Abstract :
PURPOE: To decribe the ytem for grading age-related macular degeneration from fundu photograph in the Age-Related Eye Dieae tudy. Thi i a propective multicenter cohort tudy of the coure of age-related macular degeneration and a placebo-controlled clinical trial of the effect of high-doe vitamin and mineral upplement on development of advanced age-related macular degeneration.
METHOD: tandardized tereocopic 30-degree color fundu photograph are taken at 11 clinical center and evaluated by grader at a reading center for quality and age-related macular degeneration abnormalitie. Macular ubfield are defined by a grid, and preence and everity of variou age-related macular degeneration abnormalitie are graded uing tandard/example photograph and meauring circle. Advanced age-related macular degeneration abnormalitie (preence/abence) include retinal pigment epithelial detachment, erou (or hemorrhagic) enory retinal detachment, hard exudate, ubretinal/ubretinal pigment epithelial hemorrhage, ubretinal fibrou tiue, and photocoagulation car. Other abnormalitie (multitep cale) include retinal pigment epithelial abnormalitie (geographic atrophy, depigmentation, and increaed pigment), and druen (ize, type [hard veru oft ditinct or inditinct], and total area). Contemporaneou variability i teted by having different grader evaluate ample of photograph, and temporal variability by annual regrading of a dedicated ubet.
REULT: In a cumulative ample of 1230 eye for contemporaneou reproducibility, agreement on advanced age-related macular degeneration wa 96% (kappa = 0.88) and for four-tep age-related macular degeneration level wa 83% (κ = 0.77). Agreement wa moderate for pigment epithelial detachment (κ = 0.54) and ubtantial for erou enory retinal detachment, hard exudate, ubretinal/ubretinal pigment epithelial hemorrhage, ubretinal fibrou tiue, and central geographic atrophy (κ = 0.73–0.82). For pigment abnormalitie, agreement wa ubtantial for geographic atrophy (κ = 0.63; κweighted = 0.71, 0.75 weight for one-tep diagreement), and moderate for depigmentation (κ = 0.41, κweighted = 0.51) and increaed pigment (κ = 0.54, κweighted = 0.71). For druen, agreement wa moderate to ubtantial for preence/maximum ize (κ = 0.50, κweighted = 0.68), type (κ = 0.61, κweighted = 0.69), and area (κ = 0.56, κweighted = 0.77). ix annual regrade of 119 eye howed little temporal drift in grading of variou age-related macular degeneration abnormalitie, except for druen type.
CONCLUION: The Age-Related Eye Dieae tudy ha demontrated atifactory reliability for detecting onet of advanced age-related macular degeneration in a cohort, and moderate to ubtantial agreement on variou abnormalitie acro the age-related macular degeneration pectrum. The Age-Related Eye Dieae tudy ytem for claification of age-related macular degeneration i uitable for longitudinal multicenter tudie
