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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Further investigation of the palpebral response to stimuli such as antigens, toxic chemicals, and mechanical effects is required gfading determine whether the response is similar and how it should be best depicted or photographed for grading purposes. Evaluation of the range of areas of the fluorescein staining patterns of the tarsal conjunctiva in man.

Word description, sketches and grading scales were used more for recording the anterior eye health of contact lens wearers than other patients, but photography was used by a similar number. 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. There has been much discussion and debate in the literature concerning the merits and relative difficulties of constructing photographic versus pictorial grading scales, with the suggestion that painted grading scales, although not as realistic as photographs, allow more control in depicting incremental increases in severity that are clear and unambiguous to the clinician.

Slit lamp classification system. Accepted Mar The occasional apparent reversal in severity in several of the scales could arise scalees deficiencies in the scale images, such as the lack of an appropriate photographic image taken with similar perspective and illumination or from scale designers considering a range of feature characteristics to assess the grade of an image. Tarsal conjunctival morphometry of Asymptomatic soft contact lens wearers and non-wearers.

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. Quantification of conjunctival vascular gradiny by digital imaging.


Palpebral hyperaemia and staining grading is complicated by the variable presentations possible. Image analysis discrimination was described by the standard deviation of repeated measures divided by the scale range. Handbook of Contact Lens Management. Invest Ophthalmol Vis Sci ; Sign up for our free e-newsletters Get all the latest jobs and product news emailed to you every week Click here to register. Editor’s choice Look local: Characteristics of corneal staining in hydrogel contact lens wearers.

The increments of the grading scales were best described by a quadratic rather than a linear function. Lies, statistics, and clinical significance. The printed grading scales were more sensitive for grading features of low severity, but grades were not comparable between grading gfading.

Arch Ophthalmol ; Validation of grading scales for contact lens complications.

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

Evidence suggests that concordance tends to improve with training or practice. What we are not that good at, however, is being consistent with our colleagues. Edge detection and colour extraction image analysis techniques are highly repeatable and offer the potential for more repeatable and sensitive grading than gradding printed subjective grading scales.

Am J Ophthalmol ; Objective measurement of contact-lens induced conjunctival redness. Finer scales have the advantage of being capable of recording clinical change more sensitively. Clinical monitoring of ocular physiology using digital image analysis.

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.

Practitioners often overcome this limitation by adopting half-point scales, or by assigning plus and minus symbols next to an integer scale. The response rate was 31 per cent. The subjective judgement that a practitioner makes at the slit lamp is however a complex one to mimic objectively.

The primary reason cited for not using grading scales was a preference for recording clinical data using other means, such as sketches, photographs or written descriptions.

National Center for Biotechnology InformationU. Int J Microcirculation Clin Exp ; 6: Another interesting finding was that grading scales are more likely to be used by optometrists who have recently graduated, have a postgraduate certificate in ocular therapeutics, see more contact lens patients or use other forms of grading scales. Whilst Efron overcomes these difficulties by encouraging artistic clarity and licence so as to emphasise and isolate the condition that is being evaluated, it is considered by some a departure from the real life situation in as much as different conditions feed and depend on each other and, therefore, occur simultaneously and should cclrh as such in a single hrading.


Both clinical grading scales have been published in prominent textbooks and widely distributed around the world, free of charge, by several major contact lens companies. Grading scale grades are not interchangeable, with scales starting either at grade 0 or 1 and with a wide range of values for the highest grade. Grading conjunctival hyperaemia using a photography-based method. Practitioners who use photography to document complications admit, in many cases, to also use grading scales.

Automated measurement of bulbar redness. However, there is a limit to such interpolation; 0.


The average time taken to record anterior eye health was 6. Therefore an epithelial scratch, punctate staining, and confluent ulceration could all have similar intensity of green colouration and edge detected area. Palpebral hyperaemia scale images were well described by colour extraction techniques. Quantitative slit lamp observations in contact lens practice.

Guillon MShah D.

Included in the improved version will be high definition images and compatibility with iPads as well as iPhones. Annunziato and Efron pictorial, and CCLRU and Vistakon-Synoptik photographic grades of bulbar hyperaemia, palpebral hyperaemia roughness, and corneal staining were analysed.

Most practitioners graded to the nearest whole unit These image analysis techniques grafing 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.

Analysis of microvascular network in bulbar conjunctiva by image processing.

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