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J. M. Kruger, S. Frenkel, A. Solomon; A Novel Slit Beam-Based Scoring System for Evaluating Conjunctival Hyperemia. Invest. Ophthalmol. Vis. Sci. 2010;51(13):2386.
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A number of scoring systems have been developed to grade bulbar conjunctival hyperemia. They rely, however, on accessories such as reference charts or digital analysis software, and their utility in clinical practice is therefore limited. To address this issue, we have developed a simple quantitative technique in which the slit-lamp beam is used to randomly sample points on the ocular surface.
Ten ophthalmology residents were asked to evaluate three computer generated drawings representing varying degrees of conjunctival hyperemia (mild, moderate, severe). The slit-lamp beam was focused on the center of the image and adjusted to the narrowest visible width. The points immediately adjacent to the two tips of the beam were assessed for the presence of a vessel. Twenty-four points were randomly sampled by placing the beam in four orientations (0, 45, 90, and 135 degrees) with three different lengths in each orientation. The overall score was converted to a percentage. The participants were asked to assess the technical difficulty of the technique on a 5-point Likert scale. Prior to performing the technique, the participants were asked to provide their own estimations of the degree of injection (defined as the percentage of the ocular surface area occupied by vessels).
Residents were able to use the proposed technique to discriminate between the three degrees of conjunctival injection (ANOVA p-value < 0.0001, F Ratio 48.9). The consistency of the proposed scoring system was superior to the resident’s subjective estimations of bulbar hyperemia (average standard deviations of 11 and 15.6% respectively). All 10 participants rated the technique as easy to perform (5 selected "extremely easy", 5 selected "relatively easy").
We have described a technique for using the slit-lamp beam to quantify the degree of bulbar injection. Our results suggest that the technique is reliable and easy to perform. It may therefore serve as a useful clinical tool for assessing and monitoring bulbar hyperemia.
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