title: Novel grading system for pupillary ruff changes and associated features.
abstract: BACKGROUND
  To evaluate the reproducibility of a new system for grading pupil ruff changes and associated findings.
  
  
  METHODS
  Observational comparative study.
  
  
  METHODS
  Forty-seven photograph sets including iris, pupil edge and ruff, and inferior anterior chamber drainage angle.
  
  
  METHODS
  A novel system for recording pupillary ruff changes was developed, along with reference iris, pupil and gonioscopy images. A prospective masked agreement study was undertaken using two observers who graded the photograph sets using this new system. Parameters included pupillary ruff absence and abnormality, pupil edge pigment, trabecular meshwork pigment, Sampaolesi line pigment, iris root pigment, and pigment 'lumps' and 'piles'.
  
  
  METHODS
  Intraobserver and interobserver agreement for the parameters of the grading system, assessed with the intraclass correlation coefficient and Bland-Altman plots.
  
  
  RESULTS
  Photographs of 47 eyes of 47 glaucoma suspects and glaucoma patients were evaluated. Agreement percentages of ≥95% (average 96%) and ≥60% (average 70%) were obtained for intraobserver and interobserver agreement, respectively. The average interobserver single-measure intraclass correlation coefficient and repeat-measures intraclass correlation coefficient were 0.75 (range 0.54-0.88) and 0.85 (range 0.70-0.94), respectively. There was a non-significant trend towards interobserver systematic bias on one of the nine parameters (iris stroma pigment at the pupil edge).
  
  
  CONCLUSIONS
  This grading system provides a reliable and reproducible system for encoding of clinical signs of pupil ruff atrophy for clinical research.
authors: Department of Ophthalmology, Wellington Hospital, Riddiford Street, Newtown, Wellington, New Zealand.
authors: Tracey
authors: T
authors: Wong
authors: Ghee Soon
authors: GS
authors: Ang
authors: Simon
authors: S
authors: Nicholas
authors: Anthony P
authors: AP
authors: Wells
mesh_terms: D001284:Atrophy / Q000145:classification; D005902:Glaucoma, Open-Angle / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D006068:Gonioscopy; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D007498:Iris / Q000473:pathology*; D015588:Observer Variation; D009798:Ocular Hypertension / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D009901:Optic Nerve Diseases / Q000175:diagnosis*; D010781:Photography; D011446:Prospective Studies; D011680:Pupil; D015203:Reproducibility of Results; D014130:Trabeculectomy