Experience and training as determinants of grading reliability when assessing the severity of contact lens complications

Purpose: A study was conducted to investigate the influence of experience and training on grading reliability when assessing the severity of contact lens complications. Methods: Twenty-three optometry students who were unfamiliar with the use of grading scales each used the Efron Grading Tutor computer program to ascertain grading reliability at an 'initial' experimental session and a 'final' session 3 weeks later. Twelve subjects (the 'trained' group) were given a tutorial on grading techniques and were asked to complete two grading exercises between the initial and final sessions. The other 11 subjects (the 'untrained' group) received no such training between the two sessions. Differences in grading reliability between the initial and final grading sessions were evaluated. Results: Grading reliability was superior (lower) for the combined subject cohort at the final session (mean ± standard deviation 0.33 ± 0.12) compared with the initial session (0.46 ± 0.25) (p = 0.004). However, there was no difference in the improvement in grading reliability between the two groups. Conclusions: Grading reliability improves statistically with some experience, although perhaps not to a clinically meaningful extent. No added benefit can be derived from supplemental training. © 2003 The College of Optometrists.