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AgreementinreadingcentergradingofIsotretinoin(Accutane)-inducedmeibographychanges

Poster·May2016

DOI:10.13140/RG.2.1.1966.6801

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10authors,including:

ScottGHauswirth

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JustinKwan

MarshallB.KetchumUniversity

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MiltonMHom

IndependentResearcher

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LeslieE.O'Dell

SalusUniversity

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Halleran, Clare1 ; Hauswirth, Scott G.2 ; Kwan, Justin T.3 ; Hom, Milton M.5 ; O'Dell, Leslie8 ; Moy, Allison6 ; Schachter, Aubrey7 ; Harthan, Jennifer4 ; Lin, Meng C.10; McNamara, Nancy A.9

1.  East Coast Eye Care, Clarenville, NL, Canada. 2. Minnesota Eye Consultants, Minneapolis, MN. 3. Marshall B. Ketchum University, Fullerton, CA, 4. Cornea, Illinois College of Optometry, Chicago, IL. 5. Private Practice, Azusa, CA. 6. Clearvue Vision Center, Kent, WA 7. Advanced Eye Care, Pismo Beach, CA 8. Dry Eye centre of Pennsylvania, York, PA

9. University of California SF, San Francisco, CA 10. UC berkeley, Berkeley, CA

Presentation Number: 6219- A0147

u Meibography changes have been documented in individuals using Isotretinoin (Accutane) medication1

u Meibography is increasingly being performed by eye

care practitioners to assess meibomian gland structure2

u Several methods of grading meibomian gland structure via meibography exist.

This study had the purpose to examine the inter-observer reliability between different masked observers for two of the most common grading methods on patients with isotretinoin-related meibomian gland atrophy

u Meibography images from patients who had a history of isotretinoin use were complied.

u The lower eyelid images were captured with the Oculus Keratograph 5M and ReSeeVit instruments.

u Masked observers graded the provided images using either the Pult or Arita grading scales; the scale each observer used was assigned randomly.

u The Pult and Arita scales were evaluated using Cohen kappa, weighted kappa, and intra-class correlation to determine agreement.

Methods

u Eighteen lower lid images were graded by four masked graders.

u Un-weighted kappa indicated slight agreement between graders using the Pult scale (0.14[0.00-0.46]) and ICC of 0.733[0.426-0.89], p<0.001. With weighted kappa, the Pult scale indicated moderate agreement (0.48) between graders.

u  Un-weighted kappa indicated fair agreement between graders using the Arita Scale (0.23[0.00-0.55]) and an ICC of 0.524[0.10-0.79], p=0.009. Weighted kappa also indicated fair agreement (0.36).

u In all 18 images, at least one observer graded some

degree of meibomian gland atrophy

Purpose

Figure 1. Meibography images

Results

Introduction

Figure 2. Arita Grading Scale

Figure 3. Heiko-Pult grading Scale

Conclusions

u Isotretinoin has been documented to cause structural changes in meibomian gland architecture visible via meibography1

u  As meibography becomes more widespread in clinical practice, incorporation of a pictorial scale which is reliable and repeatable is necessary.

u The Pult scale seemed to fare better than the Arita scale

with respect to inter-observer agreement, and thus may be preferred for diagnosing and monitoring meibomian gland atrophy and interlaboratory collaborations

u Baseline Meibography on patients taking Isotretinoin may be helpful to monitor possible meibomian gland atrophy.

Commercial Relationships Clare Halleran, Allergan Inc(R) Scott Hauswirth, Allergan Inc (R),BioTissue Inc(C), Bausch & Lomb(C), Shire(C),Tear Science(R) Justin Kwan,Johnson & Johnson Vision Care(C), Allergan Inc (C) Milton Hom, Allergan Inc (F), Bausch & Lomb (F), Shire (C), OptoVue (R) Leslie O'Dell, Paragon Biotech (C) Allison Moy, None Aubrey Schachter, None Jennifer Harthan, Allergan Inc (F), Bausch & Lomb (F), Contamac(F), Metro Optics (F) Meng Lin, None| Nancy McNamara, None

References 1.Moy, A, McNamara NA, Lin MC.Effects of Isotretinoin on Mebomian Glands. Optom Vis Sci. 2015; 92(9): 925-30 2. Arita R, Itoh K, Amano S. Noncontact infrared meibography to document age-related changes of the meibomian glands in the normal population.Ophthalmology.2008;115(5):911-5

Contact Information Clare Halleran O.D. – drclarehalleran@gmail.com