title: Assessment of Bulbar Redness with a Newly Developed Keratograph.
abstract: OBJECTIVE
  To determine the validity and reliability of the clinical assessment of bulbar redness (BR) using a newly developed corneal topographer.
  
  
  METHODS
  This is a cross-sectional diagnostic evaluation study. The BR scores [Oculus Index (OI)] from 30 eyes of 26 patients with different degrees of conjunctival hyperemia were assessed and scored automatically using a new method: a keratograph equipped with scanning and scoring software. The values obtained via this system were correlated with three image-based comparative subjective scales: the Institute for Eye Research (IER), the Efron, and the Validated Bulbar Redness (VBR) grading scales. The IER and Efron scores were interpolated to 0.1 unit, and the VBR scores were interpolated to 1 unit. We also evaluated the repeatability of each method and the level of agreement between the OI score and the scores achieved using the three other image-based methods.
  
  
  RESULTS
  There was a significant correlation between the OI score and the scores obtained with the IER (r = 0.921, p < 0.001), Efron (r = 0.958, p < 0.001), and VBR (r = 0.965, p < 0.001) scales. The intraobserver intraclass correlation coefficients were 0.947, 0.874, 0.810, and 0.920 for the OI, IER, Efron, and VBR, respectively, and the intraobserver coefficients of repeatability were 13.924, 16.111, 17.684, and 16.900, respectively. Furthermore, the interobserver intraclass correlation coefficients were 0.889, 0.880, 0.884, and 0.881 for the OI, IER, Efron, and VBR, respectively, and the interobserver coefficients of repeatability were 15.934, 16.366, 22.059, and 21.373, respectively.
  
  
  CONCLUSIONS
  The OI is an objective and reliable method for scoring BR. Its reproducibility was the highest of all the four modalities. The keratograph is recommended, therefore, as a suitable alternative for BR assessment.
authors.affiliation: *MD †MD, PhD Department of Ophthalmology and Visual Science, Eye, Ear, Nose, and Throat Hospital, Shanghai Medical College, Fudan University, Shanghai, China (SW, JH, LT, XC, XS, JX); and Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen, China (JH).
authors.forename: Suqian
authors.initials: S
authors.lastname: Wu
authors.forename: Jiaxu
authors.initials: J
authors.lastname: Hong
authors.forename: Lijia
authors.initials: L
authors.lastname: Tian
authors.forename: Xinhan
authors.initials: X
authors.lastname: Cui
authors.forename: Xinghuai
authors.initials: X
authors.lastname: Sun
authors.forename: Jianjiang
authors.initials: J
authors.lastname: Xu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003228:Conjunctiva / Q000098:blood supply; D003229:Conjunctival Diseases / Q000175:diagnosis*; D019781:Corneal Topography / Q000295:instrumentation*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006940:Hyperemia / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010781:Photography; D015203:Reproducibility of Results