An international classification and grading system for age-related maculopathy and age-related macular degeneration

Bird, Alan C.; Bressler, Neil M.; Bressler, Susan B.; Chisholm, I H; Coscas, G.; Davis, Matthew D.; Jong, Paulus T. V. M. de; Klaver, Caroline C.W.; Klein, Barbara E.K.; Klein, Ronald; Mitchell, Paul; Sarks, J P; Sarks, S H; Soubrane, G.; Taylor, Hugh R.; Vingerling, Johannes R.

doi:10.1016/s0039-6257(05)80092-x

Cited by 1,713 publications

(1,222 citation statements)

References 9 publications

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“…This degenerative disease results in a loss of central and colour vision, leading to difficulty with reading, recognizing faces, and driving, thus impacting profoundly on the independence of those affected. The two forms of advanced AMD resulting in loss of vision are geographic atrophy (GA) and choroidal neovascularization (CNV) (Bird et al, 1995;Jager et al, 2008). The prevalence of this condition is likely to increase dramatically in the future, as a result of increasing life-expectancy and the consequential increasing senescence of society (van Leeuwen et al, 2003).…”

Section: Introductionmentioning

confidence: 99%

The association between macular pigment optical density and CFH, ARMS2, C2/BF, and C3 genotype

Loane

Nolan

McKay

et al. 2011

Experimental Eye Research

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Keywords: age-related macular degeneration age-related maculopathy susceptibility 2 gene carotenoids Complement factor H lutein macular pigment zeaxanthin a b s t r a c t Age-related macular degeneration (AMD) is the most common cause of blindness in older people in developed countries, and risk for this condition may be classified as genetic or environmental, with an interaction between such factors predisposing to this disease. This study investigated the relationship between AMD risk genes, macular pigment optical density (MPOD), which may protect against AMD, and serum concentrations of the macular carotenoids, lutein (L) and zeaxanthin (Z). This was a cross-sectional study of 302 healthy adult subjects. Dietary intake of L and Z was assessed by food frequency questionnaire, and MPOD was measured by customized heterochromatic flicker photometry. We also calculated MPOD Area as the area of MP under the spatial profile curve, to reflect MP across the macula. Serum L and Z were measured by HPLC. Genotyping of tag SNPs in the genes CFH, ARMS2, C3, C2 and BF was undertaken with multiplex polymerase chain reaction (PCR) and primer extension methodology (ABI Snapshot, ABI Warrington UK) on DNA extracted from peripheral blood. The mean AE SD (range) age of the subjects in this study was 48 AE 11 (21e66) years. There was a statistically significant association between CFH genotype and family history of AMD, with subjects having two non-risk CFH haplotypes (n ¼ 35), or one non-risk and one protective CFH haplotype (n ¼ 33), being significantly more likely to have a negative family history of AMD (Pearson Chi square: p ¼ 0.001). There was no significant association between the AMD risk genes investigated and either MPOD (One way ANOVA: p > 0.05) or serum concentrations of L or Z (One way ANOVA: p > 0.05, for both). Subjects who were homozygous for risk alleles of both CFH and ARMS2 (n ¼ 4) had significantly lower MPOD at 0.5 and 1 retinal eccentricity (Independent samples t test: p < 0.05) and lower MPOD Area which approached statistical significance (Independent samples t test: p ¼ 0.058), compared to other subjects (n ¼ 291). In conclusion, this study did not detect an association between individual AMD risk genotypes and the putatively protective MP, or serum concentrations of its constituent carotenoids. However, the combination of homozygous risk alleles at both CFH and ARMS2 loci was associated with significantly lower MPOD centrally, despite comparable serum concentrations of the macular carotenoids. These findings suggest that the maculae of subjects at very high genetic risk of AMD represent a hostile environment for accumulation and/or stabilization of MP.

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Section: Introductionmentioning

confidence: 99%

The association between macular pigment optical density and CFH, ARMS2, C2/BF, and C3 genotype

Loane

Nolan

McKay

et al. 2011

Experimental Eye Research

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“…13 Details of the grading procedures are presented elsewhere. 14,15 In brief, following the specifications outlined by the International group, a grid consisting of three circles concentric with the centre of the macula that represent, respectively, the central, middle, and outer subfields was used to assist with the grading of early and late AMD lesions.…”

Section: Assessment Of Amd On Macula Photographsmentioning

confidence: 99%

“…Area covered by drusen in each of the three circles was categorised as o10, o25, o50, or 50% or more as outlined in the International Classification System. 13 …”

Section: Assessment Of Amd On Macula Photographsmentioning

confidence: 99%

Characteristics of progression of early Age-related macular degeneration: the Cardiovascular Health and Age-related maculopathy Study

Tikellis

Robman

Dimitrov

et al. 2006

Eye

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Aims To determine the risk of age-related macular degeneration (AMD) progression posed by the presence of each early AMD characteristic. Methods A prospective cohort study of 254 participants aged 50 years and older, all with early AMD features at their baseline visit followed for an average of 7 years. Stereoscopic colour fundus photographs were graded for early AMD features using the International Classification System. AMD status was stratified into six exclusive levels along a continuum of disease severity according to drusen type, pigmentary abnormalities, or late AMD. Progression was assessed according to three definitions: a change between or within a severity level, or by side by side grading. Results The progression rate of early AMD ranged between 3.4 and 4.67% per annum depending upon the definition used. In total, 15 (6%) cases progressed from early AMD to the late complication of AMD. After controlling for age and smoking, cases with soft indistinct drusen at baseline were at a greater risk of progressing from early to late AMD than were cases without this characteristic (OR ¼ 3.72, 95%CI 1.20-11.54; P ¼ 0.02). Conclusion Our proposed definitions of AMD progression give rates that are consistent with current knowledge of progression and its determinants. Each early AMD characteristic conveys its own risk of progression to an eye, with soft indistinct drusen carrying the greater risk. An international consensus on what defines AMD progression would greatly help the research community when trying to assess the importance of new risk factors and the effectiveness of novel interventions.

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“…Exudative AMD included active CNV and disciform scar. The International Classification and Grading of AMD nomenclature 22 was used for the definition of active CNV, disciform scar, and age-related maculopathy (stage 2a-3 as per Rotterdam study criteria). 23 The CNV lesions were defined as classic, occult, or mixed as per TAP study criteria.…”

Section: Patientsmentioning

confidence: 99%

Pulsatile ocular blood flow in asymmetric age-related macular degeneration

Sandhu

Sivaprasad

Shah

et al. 2006

Eye

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Purpose Ocular perfusion abnormalities have been proposed in the pathogenesis of age-related macular degeneration (AMD) with differences in pulsatile ocular blood flow (POBF) in eyes with asymmetric AMD in Japanese and Taiwanese patients. The purpose of our study was to observe POBF difference in the fellow eyes of Caucasians with asymmetric AMD. Methods This was a cross-sectional study comparing POBF in three groups of patients with asymmetric AMD in the fellow eyes: Group 1 (n ¼ 21) with drusen and active choroidal neovascularisation (CNV); Group 2 (n ¼ 18) with drusen and disciform scar; Group 3 (n ¼ 8) with CNV and disciform scar. The POBF was adjusted for intraocular pressure (IOP), pulse rate (PR), and axial length using multiple regression analysis. Generalised estimation equation model was used to include both eyes in each group. Results The geometric mean (95% confidence interval) POBF values were as follows: Group 1 with drusen 1097.9 ll/min (957.0, 1259.7) in one eye and the fellow eye with CNV 1090.1 ll/min (932.3, 1274.7); Group 2 with drusen 946.0 ll/min (794.2, 1126.7) and disciform scar 966.2 ll/min (780.3, 1196.4); Group 3 with CNV 877.1 ll/min (628.3, 1224.6) and disciform scar 767.2 ll/min (530.5, 1109.7). Adjusting for differences in axial length, pulse rate and intraocular pressure, no statistically significant difference in POBF was found between fellow eyes in the same subject. Conclusions POBF is not different between fellow eyes of Caucasian patients with asymmetric AMD. Eye (2007) 21, 506-511.

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An international classification and grading system for age-related maculopathy and age-related macular degeneration

Cited by 1,713 publications

References 9 publications

The association between macular pigment optical density and CFH, ARMS2, C2/BF, and C3 genotype

The association between macular pigment optical density and CFH, ARMS2, C2/BF, and C3 genotype

Characteristics of progression of early Age-related macular degeneration: the Cardiovascular Health and Age-related maculopathy Study

Pulsatile ocular blood flow in asymmetric age-related macular degeneration

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