A standardized grading system for scleritis

Abstract

Objective: This study evaluated the performance of a standardized grading system for scleritis using standard digital photographs.

Design: Cross-sectional interobserver agreement study.

Participants: Photo archives from the National Eye Institute.

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 2 sessions: (1) without using reference photographs and (2) 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. Interobserver agreement in grading the severity of inflammation with and without the use of grading system was evaluated.

Main outcome measures: Interobserver agreement.

Results: The proposed grading system for assessing activity in scleritis demonstrated a good interobserver agreement. Interobserver agreement (pooled κ) was poor (0.289) without photographic guidance and improved substantially when the "grading system" with standardized photographs was used (κ = 0.603).

Conclusions: 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 and clinical research.