Contact Lenses Grading Scales. Etiology. Normal grade. Comment. Bulbar redness. Dilation of bulbar vessels, e.g. due to mechanical stimulation. CCLRU O GRADING SCALES. CCLRU. SCCLRU. BULBAR REDNESS. SLIGHT. 2. SLIGHT. 3. MODERATE. SEVERE. OCCLRU. LIMBAL. Eye care professionals: See the Efron Grading Scales for a standard clinical reference for describing the severity of 16 contact lens complications.

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Two important recent studies help us to reach a more standardised approach. They conclude that grading scales that are too coarse generally allow less sensitivity cclrh the detection of meaningful clinical changes. This study again highlights the high repeatability of image analysis techniques and their ability to assess a range of indicators of anterior ocular physiology.

Arch Ophthalmol ; Whilst Efron overcomes these difficulties by encouraging artistic clarity and licence so as to emphasise and isolate the condition that is being evaluated, it is considered by some a departure from the real life situation in as much as different conditions feed and depend on each other and, therefore, occur simultaneously and should appear as such in a single image.

Researchers have examined the repeatability of discrete and continuous anterior segment grading. A second study was by Efron et al.


Curr Eye Res ; This is difficult for software to achieve accurately. Int Contact Lens Clinics ; Ccldu to choose a lab Looking at labs: Grading scales are well established as aids to assist in the monitoring of anterior eye characteristics. Staining can differ in intensity dependent on factors such as the amount of fluorescein instilled, tear film production and drainage, gradin of the woundarea, shape, and segmentation. Analysis of microvascular network in bulbar conjunctiva by image processing.

A modern grading scale adapted for smartphone use. Examples of more recently introduced grading scales.

Incremental nature of anterior eye grading scales determined by objective image analysis

Individually, our grading is repeatable, so we should continue to use the scales in the way we are doing grafing. Compared with reported values of clinician subjective grading variability using these grading scales, 7, 9, 12, 15 image analysis techniques are approximately 6—35 times more repeatable, with a sensitivity of 2. Approaches to this challenge are still emerging and further developments in this area are anticipated. Both clinical grading scales have been published in prominent textbooks and widely distributed around the scalea, free of charge, by several major contact lens companies.

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Clinical grading and the effects of scaling. Palpebral hyperaemia scale images were well described by colour extraction techniques.

The objective grading of ocular redness involves judgement of both the hue and vessel size, relative to the gradingg under question. Automatic quantitative measurement of ocular hyperaemia.

Another concern with existing clinical grading scales is that they do not cover all possible clinical appearances, particularly at the severe end of the scale, and that they may not be linear. Guillon MShah D. These image analysis techniques have been used to try to cflru how clinicians grade bulbar hyperaemia, with one study suggesting that the number of vessels and the proportion of the image occupied by vessels are more important than relative colouration 15 whereas another indicated both these factors were integral to grading.

The app enables levels of severity to be compared side-by-side in 0. Table 1 summarises the benefits. The view expressed by a small minority of optometrists was that grading scales constitute an unreliable or inaccurate method of recording clinical data is contrary to published evidence. They also believe that increasing the number of intervals to make the grading scale finer may reduce the degree of concordance between repeated measurements of the same clinical event.

The objective computer image analysis grading techniques used in these studies have not yet been generally used in clinical practice. Edge detection filled symbols and relative green colouration closed symbols with grading scale images of corneal staining. Vistakon-Synoptik palpebral conjunctivitis images were analysed selecting the palpebral hyperaemia and the area with reflections separately to distinguish between hyperaemia and roughness.


The latter consists of a series of artist illustrated depictions of 16 different conditions, while the former comprises photographs cxlru 6 conditions, two of gtading are presented graidng multiple manifestations. Social media and SEO success. Although computers and slit lamp biomicroscope cameras are becoming more common in hospitals and eye care practices, printed grading scales have the ccldu of being inexpensive and portable. There was no significant difference in discrimination between edge detection and colour extraction for ggrading of the grading scales 2.

Incremental nature of anterior eye grading scales determined by objective image analysis

Author information Article notes Copyright and License information Disclaimer. Editor’s choice Look local: CLAO J ; Word description, sketches and grading scales were used more for recording the anterior eye health of contact lens wearers than other patients, but photography was used by a similar number.

The response rate was 31 per cent. All the staining extent scales analysed, except the Vistakon-Synoptik scale, depicted more than one type of staining and therefore assessing the ability of image analysis measures to determine the severity of staining is complicated.

Lies, statistics, and clinical significance. A novel grading method for superficial punctate keratopathy magnitude and its correlation with corneal epithelial permeability.

As most eyes only have minimal hyperaemia and corneal staining 14, 23, 24 this approach to grading scale design could be considered appropriate, but could lead to errors if clinicians cc,ru between scale grade images to improve sensitivity.

Highlighting the papillae with fluorescein would appear a more appropriate method for determining palpebral roughness as previously described, 25, 26 causing an increase in edges detected and a decrease in the fluorescein coverage, despite an apparent decrease in severity with the highest CCLRU scale grade.

Quantitative slit lamp observations in contact lens practice. Image analysis discrimination was described by the standard deviation of repeated measures divided by the scale range.