Comparative Analysis of Anterior Chamber Flare Grading between Clinicians with Different Levels of Experience and Semi-automated Laser Flare Photometry

Abstract

Purpose: 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.

Conclusion: 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.

• Anterior segment flare
• Bland-Altman plot for intergrader correlation
• grading of flare
• intraocular inflammation
• laser flare photometry

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Funding

This research was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. The authors would also like to acknowledge Kowa Inc. for providing the laser flare meter for semi-automated grading by senior and junior graders. Rupesh Agrawal is funded by National Medical Research Council, Singapore for overseas training and fellowship at Institute of Ophthalmology and Moorfields Eye Hospital, London, UK.

Author contributions

RA collated all the data and wrote the first draft of the manuscript. JS, AK, and ZS reviewed the first draft of the manuscript and were the junior clinical graders. PK was the expert for flare reading and edited the draft and gave intellectual inputs. CP was the senior grader and edited and reviewed the draft and conceptualized the study.