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° 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%; κ=0.26–0.63) and intermediate soft drusen (76–94%; κ=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%; κ=0.60–0.95) and substantial to almost perfect for the presence of choroidal neovascularization (84–100%; κ=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.
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Acknowledgements.
We thank Andrew Webster for general support and Nicola Harris for data input. This work was supported by Deutsche Forschungsgemeinschaft grant SCHO 734/1-1 to H.P.N.S., a grant from Friends of Moorfields to T.P., and grants from the Medical Research Council (no. G000682) and the Foundation for Fighting Blindness to S.D.
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Parts of this study were presented at the 100th annual meeting of the Deutsche Ophthalmologische Gesellschaft, 26–29 September 2002 in Berlin (no. DO.01.18)
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Scholl, H.P.N., Peto, T., Dandekar, S. et al. Inter- and intra-observer variability in grading lesions of age-related maculopathy and macular degeneration. Graefe's Arch Clin Exp Ophthalmol 241, 39–47 (2003). https://doi.org/10.1007/s00417-002-0602-8
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DOI: https://doi.org/10.1007/s00417-002-0602-8