June 2021
Volume 62, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2021
Inter and intra-observer variabilities in the measurement of aqueous flare with a custom-made ocular spot fluorometer
Author Affiliations & Notes
  • Sirisha Tadepalli
    Department of Electronics and Communication Engineering, Amrita Vishwa Vidyapeetham Amrita School of Engineering Bengaluru, Bengaluru, Karnataka, India
  • Hadiya Farhath Pattan
    Department of Cornea and Refractive Surgery, Sankara Nethralaya, Chennai, Tamil Nadu, India
  • Bongoni Vishwanath
    Department of Cornea and Refractive Surgery, Sankara Nethralaya, Chennai, Tamil Nadu, India
  • Prema Padmanabhan
    Department of Cornea and Refractive Surgery, Sankara Nethralaya, Chennai, Tamil Nadu, India
  • Rachapalle Reddi Sudhir
    Department of Cornea and Refractive Surgery, Sankara Nethralaya, Chennai, Tamil Nadu, India
  • Surekha Paneerselvam
    Department of Electrical and Electronics Engineering, Amrita Vishwa Vidyapeetham Amrita School of Engineering Bengaluru, Bengaluru, Karnataka, India
  • Abhilash Ravi Kumar
    Department of Electronics and Communication Engineering, Amrita Vishwa Vidyapeetham Amrita School of Engineering Bengaluru, Bengaluru, Karnataka, India
  • Jyotirmay Biswas
    Department of Cornea and Refractive Surgery, Sankara Nethralaya, Chennai, Tamil Nadu, India
  • Sangly P Srinivas
    School of Optometry, Indiana University Bloomington, Bloomington, Indiana, United States
  • Footnotes
    Commercial Relationships   Sirisha Tadepalli, None; Hadiya Farhath Pattan, None; Bongoni Vishwanath, None; Prema Padmanabhan, None; Rachapalle Reddi Sudhir, None; Surekha Paneerselvam, None; Abhilash Ravi Kumar, None; Jyotirmay Biswas, None; Sangly Srinivas, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2021, Vol.62, 1426. doi:
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      Sirisha Tadepalli, Hadiya Farhath Pattan, Bongoni Vishwanath, Prema Padmanabhan, Rachapalle Reddi Sudhir, Surekha Paneerselvam, Abhilash Ravi Kumar, Jyotirmay Biswas, Sangly P Srinivas; Inter and intra-observer variabilities in the measurement of aqueous flare with a custom-made ocular spot fluorometer. Invest. Ophthalmol. Vis. Sci. 2021;62(8):1426.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : In our previous study, the intensity of light scatter (ILS) from the anterior chamber was measured in cataract subjects as a measure of aqueous flare using a custom-made ocular fluorometer (TVST; 2018). While the data was sensitive, we observed a poor correlation between ILS and SUN grades for patients with mild to moderate inflammation (i.e., SUN grades 0 and 1+). To further explore the variability, we are continuing to establish the repeatability and reproducibility of ILS in uveitis patients.

Methods : Uveitis (n = 111; with SUN scores of 0 to 2+) and healthy subjects (n = 93) were included in the study. One clinician performed SUN grading. For repeatability, ILS was measured twice by the same observer. For reproducibility, ILS was recorded by two observers. We calculated the intra-observer variability (expressed as the repeatability coefficient (Rc)) and intra-class correlation coefficient (ICC) to assess intra- and inter-observer variability. The latter was further analyzed by Bland- Altman (BA) plots.

Results : The intra-observer measurements in healthy subjects revealed no statistical difference in the mean ILS (0.1480 ± 0.0700 mV; n = 93; p > 0.98). The corresponding within-subject standard deviation (Sw) is 0.0272 mV, which corresponds to a repeatability coefficient (Rc) of 0.0754 mV (= 2.77 * Sw). Uveitis patients with SUN scores of 2+ showed much higher ILS (0.3740 ± 0.1090 mV; n = 5) with Sw = 0.0418 mV, and Rc of 0.1159 mV. The inter-observer analysis with uveitis patients (n = 72 for SUN 0 and n = 8 for SUN 1) revealed an ICC of 0.63 and 0.95 for measurements with SUN grades 0 and 1, respectively. In healthy subjects (SUN grade 0), ICC was 0.73 (n = 76). Corresponding Bland-Altman plot analysis in uveitis subjects indicated 0.0044 mV and 0.0046 mV as the difference between the mean ILS between observers for SUN grades 0 and 1, respectively.

Conclusions : ILS in control and uveitis are ~ 6 and ~ 9 times larger than the maximum of Sw, respectively. The lowest inter-observer variability in ILS measurement is ICC > 0.6 in both healthy and uveitis patients. Thus, ILS measurements using the fluorometer are highly reliable and can be employed to provide a higher granularity in recording aqueous flare. Thus, we attribute the apparent variability in ILS of uveitis patients with 0 and 1+ to SUN scores' subjective grading.

This is a 2021 ARVO Annual Meeting abstract.

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