title: Development of Definitive and Reliable Grading Scales for Meibomian Gland Dysfunction.
abstract: OBJECTIVE
  To develop and validate grading scales for meibomian gland dysfunction (MGD) that allow consistent diagnosis of MGD and are suitable for clinical studies.
  
  
  METHODS
  Development and validation study of grading scales.
  
  
  METHODS
  Lid margin and meibomian gland photographs were taken in the multicenter, prospective cross-sectional study for MGD and control subjects. New grading scales for MGD signs (abnormal lid margin findings of vascularity, plugging of gland orifices, lid margin irregularity, lid margin thickening, partial glands, and gland dropout) in both upper and lower eyelids were developed. Three MGD experts, 3 general ophthalmologists, and 3 non-physicians independently tested the scales by evaluating photographs. The levels of interrater and intrarater agreement for each grading scale were estimated with the use of kappa statistics.
  
  
  RESULTS
  Thirty-eight patients with MGD and 20 control subjects were enrolled and photographed. New grading scales were developed using a total of 226 photographs. The interrater kappa values for MGD experts and for general ophthalmologists and non-physicians with reference to an MGD expert ranged from 0.36 to 0.87 (median of 0.66), 0.41 to 0.73 (0.60), and 0.30 to 0.77 (0.59), respectively. Those for intrarater reliability for 2 MGD experts ranged from 0.49 to 0.93 (0.82).
  
  
  CONCLUSIONS
  New grading scales for MGD signs were developed and found to have appropriate inter- and intrarater reliabilities for grading MGD. These grading scales are suitable for MGD diagnosis and application to multicenter trials.
authors.affiliation: Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Ophthalmology, Itoh Clinic, Saitama, Japan. Electronic address: ritoh@za2.so-net.ne.jp.
authors.forename: Reiko
authors.initials: R
authors.lastname: Arita
authors.affiliation: Research and Development Division, Santen Pharmaceutical Co Ltd, Osaka, Japan.
authors.forename: Izumi
authors.initials: I
authors.lastname: Minoura
authors.affiliation: Department of Ophthalmology, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan.
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Morishige
authors.affiliation: Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Rika
authors.initials: R
authors.lastname: Shirakawa
authors.affiliation: Tokyo Kyosai Hospital, Tokyo, Japan.
authors.forename: Shima
authors.initials: S
authors.lastname: Fukuoka
authors.affiliation: Research and Development Division, Santen Pharmaceutical Co Ltd, Osaka, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Asai
authors.affiliation: Research and Development Division, Santen Pharmaceutical Co Ltd, Osaka, Japan.
authors.forename: Tateki
authors.initials: T
authors.lastname: Goto
authors.affiliation: Research and Development Division, Santen Pharmaceutical Co Ltd, Osaka, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Imanaka
authors.affiliation: Research and Development Division, Santen Pharmaceutical Co Ltd, Osaka, Japan.
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Nakamura
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D003941:Diagnostic Techniques, Ophthalmological / Q000145:classification*; D005141:Eyelid Diseases / Q000145:classification* / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008537:Meibomian Glands / Q000473:pathology*; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires