NIH scale appears most sensitive to changes in graft-versus-host disease

This prospective multicenter study sought to validate and select the best measurement scales for rating ocular chronic graft-versus-host disease (GVHD) after allogeneic hematopoietic cell transplantation. The authors compared five scales, with the results supporting the use of the National Institutes of Health (NIH) eye score to assess eye symptom changes in clinical trials for chronic GVHD.

The study enrolled 387 patients with chronic GVHD. The five scales were recommended for use in clinical trials by the NIH Chronic GVHD Consensus Conference or were previously validated in dry eye syndromes. The measures were required to be easy to use by both transplantation and nontransplantation care providers and easily available in the outpatient setting.

The authors compared clinician or patient-reported changes in eye symptoms with calculated changes in the NIH eye score, patient-reported global rating of eye symptoms, Lee eye subscale, Ocular Surface Disease Index, and Schirmer test. All of the scales except the Schirmer test correlated with both clinician-reported and patient-reported changes in ocular GVHD activity. However, changes in the NIH eye score showed the greatest sensitivity to symptom change reported by clinicians or patients.

The authors say that this four-level scale takes less than 15 seconds to complete during an outpatient visit, without requiring a formal patient survey, special equipment or trained personnel. Also, it required less time to collect than the other measurement scales and was collected more frequently during the study. They say this makes it most likely to be captured reliably and efficiently, and that its use would dramatically decrease the time required to assess ocular chronic GVHD and eliminate the need for the Schirmer test.