Publications by Marc Schulze
Schulze,M. M., Hutchings,N., Simpson,T. L. Grading bulbar redness using cross-calibrated clinical grading scales. Investigative Ophthalmology and Visual Science 2011;52,8:5812-5817. [ Show Abstract ]
Purpose. To determine the between-scale agreement of grading estimates obtained with cross-calibrated McMonnies/Chapman- Davies (MC-D), Institute for Eye Research (IER), Efron, and Validated Bulbar Redness (VBR) grading scales. Methods. Modified reference images of each grading scale were positioned on a desk according to their perceived redness (within a 0 to 100 range) as determined in a previous psychophysical scaling experiment. Ten observers were asked to represent perceived bulbar redness of 16 sample images by placing them, one at a time, relative to the reference images of each scale. Only 0 and 100 were marked on the scale, but not the numerical position of the reference images. Perceived redness was taken as the measured position of the placed image from 0 and was averaged across observers. Results. Overall, perceived redness depended on the sample image and the reference scale used (repeated measures ANOVA; P = 0.0008); six sample images had a perceived redness that was significantly different between at least two of the scales. Between-scale correlation coefficients of concordance ranged from 0.93 (IER vs. Efron) to 0.98 (VBR vs. Efron). Between-scale coefficients of repeatability ranged from five units (IER vs. VBR) to eight units (IER vs. Efron) of the 0 to 100 range. Conclusions. The use of cross-calibrated reference grades for bulbar redness grading scales allows comparison of grading estimates obtained with different scales. Perceived redness is dependent on the dynamic range of the reference images of the scale, with redness estimates generally being found to be higher for scales with a shorter dynamic range. © 2011 The Association for Research in Vision and Ophthalmology, Inc.
Schulze,M. M., Hutchings,N., Simpson,T. L. The conversion of bulbar redness grades using psychophysical scaling. Optometry and Vision Science 2010;87,3:159-167.
Schulze,M. M., Hutchings,N., Simpson,T. L. The perceived bulbar redness of clinical grading scales. Optometry and Vision Science 2009;86,11:E1250-E1258. [ Show Abstract ]
Purpose. To use a psychophysical scaling method to estimate the perceived redness of reference images of the McMonnies and Chapman-Davies (six reference levels), Institute for Eye Research (four), Efron (five), and Validated Bulbar Redness (five) bulbar redness grading scales. Methods. Regions of interest were cropped out of the grading scale reference images; three separate image sets (color, grayscale, and binarized) were created for each scale, combining to a total of 20 images per image set. Ten naïve observers were asked to arrange printed copies of the 20 images per image set across a distance of 1.5 m on a flat surface, so that separation reflected their perception of bulbar redness; only start and end point of this range were indicated. The position of each image was averaged across observers to represent the perceived redness for this image, within the 0 to 100 range. Subjective data were compared with physical attributes (chromaticity and spatial metrics) of redness. Results. For each image set, perceived redness of the reference images within each scale was ordered as expected, but not all consecutive within-scale levels were rated as having different redness. Perceived redness of the reference images varied between scales, with different ranges of severity being covered by the images. Perception of redness severity depended on the image set (repeated-measures analysis of variance; all p ≤ 0.0002). The perceived redness was strongly associated with the physical attributes of the reference images. Conclusions. Subjective estimates of redness are based on a combination of chromaticity and vessel-based components. Psychophysical scaling of perceived redness lends itself to being used to cross-calibrate these four clinical scales. © 2009 American Academy of Optometry.
Schulze,M. M., Hutchings,N., Simpson,T. L. The use of fractal analysis and photometry to estimate the accuracy of bulbar redness grading scales. Investigative Ophthalmology and Visual Science 2008;49,4:1398-1406. [ Show Abstract ]
Purpose. To use physical attributes of redness to determine the accuracy of four bulbar redness grading scales, and to cross- calibrate the scales based on these physical measures. Methods. Two image-processing metrics, fractal dimension (D) and percentage of pixel coverage (% PC), as well as photometric chromaticity were selected as physical measures, to describe and compare grades of bulbar redness among the McMonnies/Chapman-Davies scale, the Efron Scale, the Institute for Eye Research scale, and a validated scale developed at the Centre for Contact Lens Research. Two sets of images were prepared by using image processing: The first included multiple segments covering the largest possible region of interest (ROI) within the bulbar conjunctiva in the original images; the second contained modified scale images that were matched in size and resolution across scales, and a single, equally-sized ROI. To measure photometric chromaticity, the original scale images were displayed on a computer monitor, and multiple conjunctival segments were analyzed. Pearson correlation coefficients between each set of image metrics and the reference image grades were calculated to determine the accuracy of the scales. Results. Correlations were high between reference image grades and all sets of objective metrics (all Pearson's r ≥ 0.88, P ≤ 0.05); each physical attribute pointed to a different scale as being most accurate. Independent of the physical attribute used, there were wide discrepancies between scale grades, with almost no overlap when cross-calibrating and comparing the scales. Conclusions. Despite the generally strong linear associations between the physical characteristics of reference images in each scale, the scales themselves are not inherently accurate and are too different to allow for cross-calibration. Copyright © Association for Research in Vision and Ophthalmology.
Schulze,M. M., Jones,D. A., Simpson,T. L. The development of validated bulbar redness grading scales. Optometry and Vision Science 2007;84,10:976-983. [ Show Abstract ]
PURPOSE: To develop a perceptually and physically based bulbar redness grading scale. METHODS: Digital conjunctival hyperemia photographs were taken using a photo-slit lamp at controlled exposures. Nine participants arranged 25 images on a tabletop over a range of 1.5 m, using separation to represent changes in redness. The position of each image was recorded and normalized for a 0 to 100 scale, and compared to chromaticity of each image obtained using a spectrophotometer. The performance of two versions of the scale (5 and 10 images) and a continuous grading scale was evaluated based on repeatability data collected from nineteen observers who used each scale twice to grade 30 randomly presented images of bulbar redness. RESULTS: Psychophysical scaling was highly correlated between single observers (Pearson's r >or= 0.92, p < 0.05). The averaged subjective grades significantly correlated with chromaticity (r = 0.95 and r = 0.99, p < 0.001 for CIE u* and log u*, respectively). Across all observers, test and retest ratings were highly correlated with either scale (r >or= 0.98), and showed high levels of repeatability expressed by intraclass correlation coefficients (ICC >or= 0.98), correlation coefficients of concordance (CCC >or= 0.96), and coefficients of repeatability (COR <or= 5.64). Despite single unit increment options, the majority of grade values assigned using the discrete scales were distributed in multiples of 5. CONCLUSIONS: Combining psychophysical and physical attributes is a promising method for the development of novel anterior segment scales; the newly developed scales performed well in a clinical setting.
Sorbara,L., Simpson,T., Duench,S., Schulze,M., Fonn,D. Comparison of an objective method of measuring bulbar redness to the use of traditional grading scales. Contact Lens and Anterior Eye 2007;30,1:53-59. [ Show Abstract ]
Purpose: The primary objective was to compare measures of bulbar redness objectively using a photometric method with standard grading methods. Measures of redness were made on 24 participants wearing a silicone hydrogel contact lens in one eye for overnight wear. This report compares hyperaemia after 1 week of daily wear (baseline) with redness measured after 6 months of overnight wear. Method: A new method of objectively measuring bulbar conjunctival redness was performed using the Spectrascan650® Photometer by Photo Research® under fixed illumination. Photometric measures in CIEu* chromaticity values involve the measurement of chromaticity, a physical analogue of redness, greenness and blueness in the image. This method was validated in Part 1 of the study using repeated measurements on the photographic CCLRU scale. In Part 2 of the study, the photographic grading scale (CCLRU) from 0 (none) to 100 (extreme) was used to make the comparison. Results: Part 1 indicated that the photometer provides a repeatable and reliable measure of bulbar redness (CCC = 0.989). A moderately strong and significant correlation was found between the CIEu* chromaticity values and the analogue data (R = 0.795, p = 0.000) at each measurement session (from baseline to 1 day, 1 week, and 1, 3 and 6 months of overnight wear). Conclusions: This new standardized and objective method of measuring bulbar redness has great potential to replace subjective grading scales, especially with multi-centre studies, where variability between investigators occurs. This method may also detect smaller changes between visits or between eyes. Crown Copyright © 2007.
Schulze M, Varikooty J, Keir N, Jones L. The clinical performance of three contact lens solutions in symptomatic and asymptomatic contact lens wearers.
Jerchel N, Sickenberger W, Schulze M. Objective classification and documentation of bulbar redness using a corneal topographer.
Clinical Conference of the British Contact Lens Association (Birmingham, UK), 2012.
Schulze M, Simpson T, Stolee P. Rasch Analysis Of Bulbar Redness Scaling And The Relationship Between Physical Redness (u’) and “Rasch Redness”.
ARVO Meeting Abstracts 2011;521966.
Simpson T, Schulze M, Stolee P. Rasch Analysis of Clinical Grading of Corneal Staining.
ARVO Meeting Abstracts 2011;521967.
Schulze M, Simpson T, Situ P, Menzies K, Walther H, Jones L. Effects of magnification on tear meniscus parameters using optical coherence tomography (OCT) images.
Optom Vis Sci 2011;87:E-abstract 115482.
Schulze M, Simpson T, Feng Y, Lucchetti E, Chou R, Hutchings N. Statistical Approach for Differentiating Happy and Unhappy Progressive Addition Lens Wearers.
Optom Vis Sci 2010E-Abstract 105398.
Schulze M, Hutchings N, Simpson T. Grading Bulbar Redness using Cross-calibrated Grading Scales.
Optom Vis Sci 2009E-Abstract 95543.
Schulze M, Hutchings N, Simpson T. Clinical Scale Constancy – The Relationship between Bulbar Redness Grading Scales.
Contact Lens & Anterior Eye 2009;32210-254.
Schulze M, Hutchings N, Simpson TL. Perceptual differences between reference images of bulbar redness grading scales.
Optom Vis Sci 2008;85.
[ Show Abstract ]
Schulze M, Simpson TL, Hutchings N. Cross-calibrating between grading scales of redness — is it possible?.
Invest Ophthalmol Vis Sci 2007;48.
[ Show Abstract ]
Schulze M, Hutchings N, Simpson T. Cross-calibrating between grading scales of redness: is it possible?.
Biomedical Imaging & Computer Vision (BICV) Conference, Waterloo, ON, CA., 2007.
Schulze M, Hutchings N, Simpson T. The use of fractal analysis to estimate the accuracy of bulbar redness grading scales.
6th Canadian Optometry Conference on Vision Science, Waterloo, Ontario, 2007.
Jones D, Schulze M, Simpson T. The Application of Clinical Grading Scales by Trained and Non-trained Observers.
Contact Lens & Anterior Eye 2001;2523-51.
Schulze M, Jones D, Simpson T. The Production of an Enhanced Grading Scale for Determination of Ocular Hyperaemia (BCLA 2001 Da Vinci Award).
Contact Lens & Anterior Eye 2001;2523-51.
Schulze M, Jones D, Simpson T. The production of an enhanced grading scale for determination of ocular hyperemia.
Optom Vis Sci 2000;77,12s:184.