Trachomatous Scar Ranking: A Novel Outcome for Trachoma Studies

Angela Baldwin Francis I. Proctor Foundation, University of California, San Francisco, California.
School of Public Health, University of California, Berkeley, California.

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Alexander M. Ryner Francis I. Proctor Foundation, University of California, San Francisco, California.

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Zerihun Tadesse The Carter Center Ethiopia, Addis Ababa, Ethiopia.

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Ayalew Shiferaw The Carter Center Ethiopia, Addis Ababa, Ethiopia.

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Kelly Callahan The Carter Center, Atlanta, Georgia.

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Dionna M. Fry Francis I. Proctor Foundation, University of California, San Francisco, California.

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Zhaoxia Zhou Francis I. Proctor Foundation, University of California, San Francisco, California.

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Thomas M. Lietman Francis I. Proctor Foundation, University of California, San Francisco, California.
Department of Ophthalmology, University of California, San Francisco, California.

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Jeremy D. Keenan Francis I. Proctor Foundation, University of California, San Francisco, California.
Department of Ophthalmology, University of California, San Francisco, California.

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DOI:
https://doi.org/10.4269/ajtmh.16-0958
Volume/Issue:
Volume 96: Issue 6
Page(s):
1378–1381
Restricted access
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We evaluated a new trachoma scarring ranking system with potential use in clinical research. The upper right tarsal conjunctivas of 427 individuals from Ethiopian villages with hyperendemic trachoma were photographed. An expert grader first assigned a scar grade to each photograph using the 1981 World Health Organization (WHO) grading system. Then, all photographs were ranked from least (rank = 1) to most scarring (rank = 427). Photographic grading found 79 (18.5%) conjunctivae without scarring (C0), 191 (44.7%) with minimal scarring (C1), 105 (24.6%) with moderate scarring (C2), and 52 (12.2%) with severe scarring (C3). The ranking method demonstrated good internal validity, exhibiting a monotonic increase in the median rank across the levels of the 1981 WHO grading system. Intrarater repeatability was better for the ranking method (intraclass correlation coefficient = 0.84, 95% CI = 0.74–0.94). Exhibiting better internal and external validity, this ranking method may be useful for evaluating the difference in scarring between groups of individuals.

Author Notes

* Address correspondence to Jeremy D. Keenan, 513 Parnassus Avenue, MedSci S334B, Box 0412, University of California, San Francisco, CA 94143. E-mail: jeremy.keenan@ucsf.edu

Authors' addresses: Angela Baldwin, Francis I. Proctor Foundation, University of California, San Francisco, CA, and University of California, Berkeley, CA, E-mail: angela.baldwin@ucsf.edu. Alexander M. Ryner, Dionna Fry, and Zhaoxia Zhou, Francis I. Proctor Foundation, University of California, San Francisco, CA, E-mails: alexander.ryner@ucsf.edu, dionna.fry@ucsf.edu, and zhaoxia.zhou@ucsf.edu. Zerihun Tadesse and Ayalew Shiferaw, The Carter Center Ethiopia, Addis Ababa, Ethiopia, E-mails: zerihun.tadesse@cartercenter.org and ayalew.shiferaw@cartercenter.org. Kelly Callahan, The Carter Center, Atlanta, GA, E-mail: kelly.callahan@cartercenter.org. Thomas M. Lietman and Jeremy D. Keenan, Francis I. Proctor Foundation, University of California, San Francisco, CA, and Department of Ophthalmology, University of California, San Francisco, CA, E-mails: tom.lietman@ucsf.edu and jeremy.keenan@ucsf.edu.

Copyright:
© The American Society of Tropical Medicine and Hygiene 2017
Received:
07 Dec 2016
|
Accepted:
28 Jan 2017
|
Published Online:
07 Jun 2017
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645
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