title: Inter-grader Agreement of the Ocular Staining Score in the Sjögren's International Clinical Collaborative Alliance (SICCA) Registry.
abstract: OBJECTIVE
  To determine the intra-observer and inter-observer reliability of a novel ocular staining score among trained ophthalmologists.
  
  
  METHODS
  Reliability analysis within a prospective, observational, multicenter cohort study.
  
  
  METHODS
  Those enrolled in the National Institutes of Health-funded Sjögren's International Collaborative Clinical Alliance (SICCA) who presented for follow-up at the University of California San Francisco, Aravind Eye Hospital, Johns Hopkins University, and the University of Pennsylvania were included. Study participants were graded using the ocular staining score by at least 2 masked SICCA-trained ophthalmologists. The primary outcome for this study was the intraclass correlation coefficient (ICC) for the total ocular staining score. ICCs were also calculated for tear break-up time (TBUT) and conjunctival and corneal staining.
  
  
  RESULTS
  Total ocular staining score had an ICC of 0.91 for the right eye (95% confidence interval [CI] 0.85-0.96) and 0.90 for the left eye (95% CI 0.83-0.97). Corneal staining (right eye 0.86, 95% CI 0.76-0.93, left eye 0.90, 95% CI 0.81-0.95) and conjunctival staining (right eye 0.87, 95% CI 0.80-0.93, left eye 0.85, 95% CI 0.75-0.93) demonstrated excellent agreement. The ICC for TBUT was slightly lower (right eye 0.77, 95% CI 0.64-0.89; left eye 0.81, 95% CI 0.68-0.90).
  
  
  CONCLUSIONS
  Previous studies have shown that the ocular staining score is correlated with other diagnostic components of Sjögren syndrome. In this study, we demonstrate high reliability in grading among trained ophthalmologists, completing the validation of this test.
authors: Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California; Department of Ophthalmology, University of California San Francisco, San Francisco, California; Department of Optometry, University of California, Berkeley, Berkeley, California.
authors: Jennifer
authors: J
authors: Rose-Nussbaumer
authors: Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California; Department of Ophthalmology, University of California San Francisco, San Francisco, California; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California.
authors: Thomas M
authors: TM
authors: Lietman
authors: Department of Dentistry, University of California San Francisco, San Francisco, California.
authors: Caroline H
authors: CH
authors: Shiboski
authors: Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California.
authors: Stephen C
authors: SC
authors: Shiboski
authors: Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Vatinee Y
authors: VY
authors: Bunya
authors: Department of Ophthalmology, Johns Hopkins University, Baltimore, Maryland.
authors: Esen K
authors: EK
authors: Akpek
authors: Aravind Eye Care System at Madurai, Madurai, India.
authors: Muthiah
authors: M
authors: Srinivasan
authors: Aravind Eye Care System at Madurai, Madurai, India.
authors: Jeena
authors: J
authors: Mascarenhas
authors: Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Giacomina
authors: G
authors: Massaro-Giordano
authors: Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California; Department of Optometry, University of California, Berkeley, Berkeley, California.
authors: Nancy A
authors: NA
authors: McNamara
authors: Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California; Department of Ophthalmology, University of California San Francisco, San Francisco, California; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California.
authors: John P
authors: JP
authors: Whitcher
authors: Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California; Department of Ophthalmology, University of California San Francisco, San Francisco, California. Electronic address: Bruce.Gaynor@ucsf.edu.
authors: Bruce D
authors: BD
authors: Gaynor
mesh_terms: D000368:Aged; D003228:Conjunctiva / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D012859:Sjogren's Syndrome / Q000175:diagnosis* / Q000378:metabolism; D013666:Tears / Q000737:chemistry*