ArticlePloS one2019
Awareness of treatment: A source of bias in subjective grading of ocular complications.
Article in PloS one, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
4 citing papers in PubMed.
- Conjunctival Vascular Metrics Using Automated Vessel Detection from Slit Lamp Images for Hyperemia Severity Assessment.Diagnostics (Basel, Switzerland) · 2026Article
- From Proteome to miRNome: A Review of Multi-Omics Ocular Allergy Research Using Human Tears.International journal of molecular sciences · 2026Review
- Grading Scales of Conjunctival Inflammation.Diagnostics (Basel, Switzerland) · 2025Review
- Toward automated assessment of conjunctival hyperemia: A semisupervised artificial intelligence approach.Annals of the New York Academy of Sciences · 2025Article
Corrections and comments
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Authors and funding
2 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeBias has been described as one important obstacle in scientific research. The aim of this study was to explore "awareness of treatment" as a possible source of bias in subjective grading of ocular complications.
methodsThirty subjects with similar, basic experience with grading scales participated in the study. The Efron grading scales were used to grade 24 images of three different ocular conditions (eight images each of bulbar hyperaemia, limbal vascularization and corneal staining). Three consecutive, two weeks apart, grading sessions were scheduled, in which the same images were graded, although in the third session images were deceptively labelled as either "treated" or "untreated". Grading results from the first and second sessions were compared to determine grading reliability and discrepancies with the third session informed of grading bias originating from "awareness of treatment".
resultsModerate to good test-retest reliability was found for all conditions, with median intraclass correlation values of 0.80 (0.62-0.84) for bulbar hyperaemia, 0.68 (0.65-0.77) for limbal vascularization and 0.68 (0.66-0.74) for corneal staining. Grading values from the first and third sessions evidenced negative and positive systematic errors (bias) for "treated" and "untreated" conditions, respectively. Statistically significant differences were found between the average grading discrepancies of session 1 and session 2 and those of session 1 and session 3 (all p<0.001).
conclusions"Awareness of treatment" may be considered a source of bias of subjective grading of ocular complications, although the actual effect of bias is unlikely to be of clinical significance.
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