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Alex Bedolla, Tyler Brown, Brittany Chung, Jyotsna Maram, Yue Shi, Srinivas Sadda, Olivia L Lee; Application of conjunctival hyperemia severity scale to assess color photographs of eyes with pterygia. Invest. Ophthalmol. Vis. Sci. 2020;61(7):491.
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© ARVO (1962-2015); The Authors (2016-present)
Assess the performance of a scale to assess conjunctival hyperemia in eyes with pterygium based on standard color photography.
Two certified and masked graders used the hyperemia scale to assess pterygium on primary gaze flash color photo images (Canfield Scientific, Inc., Fairfield, NJ) previously taken from 152 eyes and available at the reading center. Each image was assigned a hyperemia severity, allowing for half-step (“0.5”) severity scores. This scale classifies conjunctival hyperemia into 5 severities: None (0), Trace (1), Mild (2), Moderate (3), and Severe (4). These levels on the scale were defined as follows. None (0): Normal Conjunctival vessels without engorgement. Trace (1): Trace flush, reddish pink, minimally dilated blood vessels of slightly increased density with normal underlying sclera easily visible. Mild (2): mild flush, reddish pink, mildly increased density of dilated deep blood vessels and pink appearance of the sclera. Moderate (3): bright red color, with significantly tortuous and engorged deep blood vessels and minimal white scleral tissue visible between. Severe (4): deep bright diffuse redness, dense network of engorged vessels and no normal white scleral tissue visible beneath. A random subset of 35 images was re-evaluated by one of the graders to test reproducibility. Kappa analysis was performed to evaluate the intra- and inter- grader reproducibility.
Among the 152 eyes, 151 eyes with pterygia were analyzable using the described scale with all 5 severities represented. All eyes in the dataset included nasal pterygium and in the nasal hyperemia grading there was exact agreement between graders in 50.66% of cases, and agreement within one-step in 88.16%. For intra-grader reproducibility, the weighted Kappa for global, nasal, and temporal quadrants was 1, 0.944, and 1. For inter-grader reproducibility, the weighted Kappa for global, nasal, and temporal quadrants was 0.864, 0.784, and 0.881.
Using a standardized grading scale and flash color photography (with a simple set focus camera), the severity of conjunctival hyperemia in eyes with pterygium could be assessed with a high-level of reproducibility. This scale may be useful clinical research and clinical trials of pterygia.
This is a 2020 ARVO Annual Meeting abstract.
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