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

Efron, Nathan; Morgan, Philip B.; Farmer, Craig; Furuborg, Jan; Struk, Robert; Carney, Leo G.

doi:10.1046/j.1475-1313.2003.00096.x

Cited by 17 publications

(10 citation statements)

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“…Efron investigated the influence of experience and training on grading reliability and found a tenuous benefit for experience and none for training. 5 Begley et al, 6 in an investigation of corneal staining grading questioned investigators, found that they used different strategies for assigning grades, and found statistically significant differences in outcomes. Further analysis of the present data indicates that different strategies for grading limbal redness may exist among practitioners in the United States, Germany, and Australia.…”

Section: Discussionmentioning

confidence: 99%

“…The philosophy for grading signs, although subject to some generalized categorizing, is highly internalized by an observer 4 and may be difficult to influence or change outside of research settings. 5 Some practitioners may weight toward the most or least severe sign, some may average over the affected area or tissue, and others may discount signs they consider to be within normal limits that other practitioners would note with more severity. 6 Using limbal redness as the example, a patient wearing lowoxygen transmissible soft contact lenses may report that their eyes are red.…”

mentioning

confidence: 99%

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Comparison of Subjective Grading of Limbal Redness By Eyecare Practitioners in Three Countries

Long¹

2009

Eye &Amp; Contact Lens: Science &Amp; Clinical Practice

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These findings support the generalization of results of limbal redness grades from trials that are conducted in several countries or in one country and used in another, i.e., practitioners may expect similar findings for this sign among their patients no matter which of their colleagues are investigators. They also indicate that different strategies for grading limbal redness may exist among practitioners in the countries tested. Study sponsors may want to include standardized training for investigators.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Comparison of Subjective Grading of Limbal Redness By Eyecare Practitioners in Three Countries

Long¹

2009

Eye &Amp; Contact Lens: Science &Amp; Clinical Practice

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“…However, there was no difference in the improvement in grading reliability between the two groups. From this, Efron et al 33 concluded that grading reliability improves statistically with some experience, although perhaps not to a clinically meaningful extent. No added benefit can be derived from supplemental training in terms of grading reliability.…”

Section: Impact Of Experience and Training On Grading Performancementioning

confidence: 99%

“…To examine this, Efron et al 33 conducted a further experiment whereby the influence of experience and training on grading reliability was assessed on a group of subjects with a common knowledge base.…”

Section: Impact Of Experience and Training On Grading Performancementioning

confidence: 99%

Grading scales

Efron

2012

Contact Lens Complications

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“…Additionally, non-optometrists had difficulty in interpolating their grades into 0.1 increments, preferring unit or half-unit steps. Regarding training, a parallel study revealed a slight improvement in accuracy when optometrists were trained in between consecutive sessions, but the results failed to achieve statistical significance 11 .…”

Section: Introductionmentioning

confidence: 99%

Grading Contact Lens Complications: The Effect of Knowledge on Grading Accuracy

Cardona

Serés

2009

Current Eye Research

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2Purpose: Grading contact lens complications is a time-effective process which, if performed accurately, may improve patient management significantly. Multiple factors have been identified that influence grading accuracy, such as the knowledge, training and experience of the observer. The aim of this study was to further explore the effect of knowledge on grading accuracy, both in terms of intensity and specificity, and to do so by avoiding the need to require the subjects to interpolate between whole number grades. Material and Methods:Optometry students were divided into three knowledge groups according to their academic progress and in such a way that knowledge intensity and specificity could be evaluated separately. A vertical visual analogue scale was devised to allow subjects to grade three different conditions of medium severity (position 50 of the scale) from the Institute for EyeResearch grading scale, mainly, bulbar hyperaemia, limbal vascularisation and lid redness.Results: Bulbar hyperaemia was graded lowest (mean = 21.5; SD = 1.4), followed by limbal vascularisation (mean = 40.7; SD = 1.6) and lid redness (mean = 51.2; SD = 1.3) and these differences were found to be statistically significant (ANOVA p = 0.000). Knowledge was found to influence the grading process, resulting in statistically significant differences in the overall grading performance of the three knowledge groups (ANOVA, p = 0.048). Furthermore, even if knowledge intensity failed to improve grading accuracy over a certain threshold, a combination of knowledge intensity and specificity resulted in an enhancement of the homogeneity of the grading data. Conclusions: Knowledge intensity and specificity both contribute to improve grading skills, albeit through different mechanisms. An intermediate knowledge of contact lens complications is required to attain good grading accuracy and a basic training in pathology is also advised. ABSTRACTContact lens complications; Grading scales; Grading accuracy; Interpolation skills; Knowledge KEY WORDS 3The grading of contact lens complications is a complex and essential process that stems from the need to correctly identify the severity of a condition and, therefore, to allow for the most appropriate form of treatment. The prognosis of many contact lens complications depends on the ability of the clinician to decide upon the actual severity and urgency of the condition and to act accordingly, either through treatment or referral.

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

Abstract: Grading reliability improves statistically with some experience, although perhaps not to a clinically meaningful extent. No added benefit can be derived from supplemental training.

Cited by 17 publications

References 11 publications

Comparison of Subjective Grading of Limbal Redness By Eyecare Practitioners in Three Countries

Comparison of Subjective Grading of Limbal Redness By Eyecare Practitioners in Three Countries

Grading scales

Grading Contact Lens Complications: The Effect of Knowledge on Grading Accuracy

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