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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EFRON-CCLRU GRADING SCALES for (Android) Free Download on MoboMarket

This is difficult for graading to achieve accurately. If we are working in settings where patients are being seen by multiple practitioners, it is critical that the same scales be used and the same rules applied, to ensure that numbers assigned to appearance by different practitioners match.

Social media and SEO success Seven ways: Staining can differ in intensity dependent on factors such as the amount of fluorescein instilled, tear film production and drainage, depth of the woundarea, shape, and segmentation.

What we are not that gradding at, however, is being consistent with our colleagues. Finer scales have the advantage of being capable of recording clinical change more sensitively. Contact Lens Ant Eye ; The app enables levels of severity to be compared side-by-side in 0.

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

Edge detection and colour extraction image analysis techniques are highly repeatable and offer the potential for more repeatable and sensitive grading than using printed subjective grading scales.

Quantification of conjunctival vascular reaction by digital imaging. 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. 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.

A new computer assisted objective method for quantifying vascular changes of the bulbar conjunctivae. Grading scales for contact lens complications. 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. Therefore this study aimed to determine, by objective image analysis, whether commonly used clinical pictorial and photographic subjective grading scales are incremental in nature.


Annunziato and Efron pictorial, and CCLRU and Vistakon-Synoptik photographic grades of bulbar hyperaemia, palpebral hyperaemia roughness, and corneal staining were analysed. Approaches acales this challenge are still emerging and further developments in this area are anticipated. Wolffsohn JSPurslow C. To use previously validated image analysis techniques to determine the incremental nature of printed subjective anterior eye grading scales.

Characteristics of corneal staining in hydrogel contact lens wearers.

Slit lamp classification system. A general increase in edges detected with increasing scale grade was seen in the all the scales analysed, although the change in green colouration was more variable. To examine the incremental nature of the Annunziato, sacles Efron Millennium Edition9 and Vistakon-Synoptik 4 grading scales, the printed images of bulbar hyperaemia, palpebral hyperaemia also referred to as papillary conjunctivitisand corneal staining extent were scanned at dpi stored in tagged image format TIFF scalee analysed.

They conclude that grading scales that are too coarse generally allow less sensitivity in the detection of meaningful clinical changes. Grading scales are well established as aids to assist in the monitoring garding anterior eye characteristics. National Center for Biotechnology InformationU.

Practitioners must record the grading scale used, and ideally standardise this within an individual practice or corporate groups.

Edge detection techniques are local rather than global in nature and examine the surrounding pixels to determine the presence of edges vessels or areas of staining. Assessment of conjunctival hyperaemia in contact lens wearers. Tarsal conjunctival morphometry of Asymptomatic soft contact lens wearers and non-wearers. Therefore an epithelial scratch, punctate staining, and confluent ulceration could all have similar intensity of green colouration and edge detected area. Paper records may also have specific sections for recording clinical information, as well as previously drawn ocular sketches for annotation.

Ideally, prior to contact lens wear, the baseline data for a range of clinical variables should be collected and then be continually monitored throughout the course of the patients wearing experience. Southwest Independent Institutional Review Board, For example, there may be cclru fields for each eye, separate fields for slit lamp findings and previously drawn sketches of the eye, over which text or drawings can be interposed.


This results in the lower end of the scale being more sensitive a smaller change between grades than the upper end of the scale. These alternative approaches to record keeping can all be considered as representing good clinical practice. Automatic quantitative sxales of ocular hyperaemia. Guillon MShah D. Reproducibility of digital image analysis for measuring corneal haze after myopic photorefractive keratectomy.

Individually, our grading is repeatable, so we should continue to use the scales in the way we are doing now. 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.

Nowadays, many practitioners record clinical information electronically by entering data into defined fields within computer-based clinical management software programs — a practice that in effect prompts practitioners scalws capture all relevant aspects of the presenting signs and symptoms. This article has been cited by other articles in PMC.

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

The response rate was 31 per cent. These image analysis techniques have been used to try to determine how clinicians grade bulbar hyperaemia, with one study suggesting that the number of vessels and the proportion of the image occupied by vessels are more important than relative colouration 15 whereas another indicated both these factors were integral to grading. The intensity, incidence angle, and type of illumination will affect the reflections as well as the apparent size and shape of the papillae, and therefore the non-uniform change with increasing photographic scale intensity may be expected.

By grading to decimal places that are representative of points in between two successive integer points on the scale, 1.