International Ophthalmology

, Volume 38, Issue 6, pp 2303–2311 | Cite as

Validity of a new comprehensive pterygia grading scale for use in clinical research and clinical trial

  • Ping Huang
  • Jianyan Huang
  • Tudor Tepelus
  • Jyotsna Maram
  • Srinivas Sadda
  • Olivia L. LeeEmail author
Original Paper



To determine the reliability and agreement of a new comprehensive pterygium grading scale for use in clinical research and clinical trials.


Thirty eyes with pterygia were enrolled in this study. Primary gaze position and lateral gaze position images were taken of each eye with a modified single-lens reflex camera system. Our grading scale includes five parameters: two hyperemia parameters of pterygia on two different gaze position images and three size parameters, quantifying length, width, and area of the cornea encroachment of pterygium, using ImageJ software. All images were graded on the five parameters by two masked, certified reading center graders. Two graders independently graded all the images to determine inter-grader reliability. One grader regraded the images after 3 days to determine intra-grader reliability. Intraclass correlation coefficient (ICC) and inter-rater agreement statistic (κ) calculations were performed.


The intra-grader reliability for hyperemia grading was high on both primary and lateral gazing positions (κ value is 0.93 and 0.96). The inter-grader reliability for hyperemia grading was also good (κ value is 0.85 and 0.87). The mean value of width, length, and area of the cornea encroachment of pterygium was 4.31 ± 2.04 mm, 2.08 ± 1.43 mm, and 7.84 ± 7.62 mm2, respectively. The intra-grader agreement on width, length, and area were excellent, with ICCs of 0.98 (95% CI 0.96–0.99), 0.99 (95% CI 0.98–1.0), and 0.97 (95% CI 0.94–0.99), respectively. The inter-grader agreement on width, length, and area were also excellent, with ICCs of 0.96 (95% CI 0.90–0.98), 0.99 (95% CI 0.98–0.99), and 0.99 (95% CI 0.97–0.99), respectively.


There was excellent intra- and inter-observer reproducibility with the new comprehensive grading scale. This scale could lead to the development of standardized grading assessments and quantification of pterygia that would be valid in clinical research and clinical trials.


Pterygium Grading scale Image 



We would like to thank Dr. Vikas Chopra for providing insight and expertise that greatly assisted the research and for comments that greatly improved the manuscript.

Compliance with ethical standards

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements) or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (UCLA Office of the Human Research Protection Program (OHRPP) IRB) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media B.V. 2017

Authors and Affiliations

  • Ping Huang
    • 1
  • Jianyan Huang
    • 1
  • Tudor Tepelus
    • 1
  • Jyotsna Maram
    • 1
  • Srinivas Sadda
    • 1
    • 2
  • Olivia L. Lee
    • 1
    • 2
    • 3
    Email author
  1. 1.Doheny Image Reading CenterDoheny Eye InstituteLos AngelesUSA
  2. 2.Department of Ophthalmology, David Geffen School of MedicineUniversity of California Los AngelesLos AngelesUSA
  3. 3.PasadenaUSA

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