Ali M Masmali1, Paul J Murphy2, Christine Purslow3. 1. Cornea Research Chair (CRC), Optometry Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia; Contact Lens and Anterior Eye Research (CLAER) Unit, School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK. Electronic address: amasmali@ksu.edu.sa. 2. School of Optometry and Vision Science, University of Waterloo, Waterloo, Canada. 3. School of Health Professions, Plymouth University, Plymouth, UK; Contact Lens and Anterior Eye Research (CLAER) Unit, School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK.
Abstract
PURPOSE: This paper reports on the development of a new tear ferning (TF) subjective grading scale, and compares it with the Rolando scale. METHOD: TF patterns obtained from tear film samples collected from normal and dry eye subjects in previous studies were collated into a large image library. From this library, 60 images were selected to represent the full range of possible TF patterns, and a further sub-set of 15 images was chosen for analysis. Twenty-five optometrists were asked to rank the images in increasing order between extreme anchors on a scale of TF patterns. Interim statistical analysis of this ranking found 7 homogeneous sub-sets, where the image rankings overlapped for a group of images. A representative image (typically the mean) from each group was then adopted as the grade standard. Using this new 7-point grading scale, 25 optometrists were asked to grade the entire 60 image library at two sessions: once using the 4-point Rolando scale and once using the new 7-point scale, applying 0.25 grade unit interpolation. RESULTS: Statistical analysis found that for the larger image set, the Rolando scale produced 3 homogeneous sub-sets, and the 7-point scale produced 5 homogeneous sub-sets. With this refinement, a new 5-point TF scale (Grades 0-4) was obtained. CONCLUSIONS: The Rolando grading scale lacks discrimination between its Type I and II grades, reducing its reliability. The new 5-point grading scale is able to differentiate between TF patterns, and may provide additional support for the use of TF for both researcher and clinician.
PURPOSE: This paper reports on the development of a new tear ferning (TF) subjective grading scale, and compares it with the Rolando scale. METHOD: TF patterns obtained from tear film samples collected from normal and dry eye subjects in previous studies were collated into a large image library. From this library, 60 images were selected to represent the full range of possible TF patterns, and a further sub-set of 15 images was chosen for analysis. Twenty-five optometrists were asked to rank the images in increasing order between extreme anchors on a scale of TF patterns. Interim statistical analysis of this ranking found 7 homogeneous sub-sets, where the image rankings overlapped for a group of images. A representative image (typically the mean) from each group was then adopted as the grade standard. Using this new 7-point grading scale, 25 optometrists were asked to grade the entire 60 image library at two sessions: once using the 4-point Rolando scale and once using the new 7-point scale, applying 0.25 grade unit interpolation. RESULTS: Statistical analysis found that for the larger image set, the Rolando scale produced 3 homogeneous sub-sets, and the 7-point scale produced 5 homogeneous sub-sets. With this refinement, a new 5-point TF scale (Grades 0-4) was obtained. CONCLUSIONS: The Rolando grading scale lacks discrimination between its Type I and II grades, reducing its reliability. The new 5-point grading scale is able to differentiate between TF patterns, and may provide additional support for the use of TF for both researcher and clinician.
Authors: Ali M Masmali; Adil Al-Shehri; Saud A Alanazi; Ali Abusharaha; Raied Fagehi; Gamal A El-Hiti Journal: J Ophthalmol Date: 2016-11-24 Impact factor: 1.909
Authors: Saud A Alanazi; Gamal A El-Hiti; Abdulaziz A Al-Baloud; Mohamed I Alfarhan; Ammar Al-Shahrani; Abdulkareem A Albakri; Saad Alqahtani; Ali M Masmali Journal: Clin Ophthalmol Date: 2019-04-10
Authors: Raied Fagehi; Abdulkareem B Al-Bishry; Mana A Alanazi; Ali Abusharha; Gamal A El-Hiti; Ali M Masmali Journal: Taiwan J Ophthalmol Date: 2020-12-17