CL Grading Scales

Question 1

Describe FDA scale for conjunctival redness

Answer 1

0-4 (None, trace, mild, moderate, severe)

Question 2

Brien Holden Vision Institute scale

Answer 2

Photographic, 0-4 scale

Severity > grade 2 is clinically significant!

Question 3

Efron scale

Answer 3

Artist-rendered drawings
0-4 scales (use in 0.1 steps)
Severity > 2 is significant!

Question 4

VBR scale

Answer 4

For bulbar redness
Photographic
0-100 scale
Validated steps

Question 5

Best way to detect change w/ a grading scale?

Answer 5

Use 0.1 - 0.5 increments

Question 6

Significance?

Answer 6

Change over time (0.7 in 0-4 scale, 25 in 100 scale)

Grade > 2 is abnormal

Question 7

Which scale has most consistent steps (bulbar redness)?

Answer 7

Efron scale

Question 8

What dye should be used to stain conjunctiva?

Answer 8

Fluorescein or Lissamine green

Question 9

Palpebral conjunctiva, how do we grade redness and roughness?

Answer 9

Separately - BHVI

Combined grade - Efron

Question 10

What should you specify when grading MG’s?

Answer 10

Gland orifice number (open vs closed)
Notching Y/N
Redness Y/N

Question 11

Lid Wiper is also called? How’s it graded?

Answer 11

Marx line

Grade for horizontal and sagittal width

Question 12

How do we grade surface wettability?

Answer 12

High mag (32x)
Diffuse light
ND filter
Range 0 - 4 (0.5 steps)

Question 13

Example of automated grading

Answer 13

R-scan keratograph 5m (Oculus)