Clinical grading of corneal staining of non-contact lens wearers

Abstract

Summary To distinguish normal from pathological corneal fluorescein staining requires knowledge of background levels of staining among otherwise healthy individuals. Corneal staining of 102 non‐contact lens wearing subjects was assessed using a photographic grading scale that uses a generic (0 to 4) scale to score corneal staining. Some degree of corneal staining was found on 79% of the corneas. Low inter‐observer variability suggests that the corneal staining grading scale can be used successfully with decimal rather than integer scale increments.

Limbal and Bulbar Hyperaemia in Normal Eyes

“…The observers were instructed that, if they considered the ocular hyperaemia to be less than grade 1, they should attempt to grade between the pictured grade 1 and an imagined perfectly white eye, which would represent grade 0. The ability to extrapolate CCLRU grading scales has been demonstrated in previous studies (Dundas et al. , 2001; Mackinven et al.…”

“…, 2007) have shown that the normal ocular appearance is not necessarily the lowest level on a grading‐scale, nor is the grading scale level the same for each clinical appearance. As shown in , corneal fluorescein staining (Dundas et al. , 2001) was typically less than palpebral roughness (Mackinven et al.…”

“…For example, the CCLRU grading scale states that in general, a grade of slight (grade 2) or less is considered within normal limits. However, previous studies (McMonnies and Chapman‐Davies, 1987a; Dundas et al. , 2001; Mackinven et al.…”

“…, 2003; Coles et al. , 2004) and normal levels of some appearances evaluated by the Cornea and Contact Lens Research Unit (CCLRU) grading scale are published (Dundas et al. , 2001; Mackinven et al.…”

Experience and training as determinants of grading reliability when assessing the severity of contact lens complications

“…The grading reliability of experienced subjects using the Efron Grading Scales reported in the study of Efron et al (2002) (±0.34 to ±0.56) was superior to that of inexperienced subjects reported in the study of Efron et al (2001) (± 0.54 to ± 0.67). On the other hand, Dundas et al (2000) and MacKinven et al (2001) reported that trainee optometrists, who presumably had minimal or limited experience, displayed superior reliability (±0.18 and ±0.12, respectively) compared with experienced subjects in the study of Efron et al (2002) (±0.34 to ±0.56), albeit using different grading scales.…”