Macular Degeneration: Zayit-Soudry S

Zayit-Soudry S, Moroz I, Loewenstein A. · Department of Ophthalmology, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Tel-Aviv, Israel. · Surv Ophthalmol. · Pubmed #17472800 No free full text.

Abstract: Detachment of the retinal pigment epithelium is a prominent feature of many chorio-retinal disease processes, the most prevalent of which is age-related macular degeneration (AMD). Detachment of the retinal pigment epithelium may or may not be associated with choroidal neovascularization and may be caused by different types of pathogenesis, each associated with distinct angiographic features, natural course, visual prognosis, and response to treatment. The phrase "detachment of the retinal pigment epithelium" is used quite often, not always in the correct association and with no clear differentiation between its various types. It is important to identify the specific nature of detachment of the retinal pigment epithelium, and to establish an accurate diagnosis and treatment plan. Therefore, we present a review of the existing types of detachment of the retinal pigment epithelium with what we propose as being appropriate nomenclature and classification, and potential treatment recommendations.

Zayit-Soudry S, Alfasi M, Goldstein M, Moisseiev J, Axer-Siegel R, Pollack A, Yassur Y, Loewenstein A. · Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. · Retina. · Pubmed #17621192 No free full text.

Abstract: PURPOSE: To determine the rate of agreement among five retina specialists in classifying various angiographic features of subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD), as evaluated on printed digital fluorescein angiogram (FA) frames, as well as determination of eligibility for photodynamic treatment (PDT) according to established guidelines. METHODS: Ninety-two digital FAs demonstrating subfoveal CNV secondary to AMD were evaluated independently by five retina specialists. The pattern of classic component could be classified as no classic component, minimally classic, predominantly classic, or classic only. Each grader was asked to determine eligibility of each case to PDT according to established treatment guidelines, national health insurance guidelines, and one's own personal judgment. RESULTS: The kappa coefficient of concordance calculated for all five observers regarding CNV localization was 0.285, indicating fair overall agreement, and was 0.295, indicating fair agreement, regarding classification of leakage pattern. The kappa coefficient of agreement calculated for all five graders regarding eligibility for treatment according to established international guidelines, national health insurance, and each grader's own personal judgment was 0.163, 0.33, and 0.164, respectively, indicating slight to fair overall agreement. CONCLUSION: Considerable variability may exist among retina specialists interpreting FAs and should be considered in the assessment of treatment guidelines.