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Age-related Macular Degeneration Phenotype Consensus Meeting

Table 1: Comparing color photographs grading

 

AREDS

Beaver Dam

Blue Mountains

CAPT

Melbourne

MEH

Rotterdam

Wilmer Eye Institute

Quality

Good

Fair

Borderline/Poor

Explained/unexplained

Focus/Field/Stereo/Other

Good

Fair

Borderline/Poor

Explained/unexplained

Focus/Field/Stereo/Other

Gradable/ungradeable/

Not present

Good/fair/poor for

Focus/Field/Stereo

1, Good

2, fair

3, poor

4, missing

Focus – field- stereo

Good – fair – poor

NO MISSING on grading form

1-5: perfect – not gradable

9: Missing

Focus – field

Good – fair – cannot grade

Reasons given

Focus – field- stereo

Adequate Fair- poor

Missing

Measuring tools

C0-2: size

I1-2; O1-2:  area

C0-2: size

I1-2; O1-2:  area

C0-2: size

I1-2; O1-2:  area

C0 (63 μ)

C1 (125 μ)

C2 (250 μ)

C0- C4: 63 μ; 125 μ; 175 μ; 250 μ; 500 μ circles

C0-C4: 63 μ; 125 μ; 175 μ; 250 μ; 500 μ circles

C0-C2: 63 μ; 125 μ; 250 μ circles

C2 = 250 μ

C0, C1, C2 for fellow eye Drusen for most advanced AMD

MPS for FFA

Double grading

Yes: Preliminary and detailed

Yes: Preliminary and detailed and edit

(and longitudinal regrades for incidence)

No

Open adjudication

Side-by-side grading for F/U

Yes, with open adjudication

Senior grader might grade some images alone

No

Side-by-side grading for F/U

Collate clinical result with grading for observational studies

Yes, with open adjudication

Senior grader might grade some images alone

YES

Yes with review

Grading rules

<50% Not present

51-90% Q

>90% Present

 

SAME

 

SAME

 

SAME

Does not use category of Questionable

 

SAME

 

SAME

 

SAME

Grid used

500 μ -1500 μ -3000 μ radius

9 fields

SAME

 

9 fields

SAME

 

3 fields

SAME

 

3 fields

SAME

 

3 fields

SAME

 

3 fields

SAME

 

3 fields

 

SAME

Number of fields taken

3 stereo fields: Fields 1M, 2, 3M

3 fields: Fields 1-3, plus iris

7 fields, disc and macula stereo

Stereo Fields 1-2 at baseline then Field 2

Field 2: up until 2002 stereo film

Currently in the process of evaluating digital

Usually Field 2: Centred on the macula

35 degree field of the macula

Stereo fields 1+2

Drusen grading protocol based on:

Wisconsin

Wisconsin

Wisconsin

International

International

International

International

Wisconsin

 

Estimate max. size

Estimate max. size

Estimate max. size

 

 

 

 

Est.max.size

<63 μ

C0

<C0

C0

C0

C0

C0

C0

C0

63-125 μ

C1

C0 - <C1

C1

C1

C0-C1

C1

C1

C1

125-250 μ

C1 – C2

C1 – <C2

C2

C2 (250 μ)

C1-C2 and C2 – C3

C1 – C3

C2

>125

250-500 μ

C2

≥C2

≥C2

>C2

>C3

C3 – C4

 

No

>500 μ

No

No

No

 

No

> C4

 

No

Number

Only record area covered by drusen

Same as AREDS

<10;  ≥10

Only >125 μ

<10; 10-20, >20

Total number by type of Drusen: Q; 1-9; 10-19; ≥ 20

1-9, 10-19; 20- 50; >50

In grid-outside grid; size C0; C1; C2

0; 0-10, <20; >20

Any size: 1-4; 5-19; 20 or more

Confluency

Soft distinct

Soft indistinct

Hard distinct

Hard indistinct

Soft distinct

Soft indistinct

In all subfields

Plus measure longest continuous

Soft distinct

Soft indistinct

None

<10 pairs

≥10 pairs

Soft distinct

Soft indistinct

Within grid

Per circle per drusen

0, Q or <10%

<50%

>50%

In pairs:

No/Q/<10; ≥10

Area

None/Q/<C0

<C1; <C2; <I2; <O2; <Half DD; <1DD; >1DD, CG

Per subfields:

NA/<C0

<C1; 2xC1; <C2; <2C2, <4C2; <50%; >50%

Global area: None/Q/<C0

<C1; <C2; <I2; <O2;

None/Q/<C0

<C1; <C2; <I2; <O2; <Half DA; <1DA; ≥1DA, CG

 

None/<10CAPT drusen; <10%; 10-25%; ≥25-50%; ≥50%

Fovea - 3 fields: central-middle – outer – outside grid

<10%

<25%; <50%; ≥50%

central-middle – outer circle

<10%

<25%; <50%;

≥50%

central-middle – outer circle

<1%; <10%

<25%; <50%

≥50%

<10%. 11-33%; 34-67%; >67%

Reticular Drusen

No/Q/Outside grid/Within and outside grid/CG

Yes, in all subfields

No/Q/Outside grid/Within and outside grid/CG

Yes: within or outside grid

No

No

Yes

Yes

Calcified/

Crystalline Drusen

No/Q/Outside grid/Within and outside grid/CG

Yes – global list

No/Q/Outside grid/Within and outside grid/CG

No

Yes

Yes

No

No

Hyperpigmentation

Absent/

present

Yes

Yes/No/Cannot grade

Yes

Yes

Absent/present

Max size

≥C0 <C1

≥C1 <C2

≥C2 <C3

≥C3

Yes:

Punctate

Linear

Mixed

Absent

Q or outside grid

<C1

<C2

≥C2

Yes:

<St 2

≥St 2

 

Area

None/Q/

<I2; <O2; <1/2 DA; <1DA; <2DA; ≥2DA

Per subfields:

<C1; <C2; ≥C2

Global: <C0; <C1; <C2; ≥C2

 

None/Q/<C0

<C1; <C2; <O2; ≥O2; CG

No/Q/

<250 μ (C2)

≥250 μ

Fovea = 3 fields

<10%; <25%, <50%, >50%

≤C0

>C0

NO

 

Hypopigmen tation/RPE depigmentation

Yes

Yes/No/Cannot grade

Yes

Yes

Absent/present

Max size

≥C0 <C1

≥C1 <C2

≥C2 <C3

≥C3

Yes

Absent

Q or outside grid

<C1

<C2

≥C2

<Std 4

≥Std4

Area

None/Q/

<I2; <O2; <1/2 DA; <1DA; <2DA; ≥2DA

Per subfields:

<C2; <25%; <50%; ≥50%

Global: <C2; <O2; ≥O2

 

None/Q/<I1; <O2; <Half DA; <1DA; <2DA, ≥2DA; CG

No/Q or <250 μ;

≥250 μ  –≤1DA;

>1DA -≤ 2DA, >2DA

Fovea = 3 fields

<10%; <25%, <50%, >50%

≤C0

>C0

NO

NO

 

GA definition

 

Min 2 out of 3 of these: Circular in shape, sharp borders, visibility of choroidal vessels

SAME

SAME

SAME

SAME

SAME

SAME

Std 3

GA minimum area

I2

I1 (≥175 μ)

 

Present: >250

C2

≥175 μ

>175 μ

Standard 3

Centre point involved indicated

Yes

Yes

Yes

No

Yes: Fovea  3 fields: central-middle – outer – outside grid

No

No

Yes

GA Size

None/Q/

<I2; <O2; <1/2 DA; <1DA; <2DA; ≥2DA

Per subfields:

Per subfields:

<25%; <50%; ≥50%

None/Q/<I1; <O2; <Half DA; <1DA; <2DA, ≥2DA; CG

No/Q or <250 μ

≥250 – <1 MPS DA;

≥1 MPS DA - <2DA, ≥2 MPS DA

≥C2 - <C3

≥C3 - <C4

≥C3- <1000 μ

≥1000 - <3000μ

≥3000 - <6000μ

≥C2 - <C3

≥C3 - <C4

≥C3- <1000 μ

≥1000 - <3000μ

≥3000 - <6000μ

≥6000

Per fields:

Q; <25%; <50%;

≥50%

<Std 3

≥Std 3

Neovascular AMD

Yes

Yes

No/Q/PED ≥90%; Mixed; RD ≥90%

Same as AREDS

Graded as Exudative event on FFA

Yes

Yes, by circle

Yes

Yes

Fovea involved

No

Yes

No

N/A

Yes

No

NO

Yes

Area

Within Field 2 in DA

Within Field 2 in DA

Within Field 2 in DA

N/A

By feature

≥C2 - <C3

≥C3 - <C4

≥C3- <1000 μ

≥1000 - <3000μ

≥3000 - <6000μ

Total area

≥C2 - <C3

≥C3 - <C4

≥C3- <1000 μ

≥1000 - <3000μ

≥3000 - <6000μ

≥6000

Per fields of the whole lesion:

Q; <25%; <50%;

≥50%

No

Serous detachment

Yes

No?

Yes/with Haem RD

N/A

Yes

Yes

No/Q/Present

No/Q/Yes

Subret haemorrhage

Yes/ with SubRPE haem

Yes, per subfields

Yes/ with SubRPE haem

N/A

 

Yes

No/Q/Present

 

Fibrous scar

Yes

Yes, per subfields

Yes

N/A

Yes

Yes

No/Q/Present

Yes: disciform or laser

Hard exudates

Yes

Yes

Yes

N/A

Yes

Yes

No/Q/Present

No/Q/Yes

Haem neuroretinal detachement

Yes

No?

Yes/with Serous RD

N/A

Yes

Ye

No

No/Q/Yes

Serous RPE detachment

Yes

No

Yes (non-drusenoid RD)

N/A

Yes

Yes

No

Yes

Drusenoid detachment

Yes

No

Yes

N/A

Yes

Sero-granular Drusen

No

Yes, foveal or not

Haem RPE detachment

Yes

No?

Yes/with Serous RD

N/A

Yes

Yes

No

 

Retinal haem

No

Yes

No

N/A

Yes

Yes

No

No/Q/Yes

Subhyloid haem

No

Yes

No

N/A

Yes

Yes

No

 

Intravitreal haem

No

Yes

No

N/A

Yes

Yes

No

 

Table 2: Comparing fluorescein angiography grading

 

Wisconsin: MPS Protocol used

CAPT

MEH

Wilmer Eye Institute: several studies are graded on FFA

Quality

Good

Fair

Borderline/Poor

Explained/unexplained

Focus/Field/Stereo/Other

1, Good

2, fair

3, poor

4, missing

Focus/clarity/stereopsis

1-5: perfect – not gradable

9: Missing

Focus – field- stereo

Adequate Fair- poor

Missing

Number of fields taken

Stereo pairs of macula

 

Stereo pairs of macula

Field 2: Centred on the macula

Not necessarily stereo

 

Evidence of neovascular event

Yes/No

Yes/No

Cannot grade

Yes/No

 

CNV

No CNV/Classic/Occult/Classic plus occult/Scar only

No CNV/Classic/Occult/Classic plus occult/Scar only

Yes/No

Percentage of classic

No

Percentage of classic lesion

Occult present

S-PED

 

No S-PED; S-PED <1DA; ≥1DA; CD size

Yes/No

Yes/No

Blood obscures CNV border

 

Yes/no

 

Yes/No

EBF obscures CNV border

 

Yes/no

 

 

Blood >50% of lesion

 

Yes/no

 

Yes/No

Other blood in fovea

 

Yes/no

 

 

Fovea involved

 

Yes/no

No

 

Component in FAZ

 

Not subfoveal/CNV, Blood, EBF, S-PED, style="mso-spacerun: yes">  Scar

 

Yes: laser scar, blocked fluorescence; feeder vessel

Lesion entirely well demarcated

 

Yes/no

 

 

Size of the lesion

 

≤1DA; ≤2DA; ≤3.5DA; ≤6DA; ≤9DA; ≤12DA; >12

≥C2 <C3;  ≥C3 <C4

≥C3 <1000;  ≥1000<3000

≥3000<6000; ≥6000

≤1DA; ≤2DA; ≤3.5DA; ≤6DA; ≤9DA; ≤12DA; ≤16DA >16

Evidence of previous laser

 

On F/U

No

 

Non-peripheral leakage

 

 

No

Yes/No

Drusen grading

 

 

Detailed grading for size and hyperfluorescence

Yes/No

GA

 

 

Presence plus area

 



Department of Health and Human Services NIH, the National Institutes of Health USA.gov