title: Comparative Analysis of Anterior Chamber Flare Grading between Clinicians with Different Levels of Experience and Semi-automated Laser Flare Photometry.
abstract: OBJECTIVE
  To assess correlation for anterior chamber flare grading between clinicians with different levels of experience and with semi-automated flare reading in a cohort of patients with heterogeneous uveitic entities.
  
  
  METHODS
  Fifty-nine observations from 36 patients were recorded and analyzed for statistical association. In each patient, flare was assessed objectively using the Kowa FM-700 laser flare photometer, and subjective masked grading by two clinicians was performed.
  
  
  RESULTS
  The study demonstrated disparity in flare readings between clinical graders with one step disagreement in clinical grading in 26 (44.06%) eyes (p < 0.001) and concordance between the flare readings by experienced grader and flare photometry. After review of semi-automated flare readings, management was changed in 11% of the patients.
  
  
  CONCLUSIONS
  Laser flare photometry can be a valuable tool to remove the observer bias in grading flare for selected cohort of uveitis patients. It can be further applied to titrate therapy in intraocular inflammation.
authors.affiliation: a Moorfields Eye Hospital, NHS Foundation Trust , London , UK.
authors.forename: Rupesh
authors.initials: R
authors.lastname: Agrawal
authors.affiliation: a Moorfields Eye Hospital, NHS Foundation Trust , London , UK.
authors.forename: Pearse A
authors.initials: PA
authors.lastname: Keane
authors.affiliation: a Moorfields Eye Hospital, NHS Foundation Trust , London , UK.
authors.forename: Jasmin
authors.initials: J
authors.lastname: Singh
authors.affiliation: a Moorfields Eye Hospital, NHS Foundation Trust , London , UK.
authors.forename: Zubin
authors.initials: Z
authors.lastname: Saihan
authors.affiliation: a Moorfields Eye Hospital, NHS Foundation Trust , London , UK.
authors.forename: Andreas
authors.initials: A
authors.lastname: Kontos
authors.affiliation: a Moorfields Eye Hospital, NHS Foundation Trust , London , UK.
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Pavesio
mesh_terms: D000328:Adult; D000368:Aged; D000867:Anterior Chamber / Q000378:metabolism / Q000473:pathology*; D001082:Aqueous Humor / Q000378:metabolism; D018916:Blood-Aqueous Barrier; D002983:Clinical Competence / Q000592:standards*; D005136:Eye Proteins / Q000378:metabolism; D005260:Female; D006801:Humans; D007834:Lasers; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D000072163:Ophthalmologists / Q000592:standards*; D010783:Photometry / Q000295:instrumentation / Q000592:standards*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014606:Uveitis, Anterior / Q000175:diagnosis* / Q000378:metabolism
chemical_list: D005136:Eye Proteins
keywords: Anterior segment flare; Bland-Altman plot for intergrader correlation; grading of flare; intraocular inflammation; laser flare photometry