication of the American Academy of Optometry.

[7]  C W McMonnies,et al.  Assessment of Conjunctival Hyperemia in Contact Lens Wearers. Part II , 1987, American journal of optometry and physiological optics.

[8]  T Grant,et al.  CCLRU standards for success of daily and extended wear contact lenses. , 1993, Optometry and vision science : official publication of the American Academy of Optometry.

[9]  M Guillon,et al.  Objective Measurement of Contact Lens-Induced Conjunctival Redness , 1996, Optometry and vision science : official publication of the American Academy of Optometry.

[10]  I L Bailey,et al.  Clinical grading and the effects of scaling. , 1991, Investigative ophthalmology & visual science.

[11]  J M Coggins,et al.  Automatic quantitative measurement of ocular hyperemia. , 1995, Current eye research.

[12]  L. Lin,et al.  A concordance correlation coefficient to evaluate reproducibility. , 1989, Biometrics.

[13]  T. Edrington,et al.  Effect of lens care systems on corneal fluorescein staining and subjective comfort in hydrogel lens wearers , 1994 .

[14]  C. McMonnies,et al.  Assessment of Conjunctival Hyperemia in Contact Lens Wearers. Part I , 1987, American journal of optometry and physiological optics.

[15]  A. Beckett,et al.  AKUFO AND IBARAPA. , 1965, Lancet.

[16]  M. Lloyd.  Lies, statistics, and clinical significance , 1992 .

[17]  E. Papas,et al.  variability Of Clinical Investigators In Contact Lens Research : 3:20 pm (cl-359) , 1995 .

[18]  B P Bergeron,et al.  Morphing as a means of generating variation in visual medical teaching materials. , 1994, Computers in biology and medicine.

[19]  M J Moseley,et al.  Analysis of method‐comparison data , 1994, Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians.

[20]  M. Guillon,et al.  Preocular Tear Film Characteristics of Nonwearers and Soft Contact Lens Wearers , 1997, Optometry and vision science : official publication of the American Academy of Optometry.

[21]  R. Woods.  Quantitative slit lamp observations in contact lens practice , 1989 .

[22]  B. Holden,et al.  High-oxygen-transmissibility soft contact lenses do not induce limbal hyperaemia. , 1997, Current eye research.

[23]  N Efron,et al.  Grading scales for contact lens complications , 1998, Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians.