Macular Degeneration: Dandekar S

Vujosevic S, Vaclavik V, Bird AC, Leung I, Dandekar S, Peto T. · Fondazione G.B. Bietti per l'Oftalmologia, IRCCS, Via Livenza 3, 00198 Roma, Italy. · Graefes Arch Clin Exp Ophthalmol. · Pubmed #17429674 No free full text.

Abstract: BACKGROUND: Patients with age-related macular degeneration (ARMD) have several imaging techniques carried out regularly. In this study we introduce a new grading model of autofluorescence images (AF), compare it with fluorescein angiography (FFA) and digital colour fundus photos (COL) and test for inter- and intraobserver reliability. METHODS: A total of 71 eyes of 54 patients with bilateral or unilateral CNV had COL, FFA and AF, fulfilling the inclusion criterion of having all 3 types of imaging carried out on the same day or within 14 days. The grading of COL was performed by a trained grader based on the International ARM classification; FFA and AF images were independently graded by two trained retinal specialists in order to assess inter-observer reliability. Overall, 30% of all images were regraded after at least 14 days interval to assess intra-observer variability. RESULTS: The intergrader agreement was exact for classification of CNV (k = 1.00); almost perfect for FFA features (k = 0.83) and correspondence of decreased AF to COL (k = 0.94); substantial for patterns of decreased and increased AF (k = 0.80, k = 0.78), correspondence of patterns of increased AF to FFA and to COL (k = 0.78, k = 0.74) and background AF (k = 0.72); moderate for CNV diameter in FFA (k = 0.45), FFA pattern (k = 0.43), dimension of increased and decreased AF (k = 0.5, k = 0.56); fair for quality of FFA and AF images (k = 0.21, k = 0.26) respectively. The intragrader agreement varied from exact to substantial for all categories. Diffuse and reticular patterns of decreased AF and reticular pattern of increased AF correlated well, with visual acuity worse than 6/24. CONCLUSION: The combined grading system was reliable for evaluating the three imaging techniques, and might be suitable for epidemiological studies and therapeutic trials where such grading is warranted. Certain AF patterns seem to predict VA outcome better than one might have predicted based on FFA. Further studies are needed to evaluate its usefulness in clinical settings for predicting outcomes for patients receiving therapy for end-stage disease.

Scholl HP, Peto T, Dandekar S, Bunce C, Xing W, Jenkins S, Bird AC. · Institute of Ophthalmology, Moorfields Eye Hospital, 162 City Road, EC1 V2PD, London, UK. · Graefes Arch Clin Exp Ophthalmol. · Pubmed #12545291 No free full text.

Abstract: PURPOSE. To introduce a revised version of the grading system established by the International ARM Epidemiological Study Group for identifying and quantifying abnormalities of age-related maculopathy (ARM) and age-related degeneration (AMD) and to investigate its reliability, specifically the inter- and intra-observer variability. METHODS. Fifty eyes of 25 patients with ARM or AMD in at least one eye were randomly selected from a large ongoing collection of clinical data and DNA in a tertiary referral UK population. Stereoscopic color fundus photographs were taken with a 30 degrees fundus camera and were centered on the macula. Presence and severity of fundus abnormalities in ARM and AMD were graded using a grid to define macular subfields and standard circles to define the size of lesions. Inter-observer variability was assessed by having three retinal specialists evaluate the color slides and intra-observer variability by re-grading the same set. RESULTS. The inter-observer agreement for all subfields was fair to substantial for small hard drusen (70-89%; kappa=0.26-0.63) and intermediate soft drusen (76-94%; kappa=0.27-0.69). Agreement ranged between 87% and 100%, between 50% and 92%, and between 78% and 100% for larger drusen, the presence of hyperpigmentation, and the presence of hypopigmentation, respectively. Agreement was moderate to almost perfect for the presence of geographic atrophy (88-98%; kappa=0.60-0.95) and substantial to almost perfect for the presence of choroidal neovascularization (84-100%; kappa=0.62-1.00). The intra-observer variability for the grading of drusen characteristics and pigmentary changes was similar in magnitude, but slightly greater for features of advanced AMD. CONCLUSION. Reproducibility was achieved using a revised version of the grading system established by the International ARM Epidemiological Study Group. This grading system may therefore be used for phenotyping of ARM and AMD.