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Priscilla Mathewson, Geraint Williams, Paul Tomlins, Sai Kolli, Philip Murray, Saaeha Rauz; A Modified Delphi Technique to Obtain Consensus on the Scoring of Ocular Surface Disease Damage and Activity Indices. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5418.
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Agreement on scoring for Ocular Surface Disease (OSD) is essential for robust clinical documentation to support translational clinical trials and comparative cohort studies. To date, there are no universally agreed scoring tools for OSD. The aim of our study is to adopt a modified Delphi technique to develop an OSD Activity and Damage Index in the United Kingdom (UK). The first step in this process is establishing an expert steering group to identify measurable disease parameters for future consensus.
Sixteen OSD specialists were invited to participate in an anonymysed online questionnaire. Panelists were selected to represent a cross-section of UK cornea and OSD experts from the Bowman Club (UK), the National Corneal Consultant Specialists Group. The questionnaire consisted of an itemization of possible clinical parameters for inclusion in a scoring tool, derived from literature review and modification of existing scoring systems. Panelists were invited to consider whether each entity should be included, and whether the grading should be categorical, binary, ordinal or continuous. Participants were encouraged to suggest additional variables for inclusion in the scoring system. Thirteen of the selected panelists responded to the questionnaire and eleven were available to convene for a Steering Group discussion of results.
Seventy-six clinical parameters subdivided into five clinical domains, (tear film; eyelids, lid margins and meibomian glands; conjunctiva and fornices; cornea; anterior chamber and sclera) were included in the questionnaire. The Group ballot ‘included’ the majority of proposed indices, with highest agreement in the fornix subset versus the tear film (lowest). Parameters with >92% agreement for inclusion into a proposed OSD scoring tool are illustrated in the image. The distribution of preferred grading scales shows that ordinal scales were most prevalent.
The preliminary stages of the modified Delphi technique to gain a UK consensus on an OSD AI and DI scoring tool, reveal broad agreement amongst selected specialists. The next step is to assimilate these data for distribution to the wider Bowman Club, for a second anonymous online questionnaire designed to both substantiate the identified disease parameters, and to indicate which indices constitute activity or damage prior to embarking on a full clinical validation process.
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