1. Prospective Correlation of Symptoms and Clinical Grading in Vernal Keratoconjunctivitis Patients Srikant K Sahu, Shraddha Pawan Sureka, Sujata Das, Apurva Hardas L V Prasad Eye Institute, Patia, Bhubaneswar, India.

2. None of the authors have any financial disclosure to make

3. Introduction Vernal keratoconjunctivitis (VKC) is a chronic, bilateral, inflammatory disease of the ocular surface Characterized by intense ocular itching, redness, stringy discharge & photophobia  Palpebral VKC  Limbal VKC  Mixed VKC

4. Problem The grading of VKC is subjective There is a mismatch between symptoms and signs – Leads to confusion in the allotment of a clinical grade There is no universal way of grading the disease Objective of the study To assess of the symptoms by Visual analogue scale and correlate it with disease severity graded by Bonini

5. Ref: Bonini S, et al. Vernal keratoconjunctivitis revisited. A case series of 195 patients with long-term follow up. Ophthalmology. 2000;107:1157–1163. Methods Visual analogue scale: Redness, itching, watering, photophobia, burning sensation, foreign body sensation, decreased vision Each symptom given score of 0 to 10 – Added Disease severity by Bonini claassification Grades 1, 2A, 2B, 3, 4 Limbal, tarsal or mixed form Allergic tendency

6. Methods - Statistics Symptom score was correlated with disease severity as per Bonini classification Spearman’s rank correlation coefficient Multiple regression analysis

7. Results Bonini grade - disease severity No. of patie nts 119 2A15 2B15 39 42 Form of disease No. of patients Palpebral16 Limbal20 Mixed24 Age at presentation 10.7 ± 5.0 years (Mean ± SD), Median 10 years Range, 3-25 years Males: Females49:11 Duration between onset & presentation 3.2 ± 2.9 years (Mean ± SD), Median 2 years Range, 0-12 years

8. Results – Symptom score & Correlation with disease severity SymptomMeanMedianStd. Deviation Spearman rP Burning2.932.80.2250.084 Itching6.772.3-0.0030.981 Photophobia3.333.20.3160.014* Watering5.462.80.1260.338 Redness7.281.80.1720.189 FB sensation2.002.80.1090.407 Decreased vision 1.402.70.1820.164 * Significant correlation

9. Results – Symptom score & Correlation with disease severity – Multivariate analysis Symptom Coefficient 95% Confidence intervals P values Burning 0.062-0.066-0.1910.335 Itching -0.080-0.231-0.0710.292 Photophobia 0.102-0.001-0.2060.053 Watering 0.030-0.088-0.1490.609 Redness 0.012-0.168-0.1910.898 FB sensation -0.015-0.149-0.1180.819 Decreased vision 0.028-0.095-0.1510.652

10. Demographic data suggests that clinical profile of the disease in our setting varies as compared to the studies reported world wide Complications like keratoconus, limbal stem cell deficiency and corneal scarring is seen more commonly in our setting Photophobia is an important symptom Tendency for increased symptom score of photophobia to be associated with increased disease severity No other symptoms showed any correlation with disease severity Thus patients symptoms need separate grading Discussion

11. Clinical symptoms of VKC do not correlate with signs and need to be graded separately for objectively treating and prospectively assessing management. VAS scores can be easily used for grading symptoms and Bonini classification for grading signs. Allergy tendency would be recorded separately. This classification would need further studies for validation and and considering prospective plotting of each of the scores on a graph every 6 months. Conclusions

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