Tarsal abnormalities: a new grading system.

Abstract

PURPOSE: The 5-stage scale currently used to grade tarsal conjunctiva is limited with respect to precisely describing the tissue condition and accurately following small changes. We conducted two preliminary studies to evaluate a new 8-stage, photographic tarsal conjunctival grading system. METHODS: We conducted a retrospective review of the records of 145 individuals in Denmark who had successfully worn Acuvue lenses for at least six months on a daily wear basis. Patients wore Acuvue lenses on a two-week replacement schedule and used one of four different care systems (AOSEPT, OPTI-FREE, OXYSEPT, and RENU). Tarsal conjunctiva and lens cleanliness were graded by the investigators. Comfort, vision, and simplicity of care system were rated by the patients. In the second, prospective study, a group of 30 patients who had successfully worn Acuvue lenses and used the OPTI-FREE care system for at least six months were followed for three months to test the repeatability of the new grading system. RESULTS: In the first study, patients using RENU were found to have significantly higher scores than AOSEPT and OPTI-FREE patients when comparing tarsal scores based on the 5-stage scale (P < 0.05). When comparing scores based on the 8-stage scale, significant differences were detected between RENU and all three of the other care systems, with RENU scores being higher (P < 0.05). Numerous differences were found among care systems in lens cleanliness and subjective patient ratings of comfort, vision, and simplicity of use. In the second study, tarsal scores did not change over time in the patients followed for three months. CONCLUSIONS: These initial studies suggest that the new grading scale may allow for more precise determination of the condition of the tarsal conjunctiva and provide for a greater ability to detect differences among lens care regimens in tarsal conjunctival scores. Early indications are that the scale is reliable and repeatable.