CAN NON-OPHTHALMOLOGISTS RELIABLY GRADE AS-OCT CELL COUNTS IN PAEDIATRIC UVEITIS?

Uveitis is a significant cause of childhood visual morbidity, and accurate assessment of anterior chamber inflammation is critical for timely diagnosis and management. The Standardisation of Uveitis Nomenclature (SUN) scale is widely used but limited by subjectivity and inter-observer variability, particularly in paediatric settings.

Anterior segment optical coherence tomography (AS-OCT) has emerged as a valuable adjunct, allowing for more objective and reproducible quantification of inflammatory cells. This study evaluates whether non-ophthalmologists specifically a final-year medical student and an optician can reliably grade AS-OCT cell counts in paediatric uveitis compared with a consultant ophthalmologist.

From a database of 93 paediatric uveitis eyes, seven central B-scans from each episode were graded by a consultant ophthalmologist, a final-year medical student, and an optician. Mean cell counts per episode were derived from these seven frames.

Agreement between graders was assessed using intraclass correlation coefficients (ICC, two-way random, absolute agreement) across SUN grades. Diagnostic performance was evaluated using false-positive and false-negative rates relative to clinical grading, and quantitative agreement was measured using mean absolute differences (MAD) in cell counts. Grader means were compared with the consultant’s ±1 standard-error (SE) range.

Statistical analysis was performed using RStudio.

Non-ophthalmologist graders demonstrated excellent reliability with the consultant ophthalmologist, with ICC values of 0.851 at 0.5+, 0.954 at 1+, 0.932 at 2+, and 0.923 at 3+.

False-positive rates were 10.9% (consultant), 23.9% (medical student), and 26.1% (optician); false-negative rates were 0%, 2.1%, and 2.1%, respectively.

Mean absolute differences were 0.59 ± 0.79 cells (medical student) and 0.66 ± 0.54 cells (optician), with both graders’ means remaining within the consultant’s SE range across all grades.

Non-ophthalmologist graders achieved a high degree of quantitative agreement with the consultant ophthalmologist in AS-OCT cell grading, with minimal deviation and low false-negative rates. Agreement improved with increasing inflammation severity, likely reflecting greater distinction between true inflammatory cells and image artefacts in active disease.

These findings suggest that non-ophthalmologists can accurately perform AS-OCT cell grading following structured guidance. Integrating non-ophthalmologist graders into AS-OCT assessment pathways could enhance early detection of disease activity, reduce clinician workload, streamline uveitis follow-up clinics, and improve access to consistent, objective monitoring in both tertiary and community settings.