The Conversion of Bulbar Redness Grades Using Psychophysical Scaling

Abstract

To use psychophysical scaling to investigate if the inclusion of reference anchors affected the perceived redness of the reference images of four bulbar redness grading scales and to convert grades between scales. Ten participants were asked to arrange printed copies of the McMonnies/Chapman-Davies (6), IER (4), and Efron (5) grading scale images relative to each other, using the stationary but unlabeled 10, 30, 50, 70, and 90 reference images of the validated bulbar redness scale as additional anchors within a given 0 (minimum) to 100 (maximum) redness range (anchored scaling). The position of each image was averaged across observers to represent its perceived redness within this range. Anchored scaling data were then compared with data from a previous study, where the images of all four grading scales had been scaled for the same experimental setup, but with no reference anchors provided (non-anchored scaling). Averaged perceived redness as determined with anchored scaling was used to cross-calibrate grades between scales. Overall, perceived redness of the reference images was significantly different within each scale (repeated measures analysis of variance, all scales p < 0.001). There were differences in perceived redness range and when comparing reference levels between scales. Anchored scaling resulted in an apparent shift to lower perceived redness for all but one reference image compared with non-anchored scaling, with the rank order of the 20 images for both procedures remaining fairly constant (Spearman's ρ = 0.99). The re-scaling of the reference images in the anchored scaling experiment suggests that redness was assessed based on within-scale characteristics and not using absolute redness scores, a mechanism that can be referred to as clinical scale constancy. The perceived redness data allow practitioners to modify the grades of the scale they commonly use for comparison of their grading estimates with grades obtained with another calibrated scale.