Objective
This study evaluated the performance of a standardized grading system for scleritis using standard digital photographs.
Design
Cross-sectional inter-observer agreement study
Participants
Photo archives from the National Eye Institute (NEI)
Methods
Three uveitis specialists from 3 different centers graded 79 randomly arranged images of the sclera with various degrees of inflammation. Grading was done using standard screen resolution (1024 × 768 pixels) on a 0 to 4+ scale, in two sessions: first, without using reference photographs; then with reference to a set of standard photographs (proposed grading system). The graders were masked to the order of images and the order of images was randomized. Inter-observer agreement in grading the severity of inflammation with and without the use of grading system was evaluated.
Main Outcome Measures
Inter-observer agreement
Results
The proposed grading system for assessing activity in scleritis demonstrated a good inter-observer agreement. Inter-observer agreement (pooled κ) was poor (0.289) without photographic guidance and improved substantially when the “grading system” utilizing standardized photographs was used (κ = 0.603).
Conclusion
Utilizing this system of standardized images for scleritis grading provides significantly more consistent grading of scleral inflammation in this study and has clear applications in clinical settings as well as in clinical research.
Progressive macular changes, including atrophy and fibrosis can occur in crystalline retinopathy, secondary to hyperoxaluria, after combined hepatorenal transplant.
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