title: Comparison of subjective grading and objective assessment in meibography.
abstract: OBJECTIVE
  To analyse repeatability of subjective grading and objective assessment in non-contact infra-red meibography.
  
  
  METHODS
  Meibography photographs of 24 subjects (female 14; mean age=46; range=19-69 years, upper-lid images=12, lower-lid images=12) were classified in two sessions by three experienced observers (OI, OII, OIII). Relative area or portion affected by meibomian glands (MG) loss was classified applying three different grading scales in randomized order: a four-grade scale (4S) (degree 0=no partial glands; 1=<25% partial glands; 3=25-75% partial glands; 3=>75% partial glands), a pictorial five-grade scale (5S) (degree 0=no meibomian gland loss (MGL); 1=<25% MGL; 3=26-50% MGL; 3=51-75%; 4=>75% MGL) and objectively by a 100-grade scale (DA) applying ImageJ software.
  
  
  RESULTS
  Observed MG loss ranged from 0% to 69%. Intra-observer agreement of the 5S (OI: κ=0.80, p<0.001; OII: κ=0.40, p=0.009; OIII κ=0.81, p<0.001) was better than of the 4S (OI: κ=0.79, p<0.001; OII: κ=0.15, p=0.342; OIII κ=0.50, p=0.0071). Intra-observer agreement of OI and OIII (±0.88 (95% confidence interval), ±1.305) was better than of OII (±2.21) in 4S and 5S (±0.99, ±2.00 and ±0.91; OI, OII and OIII, respectively) while it was relatively similar in DA (±18, ±17 and ±17). Inter-observer agreement was better in DA (OI-OII: ±13, OI-OII: ±19, OII-OIII: ±26) than in 4S (OI-OII: ±1.76; OI-OIII: ±1.29 and OII-OIII: ±1.31) or 5S (OI-OII: ±1.49; OI-OIII: ±0.91 and OII-OIII: ±1.20).
  
  
  CONCLUSIONS
  Intra-observer and inter-observer agreement was better in computerized grading followed by the subjective five-grade scale and four-grade scale.
authors.affiliation: Dr. Heiko Pult-Optometry and Vision Research, Weinheim, Germany. ovr@heiko-pult.de
authors.forename: Heiko
authors.initials: H
authors.lastname: Pult
authors.forename: Britta
authors.initials: B
authors.lastname: Riede-Pult
mesh_terms: D000328:Adult; D000368:Aged; D003936:Diagnosis, Computer-Assisted; D003941:Diagnostic Techniques, Ophthalmological; D005141:Eyelid Diseases / Q000175:diagnosis* / Q000378:metabolism; D005260:Female; D006801:Humans; D007259:Infrared Rays; D008297:Male; D008537:Meibomian Glands / Q000378:metabolism / Q000473:pathology*; D008875:Middle Aged; D012372:ROC Curve; D015203:Reproducibility of Results; D013666:Tears / Q000378:metabolism*; D055815:Young Adult