Optimising subjective grading of corneal staining in Sjögren's syndrome dry eye disease
Wolffsohn, James S Hunt, Olivia A Travé-Huarte, Sònia Giannaccare, Giuseppe Pellegrini, Marco Labetoulle, Marc
Wolffsohn, James S
Hunt, Olivia A
Travé-Huarte, Sònia
Giannaccare, Giuseppe
Pellegrini, Marco
Labetoulle, Marc
Abstract
Aim: To assess whether smaller increment and regionalised subjective grading improves the repeatability of corneal fluorescein staining assessment, and to determine the neurological approach adopted for subjective grading by practitioners. Methods: Experienced eye-care practitioners (n = 28, aged 45 ± 12 years), graded 20 full corneal staining images of patients with mild to severe Sjögren's syndrome with the Oxford grading scheme (both in 0.5 and 1.0 increments, globally and in 5 regions), expanded National Eye Institute (NEI) and SICCA Ocular Staining Score (OSS) grading scales in randomised order. This was repeated after 7-10 days. The digital images were also analysed objectively to determine staining dots, area, intensity and location (using ImageJ) for comparison. Results: The Oxford grading scheme was similar with whole and half unit grading (2.77vs2.81,p = 0.145), but the variability was reduced (0.14vs0.12,p < 0.001). Regional grade was lower (p < 0.001) and more variable (p < 0.001) than global image grading (1.86 ± 0.44 for whole increment grading and 1.90 ± 0.39 for half unit increments). The correlation with global grading was high for both whole (r = 0.928,p < 0.001) and half increment (r = 0.934,p < 0.001) grading. Average grading across participants was associated with particle number and vertical position, with 74.4-80.4% of the linear variance accounted for by the digital image analysis. Conclusions: Using half unit increments with the Oxford grading scheme improve its sensitivity and repeatability in recording corneal staining. Regional grading doesn't give a comparable score and increased variability. The key neurally extracted features in assigning a subjective staining grade by clinicians were identified as the number of discrete staining locations (particles) and how close to the vertical centre was their spread, across all three scales.
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Date
2024-03-14
Type
Article
Subject
Ophthalmology
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Citation
Wolffsohn JS, Recchioni A, Hunt OA, Travé-Huarte S, Giannaccare G, Pellegrini M, Labetoulle M. Optimising subjective grading of corneal staining in Sjögren's syndrome dry eye disease. Ocul Surf. 2024 Mar 14;32:166-172. doi: 10.1016/j.jtos.2024.03.005
Journal / Source Title
The Ocular Surface
DOI
10.1016/j.jtos.2024.03.005
PMID
38490476
Publisher
Elsevier