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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Please review our privacy policy. This article has been cited by other articles in PMC. Practitioners must record the grading scale used, and ideally standardise this within an individual practice or corporate groups. Objective measurement of contact-lens induced conjunctival redness.

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

Indeed it is estimated that overcopies of these scales — usually in the form of laminated A4 reference cards but also in large poster format — have been provided to practitioners in the past 20 years.

Clinical grading scales Closing Date: Image analysis of conjunctival hyperaemia: Approaches to this challenge are still emerging and further developments in this area are anticipated. 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. Although the difference is again within the variability of clinical grading 7 and relative change will govern clinical decision making, individual grading strategies will increase the variance between individuals, and hence decrease the statistical power of clinical research studies or the ability of clinicians to monitor small changes over time.

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C42682: Clinical grading scales

Curr Eye Res ; Image analysis of a particular feature may require the assessment of a number of characteristics to provide a more simplistic condition grade, comparable with although having better repeatability and sensitivity than subjective techniques. Support Center Support Center. This results in the lower end of the scale being more sensitive a smaller change between grades than the upper end of the scale.

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Edge detection filled symbols and relative green colouration closed symbols with grading scale images of corneal staining. What we are not that good at, however, is being consistent with our colleagues. Image analysis discrimination was described by the standard deviation of repeated measures divided by the scale range. Increments of scales used.

Most practitioners graded to the nearest whole unit Computerised grading — note the slider at the bottom of the screen allowing easy adjustments of severity. The increments of the grading scales were best described by a quadratic rather than a linear function. To examine the incremental nature of the Annunziato, 29 Efron Millennium Edition9 and Vistakon-Synoptik 4 grading scales, the gradding images of bulbar hyperaemia, palpebral hyperaemia also referred to as papillary conjunctivitisand corneal staining scalez were scanned at dpi stored in tagged image format TIFF and analysed.

The response rate was 31 per cent. Accepted Mar Grading scale grades ccpru not interchangeable, with scales starting either at grade 0 or 1 and with a wide range of values for the highest grade.

In the future, image analysis techniques could allow grading of real time or stored images and comparison with population norms without incurring the limitation of photographic or pictorial subjective grading.

Validation of grading grasing for contact lens complications. By grading to decimal places that are representative of points in between two successive integer points on the scale, 1. Variability of clinical researchers in contact lens research. 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.


Scalss grading and the effects of scaling. Therefore an epithelial scratch, punctate staining, and confluent ulceration could all have similar intensity of green colouration and edge detected area.

Vistakon-Synoptik palpebral conjunctivitis images were analysed selecting the palpebral hyperaemia and the area with reflections separately to distinguish between hyperaemia and roughness.

Both clinical grading scales have been published in prominent textbooks and widely distributed around the world, free of charge, by several major contact lens companies.

Slit lamp classification system. Individually, our grading is repeatable, so we should continue to use the scales in the way we are doing now. Edge detection filled symbols and relative red colouration open symbols with grading scale images of bulbar hyperaemia. The occasional apparent reversal in severity in several of the scales could arise from deficiencies in the scale images, such as the lack of an appropriate photographic image taken with similar perspective and illumination or from scale designers considering a range of feature characteristics to assess the grade of an image.

A second study was by Efron et al.

Image analysis techniques are 6—35 times more repeatable than subjective grading, with a sensitivity zcales 1. A new computer assisted objective method for quantifying vascular changes of the bulbar conjunctivae. Communication at the heart of it all. More recently computerised image analysis techniques have been used for grading anterior eye characteristics.

This is perhaps not surprising, given that these are common complications often related to patient symptoms and also the subject of extensive discussion in the literature and at conferences.