Corneal staining patterns in vernal keratoconjunctivitis: the new VKC-CLEK scoring scale

Area of Science:

• Ophthalmology
• Ocular Surface Disease
• Clinical Assessment

Background:

• Vernal keratoconjunctivitis (VKC) is a bilateral, itching, seasonal eye inflammation.
• Accurate assessment of ocular surface epithelial damage is crucial for managing VKC.
• Current scoring systems may not fully capture the extent of damage, particularly in limbal VKC.

Purpose of the Study:

• To introduce and validate a novel scoring system, the VKC-Collaborative Longitudinal Evaluation of Keratoconus study (VKC-CLEK) score.
• To compare the efficacy of the VKC-CLEK score with existing methods (Oxford and Van Bijsterveld) in evaluating epithelial damage in VKC patients.
• To assess the correlation between the new scoring system and patient-reported quality of life.

Main Methods:

• Twenty-five VKC patients (50 eyes) were assessed.
• Objective measures included fluorescein and lissamine green staining, and confocal microscopy.
• Epithelial damage was evaluated using Oxford, Van Bijsterveld, and the proposed VKC-CLEK scoring systems.
• The Quality of Life in children with VKC (QUICK) questionnaire was administered.

Main Results:

• The VKC-CLEK score demonstrated significant differences and correlations with both fluorescein (r=0.649) and lissamine green staining (r=0.760) compared to standard scores.
• Significant differences were observed between VKC-CLEK and standard scores in limbal VKC, but not tarsal VKC.
• VKC-CLEK showed superior concordance with the QUICK questionnaire compared to standard staining scores.

Conclusions:

• Existing Oxford and Van Bijsterveld scores are inadequate for evaluating epithelial damage in limbal VKC.
• The proposed VKC-CLEK scoring system offers a more accurate assessment of both limbal and tarsal epithelial damage in VKC.
• The VKC-CLEK system better correlates with patient-reported quality of life.