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Fang M, Airen S, Jiang H, Wang J. Ocular surface microvascular response and its relation to contact lens fitting and ocular comfort: an update of recent research. Clin Exp Optom 2021; 104:661-671. [PMID: 33689669 DOI: 10.1080/08164622.2021.1878867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
This review examines vascular responses in the ocular surface to contact lens wear and its relation to lens fitting characteristics and contact lens-related discomfort. A search of PubMed was performed to find original research in English, within the past 10 years, that studied the ocular surface, including lid-wiper vascular responses to the lens. The interaction between the lens and ocular surface triggers vascular responses, impacting the lens fitting and contact lens-related discomfort. Contact lens-related discomfort is a multifactorial event, which is affected by lens characteristics. Overall, contact lenses with low modulus and a relatively tight fit produce significant ocular comfort. If an appropriate lens fit is achieved, lens fitting characteristics may not play a critical role in contact lens-related discomfort. On the other hand, the pathogenic and vascular changes of lid-wiper vascular responses appear to play an essential role in developing contact lens-related discomfort, in concert with reactions of the cornea (compression and staining) and conjunctiva (indentation and staining). Robust evaluation of lid-wiper changes at the cellular and microvascular level may hold the key to better understanding the mechanism of contact lens-related discomfort and reveal strategies for eliminating lid wiper epitheliopathy and improving ocular comfort in contact lens wearers.
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Affiliation(s)
- Min Fang
- Shenzhen Key Laboratory of Ophthalmology, Shenzhen Eye Hospital, Jinan University, Shenzhen, Guangdong, China.,School of Medicine, Bascom Palmer Eye Institute, University of Miami Miller, Miami, FL, USA
| | - Shriya Airen
- School of Medicine, University of Miami Miller, Miami, FL, USA
| | - Hong Jiang
- School of Medicine, Bascom Palmer Eye Institute, University of Miami Miller, Miami, FL, USA.,Department of Neurology, School of Medicine, University of Miami Miller, Miami, FL, USA
| | - Jianhua Wang
- School of Medicine, Bascom Palmer Eye Institute, University of Miami Miller, Miami, FL, USA
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Abstract
The red eye is one of the most common cause encountered in ophthalmic practice but a red eye is not always related to eye diseases, instead, it may be a clinical sign of several systemic diseases which may the alarmin signal of sight-threatening or life-threatening condition. Frequently, GPs, pediatricians, immunologists, and rheumatologists are the first landing of patients with a "red eye." This paper is addressed to non-ophthalmic specialists who may be faced with patients having a red eye. Inspection of the external eye under standard office lighting or with a bright light can be easily and accurately made by a general practitioner. Three major caveats should alert the GPs to promptly refer the patient to the ophthalmologist: the presence of pain; the loss of the natural corneal transparency and specular reflex; and any patient-described reduction of visual acuity. In most cases, a red eye is due to occasional and mild ocular surface reaction as consequence of exposure of the external eye to irritants and naturally occurring environmental agents. In these cases washing the eye with a tear lubricant may help in relief of symptoms. If this treatment fails within a few days, a consultation with an ophthalmologist is suggested. The role of the general physician is crucial in the decision making to judge the severity of the ocular condition. Managing a red eye often requires the support of other specialists. Our goal is not only to preserve vision but to globally cure the patient health.
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Affiliation(s)
- Stefano Bonini
- Department of Ophthalmology, University of Rome Campus BioMedico, Rome, Italy
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3
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Pine KR, Sloan B, Jacobs RJ. The development of measurement tools for prosthetic eye research. Clin Exp Optom 2021; 96:32-8. [DOI: 10.1111/j.1444-0938.2012.00754.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Keith Raymond Pine
- Department of Optometry and Vision Science, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - Brian Sloan
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand. E‐mail:
| | - Robert John Jacobs
- Department of Optometry and Vision Science, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
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Wolffsohn JS, Dumbleton K, Huntjens B, Kandel H, Koh S, Kunnen CME, Nagra M, Pult H, Sulley AL, Vianya-Estopa M, Walsh K, Wong S, Stapleton F. CLEAR - Evidence-based contact lens practice. Cont Lens Anterior Eye 2021; 44:368-397. [PMID: 33775383 DOI: 10.1016/j.clae.2021.02.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 02/01/2021] [Indexed: 12/15/2022]
Abstract
Evidence-based contact lens -->practice involves finding, appraising and applying research findings as the basis for patient management decisions. These decisions should be informed by the strength of the research study designs that address the question, as well as by the experience of the practitioner and the preferences and environment of the patient. This reports reviews and summarises the published research evidence that is available to inform soft and rigid contact lens history and symptoms taking, anterior eye health examination (including the optimised use of ophthalmic dyes, grading scales, imaging techniques and lid eversion), considerations for contact lens selection (including the ocular surface measurements required to select the most appropriate lens parameter, lens modality and material selection), evaluation of lens fit, prescribing (teaching self-application and removal, adaptation, care regimen and cleaning instructions, as well as -->minimising risks of lens wear through encouraging compliance) and an aftercare routine.
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Affiliation(s)
| | - Kathy Dumbleton
- School of Optometry, University of California, Berkeley, CA, USA
| | - Byki Huntjens
- Division of Optometry and Visual Sciences at City, University of London, London, UK
| | - Himal Kandel
- Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Shizuka Koh
- Department of Innovative Visual Science, Osaka University Graduate School of Medicine, Japan
| | | | - Manbir Nagra
- Vision and Eye Research Institute, ARU, Cambridge, UK
| | - Heiko Pult
- Optometry and Vision Research, Weinheim, Germany
| | | | - Marta Vianya-Estopa
- Department of Vision and Hearing Sciences Research Centre, Anglia Ruskin University, Cambridge, UK
| | - Karen Walsh
- Centre for Ocular Research & Education, School of Optometry & Vision Science, University of Waterloo, Waterloo, Canada
| | - Stephanie Wong
- Centre for Ocular Research & Education, School of Optometry & Vision Science, University of Waterloo, Waterloo, Canada
| | - Fiona Stapleton
- School of Optometry and Vision Science, UNSW Sydney, Australia
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Schulze MM, Ng A, Yang M, Panjwani F, Srinivasan S, Jones LW, Senchyna M. Bulbar Redness and Dry Eye Disease: Comparison of a Validated Subjective Grading Scale and an Objective Automated Method. Optom Vis Sci 2021; 98:113-120. [PMID: 33534379 DOI: 10.1097/opx.0000000000001638] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE In this study, assessments of conjunctival redness were performed to evaluate whether patients with or without dry eye disease (DED) could be discriminated based on this measure. Our findings suggest that subjectively grading redness by quadrant, as opposed to automated en face measurements, may be more suitable for this purpose. PURPOSE This study aimed to quantify bulbar redness using the validated bulbar redness (VBR) grading scale and an automated objective method (Oculus Keratograph 5M; K5M) in participants with DED and non-DED controls. METHODS Participants with DED (Ocular Surface Disease Index score ≥20 and Oxford scale corneal staining ≥2) and controls (Ocular Surface Disease Index score ≤10 and corneal staining ≤1) attended two study visits. In part 1A of visit 1, baseline bulbar redness was graded with the VBR scale in each conjunctival quadrant of both eyes, followed by automated measurements of temporal and nasal redness with the K5M. This was immediately followed by part 1B, during which a topical vasoconstrictor was instilled into both eyes. Redness assessments were repeated 5 and 30 minutes after instillation with both instruments. Participants returned 14 days later for visit 2, where the same assessments as for visit 1A were repeated. RESULTS Seventy-four participants (50 DED and 24 controls) completed the study. There were statistically significant differences in redness between the DED and control groups when assessed with the VBR scale (14/16 comparisons; all, P < .05), whereas no significant differences in K5M-derived redness between the DED and non-DED groups were found at any location or time point. Both subjective and objective instruments detected statistically significant reductions in redness 5 and 30 minutes after instillation of the vasoconstrictor (all, P < .01). CONCLUSIONS Although both subjective and objective instruments were sensitive to detecting changes in redness induced by vasoconstriction, statistically significant differences in redness between DED and control groups were only found using the VBR scale.
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Affiliation(s)
- Marc-Matthias Schulze
- Centre for Ocular Research & Education (CORE), School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Alison Ng
- Centre for Ocular Research & Education (CORE), School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Mike Yang
- Centre for Ocular Research & Education (CORE), School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada
| | | | | | - Lyndon W Jones
- Centre for Ocular Research & Education (CORE), School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada
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Vianya-Estopa M, Nagra M, Cochrane A, Retallic N, Dunning D, Terry L, Lloyd A, Wolffsohn JS, Alderson A, Mouat G, McDonnell C, Murphy O, Huntjens B, Mayhem M, Martin E, Sweeney L, Evans K, Naroo S, Conway R, Simo L, Maldonado-Codina C, Mallon C, Underwood J, Trivedy K, Joshi M. Optimising subjective anterior eye grading precision. Cont Lens Anterior Eye 2020; 43:489-492. [DOI: 10.1016/j.clae.2020.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 03/11/2020] [Accepted: 03/11/2020] [Indexed: 10/24/2022]
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Begley C, Caffery B, Chalmers R, Situ P, Simpson T, Nelson JD. Review and analysis of grading scales for ocular surface staining. Ocul Surf 2019; 17:208-220. [PMID: 30654024 DOI: 10.1016/j.jtos.2019.01.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 01/08/2019] [Accepted: 01/10/2019] [Indexed: 11/29/2022]
Abstract
Vital dye staining has been used for over a century to assess the severity of ocular surface disease. However, despite common usage, a universally accepted "gold standard" grading scale does not exist for corneal and conjunctival staining, which can impact the ability to diagnose and monitor ocular surface conditions such as dry eye. The Food and Drug Administration (FDA) and other international regulatory agencies rely on ocular surface staining as a primary endpoint for new drug approvals, so that absence of a "gold standard" scale may affect approval of new drug treatments. To begin to address this problem, we review existing, published grading scales in an integrated fashion, highlighting their differences and similarities to emphasize common themes and the methods and elements that are important in creating a standardized scale. Our goal is to aid the field in moving towards an accepted standardized grading scale for ocular surface staining that can be applied in clinic and research settings for a variety of ocular conditions.
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Affiliation(s)
- Carolyn Begley
- Indiana University School of Optometry, Bloomington, IN, USA.
| | | | | | - Ping Situ
- Indiana University School of Optometry, Bloomington, IN, USA
| | - Trefford Simpson
- University of Waterloo, School of Optometry and Vision Science, Waterloo, ON, Canada
| | - J Daniel Nelson
- Department of Ophthalmology, HealthPartners Medical Group, Bloomington, MN, USA
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Pérez-Bartolomé F, Sanz-Pozo C, Martínez-de la Casa JM, Arriola-Villalobos P, Fernández-Pérez C, García-Feijoó J. Assessment of ocular redness measurements obtained with keratograph 5M and correlation with subjective grading scales. J Fr Ophtalmol 2018; 41:836-846. [PMID: 30293826 DOI: 10.1016/j.jfo.2018.03.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 03/20/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine correlations between ocular redness scores provided by the Keratograph 5M and those determined using two image-based grading scales. METHODS Observational prospective cross-sectional study. Two hundred and twenty six eyes of two hundred and twenty six participants (175 patients using anti-glaucoma eye drops and 51 subjects untreated). All subjects were scored automatically using the keratograph 5M. These redness scores (RS) were then correlated with the gradings provided by the Efron and McMonnies/Chapman-Davies scale (MC-D) scales (two observers). RESULTS Excellent reproducibility was observed for both the Efron (weighted K=0.897, 95% CI 0.823-0.904) and MC-D (weighted K=0.783, 95% CI 0.752-0.795) scales. Keratograph RS and the scores obtained with both Efron (Spearman's Rho=0.43, P<0.001) and MC-D (Spearman's Rho=0.48, P<0.001) scales were significantly correlated. RS for the bulbar and limbal - nasal and temporal quadrants also correlated moderately with the two subjective scales. Through Bland Altman analysis, poor agreement was detected between the objective and subjective methods: agreement values for the Efron scale or MC-D scale (matching scorers between observers) versus overall RS showed high biases (-15.58 and -22.05 respectively) and wide limits of agreement (LOA) (-46.169 to 15.005 and -52.534 to 8.19 respectively). Lowest bias was observed between temporal limbal RS and Observer 2 Efron score (-0.04). CONCLUSIONS Although it emerged as a reliable objective method, the keratograph 5M overestimated the scores compared with the subjective grading scales when used to grade the degree of ocular redness. Therefore, they should not be interchangeable methods.
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Affiliation(s)
- F Pérez-Bartolomé
- Department of Ophthalmology, Hospital Clínico San Carlos, Complutense University of Madrid, Prof. Martin Lagos Av, S/N, 28040 Madrid, Spain.
| | - C Sanz-Pozo
- Department of Ophthalmology, Hospital Clínico San Carlos, Complutense University of Madrid, Prof. Martin Lagos Av, S/N, 28040 Madrid, Spain
| | - J M Martínez-de la Casa
- Department of Ophthalmology, Hospital Clínico San Carlos, Complutense University of Madrid, Prof. Martin Lagos Av, S/N, 28040 Madrid, Spain
| | - P Arriola-Villalobos
- Department of Ophthalmology, Hospital Clínico San Carlos, Complutense University of Madrid, Prof. Martin Lagos Av, S/N, 28040 Madrid, Spain
| | - C Fernández-Pérez
- Department of Preventive Medicine, Hospital Clínico San Carlos, Complutense University of Madrid, Madrid, Spain
| | - J García-Feijoó
- Department of Ophthalmology, Hospital Clínico San Carlos, Complutense University of Madrid, Prof. Martin Lagos Av, S/N, 28040 Madrid, Spain
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9
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Macchi I, Bunya VY, Massaro-Giordano M, Stone RA, Maguire MG, Zheng Y, Chen M, Gee J, Smith E, Daniel E. A new scale for the assessment of conjunctival bulbar redness. Ocul Surf 2018; 16:436-440. [PMID: 29883738 PMCID: PMC6574084 DOI: 10.1016/j.jtos.2018.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 04/25/2018] [Accepted: 06/04/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE Current scales for assessment of bulbar conjunctival redness have limitations for evaluating digital images. We developed a scale suited for evaluating digital images and compared it to the Validated Bulbar Redness (VBR) scale. METHODS From a digital image database of 4889 color corrected bulbar conjunctival images, we identified 20 images with varied degrees of redness. These images, ten each of nasal and temporal views, constitute the Digital Bulbar Redness (DBR) scale. The chromaticity of these images was assessed with an established image processing algorithm. Using 100 unique, randomly selected images from the database, three trained, non-physician graders applied the DBR scale and printed VBR scale. Agreement was assessed with weighted Kappa statistics (Kw). RESULTS The DBR scale scores provide linear increments of 10 from 10-100 when redness is measured objectively with an established image processing algorithm. Exact agreement of all graders was 38% and agreement with no more than a difference of ten units between graders was 91%. Kw for agreement between any two graders ranged from 0.57 to 0.73 for the DBR scale and from 0.38 to 0.66 for the VBR scale. The DBR scale allowed direct comparison of digital to digital images, could be used in dim lighting, had both temporal and nasal conjunctival reference images, and permitted viewing reference and test images at the same magnification. CONCLUSION The novel DBR scale, with its objective linear chromatic steps, demonstrated improved reproducibility, fewer visualization artifacts and improved ease of use over the VBR scale for assessing conjunctival redness.
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Affiliation(s)
- Ilaria Macchi
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA; Department of Ophthalmology, University Campus Biomedico, Rome, Italy
| | - Vatinee Y Bunya
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Richard A Stone
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Maureen G Maguire
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Yuanjie Zheng
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA; School of Information Science and Engineering, Shandong Normal University, China; Shandong Normal University, School of Information Science and Engineering, Key Lab of Intelligent Computing & Information Security in Universities of Shandong, Institute of Life Sciences, Shandong Provincial Key Laboratory for Distributed Computer Software Novel Technology, Key Lab of Intelligent Information Processing, Jinan, 250358, China
| | - Min Chen
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - James Gee
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Institute of Translational Medicine and Therapeutics, University of Pennsylvania, Philadelphia, PA, USA
| | - Eli Smith
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Ebenezer Daniel
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA.
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Abstract
PURPOSE This study was conducted to determine blood flow velocities and corresponding vessel diameters to characterize the response of the bulbar conjunctival microvasculature to contact lens wear. METHODS A functional slit-lamp biomicroscope (FSLB), an adapted traditional slitlamp, was used to image the temporal bulbar conjunctiva of 22 healthy subjects before and after 6 hr of contact lens wear. All of the measurable venules on the conjunctiva were processed to yield vessel diameters and blood flow velocities. RESULTS The average blood flow velocity increased from 0.51±0.20 to 0.65±0.22 mm/sec (P<0.001) after 6 hr of lens wear. The blood flow velocity distribution showed a velocity increase that correlated with the vessel diameter increase from the baseline (r=0.826, P<0.05). This pattern maintained a similar trend after 6 hr of lens wear (r=0.925, P<0.05), and increased velocities were found across all of the vessel diameter ranges (P<0.001). CONCLUSIONS Blood flow velocity increases across all of the vessel diameter ranges in response to contact lens wear. Functional slitlamp biomicroscope is capable of characterizing the bulbar microvascular response to contact lens wear.
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Abstract
PURPOSE To compare live and photographic (still) grades of corneal staining of the same eyes and the repeatability of grading between two investigators. METHODS Thirty patients were recruited to participate in a contact lens study, and their level of corneal staining was graded by two investigators in situ (live images), using slit lamp biomicroscopy. Digital still images of the corneal staining were also captured during the study visits. An independent observer selected 105 of the still images graded by investigator 1 and another 105 images graded by investigator 2 and presented them to the original investigator in a random order, on three separate occasions. Grading was performed at the time of the live grading and the three still image sessions, using the Centre for Contact Lens Research corneal staining scale that combines grades of both extent and type to provide an overall "global staining score" from 0 to 10,000 for corneal staining. A comparison was made between live and still grades as well as the intrainvestigator repeatability for the multiple grading of the still images. RESULTS The mean (±SD) of corneal staining grades recorded for the same eyes examined live and then later on three occasions was 1795 (±1083) and 714 (±974), respectively, for participants examined by investigator 1 (p < 0.001) and 1854 (±1075) and 461 (±411) for those examined by investigator 2 (p < 0.001). There was a significant difference over the three repeated still grading sessions for each investigator (p < 0.001), although there was a high degree of consistency among the three still grading sessions for each of the investigators: the intraclass correlation for investigator 1 was 0.91 (confidence interval, 0.87 to 0.93) and that for investigator 2 was 0.82 (confidence interval, 0.77 to 0.87). DISCUSSION Digital still image grading of corneal staining significantly underrepresented the amount of corneal staining observed through a slit lamp. Clinical investigators graded corneal staining with a high degree of consistency.
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Abstract
PURPOSE This study evaluates the relationship between bulbar hyperemia, conjunctival staining, lens comfort and 3- and 9-o'clock corneal staining in rigid gas permeable (GP) contact lens wear. METHODS The study involved 55 GP contact lens wearers (with and without 3- and 9-o'clock staining) and 26 non-lens wearers. Corneal staining was graded based on a specially designed image grading scale developed at the University of Maastricht. The Efron grading scale was used to grade bulbar hyperemia and conjunctival staining. Ocular comfort and lens comfort were analyzed using a visual analogue scale (VAS) and a questionnaire to differentiate symptomatic from asymptomatic subjects. RESULTS Bulbar hyperemia showed a significant but low correlation with corneal staining, and eyes with conjunctival staining showed more corneal staining than eyes without conjunctival staining. No correlation was found between staining in the nasal and temporal regions of the cornea in subjects with substantial 3- and 9-o'clock staining. No correlation was found between VAS comfort scores and corneal staining. In those subjects with substantial 3- and 9-o'clock staining, symptomatic subjects showed more corneal staining than asymptomatic subjects. CONCLUSIONS Practitioners are advised to evaluate both the nasal and temporal regions of the cornea when assessing 3- and 9-o'clock staining, and they should be hesitant to rely on the amount of bulbar hyperemia for the prediction of the severity of 3- and 9-o'clock staining. Assessment of conjunctival staining could potentially be a useful tool in clinical practice to identify patients at risk of developing 3- and 9-o'clock staining. The lack of correlation between corneal staining and lens comfort stresses the need for regular contact lens check-ups in GP lens wearers. It appears that the simple registration of the presence or absence of ocular symptoms is a better predictor of 3- and 9-o'clock staining than using VAS comfort scores.
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Abstract
PURPOSE To investigate the effect of observation time on the precision of grading the severity of contact lens complications. METHODS Twenty-five optometry students used the Efron Grading Scales for Contact Lens Complications to grade the severity of one image of each of the 16 forms of anterior eye pathology depicted in the Efron scales. This procedure was repeated for observation times of 0.1, 2, and 60 s. RESULTS Overall, significantly greater grading precision (smaller standard deviation of mean grades) was demonstrated for longer observation times (p < 0.004); however, certain complications appear to require longer observation times for precise grading. There was a highly significant dependence of the mean grade on image (p < 0.0001), observation time (p < 0.0001), and observation time-image interaction (p < 0.0001). CONCLUSIONS Overall, a brief viewing time of a few seconds is typically all that is required for precise grading of ocular complications of contact lens wear. Some forms of pathology are more complex and may require more time to grade precisely.
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Pult H, Murphy PJ, Purslow C, Nyman J, Woods RL. Limbal and Bulbar Hyperaemia in Normal Eyes. Ophthalmic Physiol Opt 2008; 28:13-20. [DOI: 10.1111/j.1475-1313.2007.00534.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
BACKGROUND This study was conducted to investigate grading performance when estimating the severity of static versus dynamic images of contact lens-related ocular pathology. METHODS Thirty-eight subjects used the Efron Grading Scales for Contact Lens Complications to grade the severity of ocular pathological changes depicted in static and dynamic (movie clip) computer-displayed images of each of the following contact lens complications: bulbar conjunctival redness, limbal redness, papillary conjunctivitis, corneal staining, corneal infiltrates and meibomian gland dysfunction. The viewing of static and dynamic images was separated by seven weeks. RESULTS Grades assigned to dynamic images were 0.6 and 0.7 grading scale units higher than those assigned to static images for limbal redness and papillary conjunctivitis, respectively (p < 0.0001 for both). No difference was observed for the other four complications. There was an apparent trend for grading variability to be reduced (that is, observers grading in closer agreement) when grading dynamic versus static images. CONCLUSIONS Absolute grades based on an assessment of signs of pathology represented in static images may, in some instances, underestimate the true severity of the condition.
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Affiliation(s)
- Nathan Efron
- Institute of Health and Biomedical Innovation and School of Optometry, Queensland University of Technology, Queensland, Australia.
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18
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Murphy PJ, Lau JSC, Sim MML, Woods RL. How red is a white eye? Clinical grading of normal conjunctival hyperaemia. Eye (Lond) 2006; 21:633-8. [PMID: 16518366 DOI: 10.1038/sj.eye.6702295] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To quantify the level of normal bulbar conjunctival hyperaemia using the Cornea and Contact Lens Research Unit (CCLRU) grading scale, and to investigate inter-observer agreement. METHODS Bulbar conjunctival hyperaemia was assessed by two trained observers, using the CCLRU grading scale (zero to four units) interpolated into 0.1 increments, on the right eye of 121 healthy, non-contact lens-wearing subjects (male=58, female=63, median age=28 years, range 16-77). The eye was observed using a slit-lamp bio-microscope (x 10 magnification) under diffuse, white illumination. The subject's position of gaze was directed to allow grading of four quadrants: superior, nasal, inferior, and temporal conjunctiva. Bulbar redness was defined as the average of those four grades of conjunctival hyperaemia. A further twenty subjects were recruited to assess inter-observer agreement (male=8, female=12, median age=23 years). RESULTS The average bulbar redness was 1.93 (+/-0.32 SD) units. The nasal (2.3+/-0.4) and temporal (2.1+/-0.4) quadrants were significantly redder than the superior (1.6+/-0.4) and inferior (1.7+/-0.4) quadrants (P<0.0001). Males had redder eyes than females by 0.2 units. Inter-observer 95% limits of agreement for bulbar redness was 0.38 units. CONCLUSIONS The average bulbar redness of 1.9 units was higher than expected, reflecting the design of the grading scale. A bulbar redness of greater than 2.6 units may be considered abnormal, and a change in bulbar redness of > or =0.4 units may be significant.
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Affiliation(s)
- P J Murphy
- Cardiff University, School of Optometry and Vision Sciences, Cardiff, UK.
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19
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Efron N, Morgan PB, Farmer C, Furuborg J, Struk R, Carney LG. Experience and training as determinants of grading reliability when assessing the severity of contact lens complications. Ophthalmic Physiol Opt 2003; 23:119-24. [PMID: 12641699 DOI: 10.1046/j.1475-1313.2003.00096.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE A study was conducted to investigate the influence of experience and training on grading reliability when assessing the severity of contact lens complications. METHODS Twenty-three optometry students who were unfamiliar with the use of grading scales each used the Efron Grading Tutor computer program to ascertain grading reliability at an 'initial' experimental session and a 'final' session 3 weeks later. Twelve subjects (the 'trained' group) were given a tutorial on grading techniques and were asked to complete two grading exercises between the initial and final sessions. The other 11 subjects (the 'untrained' group) received no such training between the two sessions. Differences in grading reliability between the initial and final grading sessions were evaluated. RESULTS Grading reliability was superior (lower) for the combined subject cohort at the final session (mean +/- standard deviation 0.33 +/- 0.12) compared with the initial session (0.46 +/- 0.25) (p = 0.004). However, there was no difference in the improvement in grading reliability between the two groups. CONCLUSIONS Grading reliability improves statistically with some experience, although perhaps not to a clinically meaningful extent. No added benefit can be derived from supplemental training.
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Affiliation(s)
- Nathan Efron
- Eurolens Research, Department of Optometry and Neuroscience, UMIST, P.O. Box 88, Manchester M60 1QD, UK.
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Efron N, Morgan PB, Jagpal R. The combined influence of knowledge, training and experience when grading contact lens complications. Ophthalmic Physiol Opt 2003; 23:79-85. [PMID: 12535060 DOI: 10.1046/j.1475-1313.2003.00091.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE A study was conducted to evaluate the influence of knowledge, training and experience (clinical skills set) when assessing the severity of contact lens complications. METHODS Nine optometrists (who were in possession of a relevant clinical skills set) and nine 'non-optometrists' (subjects without the clinical skills set) were each invited to grade - to the nearest 0.1 increment - an image of each of 16 contact lens complications using Efron Grading Scales for Contact Lens Complications. This procedure was repeated 2 weeks later, yielding a total data base comprising 576 individual grading estimates. RESULTS The mean of the test and retest grading estimates was the same for the optometrists (2.8 +/- 0.7) and the non-optometrists (2.6 +/- 0.9) (F1,15,1 = 1.3, p = 0.26); that is, non-optometrists can grade accurately. Median grading reliability for optometrists (+/-0.41) was lower than (i.e. superior to) that for non-optometrists (+/-0.67) (p = 0.001). Non-optometrists tended to display a reluctance to grade by interpolation and to less reliably grade subtle clinical signs. CONCLUSIONS When averaged over several attempts, non-optometrists will arrive at similar estimates of severity to optometrists when grading ocular complications of contact lens wear; however, they will do so less reliably. The relative contribution of the three attributes of the clinical skills set to grading performance is presently unclear.
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Affiliation(s)
- Nathan Efron
- Department of Optometry and Neuroscience, UMIST, Manchester, UK.
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