A better picture

Objective grading has a proven track record in maintaining consistency in recording anterior eye appearance where subjective ratings may vary considerably from practitioner to practitioner. Way back in 2009, Petersen and Wolffsohn noted ‘clinicians may use a combination of vessel areas and overall hue in their judgment of clinical severity for certain conditions. Objective grading can take these aspects into account, and be used to predict an average “objective grade” to be used by a clinician in describing the anterior eye. These measures are more sensitive and reliable than subjective grading while still utilising familiar terminology, and can be applied in research or practice to improve the detection, and monitoring of ocular surface change.’¹ Reasons for subjective variability are many. One very recent study has pointed out that ‘many sources of bias have been reported to influence grading precision and reliability. The present findings revealed a statistically significant bias, referred to as “awareness of treatment”, in which examiners with moderately reliable grading skills tended to award higher grades to “untreated” conditions and lower grades to “treated” conditions.’²