Harmonizing the Classification of Age-related Macular Degeneration in the Three-Continent AMD Consortium
Harmonizing the Classification of Age-related Macular Degeneration in the Three-Continent AMD Consortium
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DOI：
10.3109/09286586.2013.867512
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发表时间：
2014-02-01
影响因子：
1.8
通讯作者：
Klein, Barbara E. K.
中科院分区：
文献类型：
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作者：
Klein, Ronald;Meuer, Stacy M.;Klein, Barbara E. K.
目的：描述在四项基于人群的队列研究中协调年龄相关性黄斑变性（AMD）表型分类的方法：比弗坝眼科研究（BDES）、蓝山眼科研究（BMES）、洛杉矶拉丁裔眼科研究（LALES）和鹿特丹研究（RS）。AMD分级方案，类别定义，比较每项研究的分级表，以确定AMD严重程度定义和病变分类是否存在系统性差异，三个分级中心。每个中心使用各自的系统对同一组60张图像进行分级，以确定AMD病变的存在和严重程度。一个共同的5步AMD严重程度量表和定义的病变测量分界点和早期和晚期AMD的发展，从这个演习。应用该严重程度量表将年龄-性别校正的早期AMD患病率在BDES中从18.7%改变为20.3%，在BMES中从4.7%改变为14.4%，在LALES中从14.1%改变为15.8%，RS为7.5%~ 17.1%。性别调整后的晚期AMD患病率保持不变。将60张图像转换为联合体量表，比较各中心的分级，结果显示各中心间AMD严重程度的准确一致率为61.0- 81.4%，一步一致率为84.7- 98.3%。AMD分类的协调减少了研究中表型定义的分类差异，产生了新的5步AMD严重程度量表，四个队列中AMD患病率的相似性增强。尽管进行了统一，但仍可能难以消除评级方面的系统性差异（如果存在）。
Purpose: To describe methods to harmonize the classification of age-related macular degeneration (AMD) phenotypes across four population-based cohort studies: the Beaver Dam Eye Study (BDES), the Blue Mountains Eye Study (BMES), the Los Angeles Latino Eye Study (LALES), and the Rotterdam Study (RS).Methods: AMD grading protocols, definitions of categories, and grading forms from each study were compared to determine whether there were systematic differences in AMD severity definitions and lesion categorization among the three grading centers. Each center graded the same set of 60 images using their respective systems to determine presence and severity of AMD lesions. A common 5-step AMD severity scale and definitions of lesion measurement cutpoints and early and late AMD were developed from this exercise.Results: Applying this severity scale changed the age-sex adjusted prevalence of early AMD from 18.7% to 20.3% in BDES, from 4.7% to 14.4% in BMES, from 14.1% to 15.8% in LALES, and from 7.5% to 17.1% in RS. Age-sex adjusted prevalences of late AMD remained unchanged. Comparison of each center's grades of the 60 images converted to the consortium scale showed that exact agreement of AMD severity among centers varied from 61.0-81.4%, and one-step agreement varied from 84.7-98.3%.Conclusion: Harmonization of AMD classification reduced categorical differences in phenotypic definitions across the studies, resulted in a new 5-step AMD severity scale, and enhanced similarity of AMD prevalence among the four cohorts. Despite harmonization it may still be difficult to remove systematic differences in grading, if present.