THE USE OF COLOR SLIDES IN THE ASSESSMENT OF CHANGES IN SOFT-TISSUE INVOLVEMENT IN GRAVES OPHTHALMOPATHY

There is a need for more reliable and validated methods to assess the eye changes in Graves' disease. Such measurements are now available fo r the assessment of proptosis, eye muscle dysfunction, and optic nerve involvement. However, no validated objective measurement exists for N O SPECS class II signs. The present study compares the use of colour s lides with clinical grading for assessing soft-tissue involvement. For ty-three patients were treated with retrobulbar irradiation. Pre-treat ment, and 6 months post-treatment the severity of class II signs was g raded from 0 to grade c in two ways; 1) Clinically, by two independent , experienced observers, who recorded their scores on the same day; 2) From colour slides, taken at the same visits, which were graded after wards in one session independently by the same observers. Inter-observ er agreement about clinical grading was low (Kappa 0.32), and was not improved by using the slides (Kappa 0.35). However, by using the clini cal scores, the observers disagreed on treatment outcome in 21/43 pati ents (49%, whereas using the slides disagreement occurred in only 6/43 (14%, p<0.01). It is concluded that the grading of soft-tissue involv ement is highly subjective. However, the use of colour slides does pro vide a more reliable way to assess a treatment effect and should be us ed in clinical trials. (J. Endocrinol. Invest. 21: 459-462, 1998) (C) 1998, Editrice Kurtis.