Purchase this article with an account.
D.A. Berntsen, G.L. Mitchell, J.J. Nichols; Reliability of Grading Lissamine Green Conjunctival Staining . Invest. Ophthalmol. Vis. Sci. 2005;46(13):2671.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Purpose: To assess the reliability of a lissamine green grading scale for conjunctival images. Methods: A 20 second video clip of the right eye of 288 contact lens wearers was recorded using a digital slip lamp camera system after instilling 10 µL of lissamine green. Optimal nasal and temporal still images from each patient’s video clip were selected for grading. A masked grader used the Oxford grading scale to grade the temporal and nasal images on two occasions separated by 1 week to determine within–grader reliability. A second masked grader graded each image on one occasion to assess between–grader reliability. Simple kappa statistics and 95% confidence intervals (95% CI) were used to determine the test–retest reliability both within– and between–graders overall and stratified based on the staining severity score from grader 1 at reading 1 (non–diseased = grades 0–2 vs. diseased = grades 3–5). Results:Of the 288 video clips, 284 nasal and 285 temporal images were obtained that were gradable and used in the analyses. The average age of the sample was 31.0 ± 11.3 years and 65% were female. There was substantial within–grader reliability for both the nasal (Kappa = 0.69, 95% CI = 0.63 to 0.75) and the temporal (Kappa = 0.73, 95% CI=0.67 to 0.79) images. There was moderate between–grader reliability for both the nasal (Kappa=0.51, 95% CI=0.44 to 0.58) and the temporal (Kappa=0.51, 95% CI=0.44 to 0.58) images. When staining severity was considered, within–grader reliability was moderate–to–substantial for diseased eyes (Kappanasal = 0.55, 95% CI = 0.42 to 0.68; Kappatemporal = 0.48, 95% CI = 0.30 to 0.66) and non–diseased eyes (Kappanasal = 0.66, 95% CI = 0.56 to 0.75; Kappatemporal = 0.74, 95%CI = 0.67 to 0.81). The kappa values from the temporal region were significantly different (p = 0.01) while the nasal region comparison did not differ (p = 0.19). Between–grader reliability was fair–to–moderate for diseased eyes (Kappanasal = 0.33, 95% CI = 0.21 to 0.44; Kappatemporal = 0.34, 95% CI = 0.18 to 0.50) and non–diseased eyes (Kappanasal = 0.50, 95% CI = 0.40 to 0.60; Kappatemporal = 0.47, 95% CI = 0.38 to 0.56). The kappa values from the nasal region were significantly different (p = 0.03) while the temporal region comparison did not differ (p = 0.17). Conclusions: Within– and between–grader reliability of lissamine green staining appears to be at least substantial–to–moderate, although it appears that the extent of conjunctival staining impacts this reliability.
This PDF is available to Subscribers Only