Srinivas R Sadda1, Robyn Guymer2, Frank G Holz3, Steffen Schmitz-Valckenberg3, Christine A Curcio4, Alan C Bird5, Barbara A Blodi6, Ferdinando Bottoni7, Usha Chakravarthy8, Emily Y Chew9, Karl Csaky10, Ronald P Danis6, Monika Fleckenstein3, K Bailey Freund11, Juan Grunwald12, Carel B Hoyng13, Glenn J Jaffe14, Sandra Liakopoulos15, Jordi M Monés16, Daniel Pauleikhoff17, Philip J Rosenfeld18, David Sarraf19, Richard F Spaide10, Ramin Tadayoni20, Adnan Tufail21, Sebastian Wolf22, Giovanni Staurenghi7. 1. Doheny Eye Institute, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California. Electronic address: ssadda@doheny.org. 2. Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Department of Surgery (Ophthalmology), Melbourne, Australia. 3. Department of Ophthalmology, University of Bonn, Bonn, Germany. 4. Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama. 5. Institute of Ophthalmology, University College London, London, United Kingdom. 6. Department of Ophthalmology and Visual Sciences, Fundus Photograph Reading Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. 7. Eye Clinic, Department of Biomedical and Clinical Sciences "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy. 8. Center for Public Health, The Queen's University of Belfast, Belfast, United Kingdom. 9. National Eye Institute, National Institutes of Health, Bethesda, Maryland. 10. Texas Retina Associates, Dallas, Texas. 11. Vitreous Retina Macula Consultants of New York, New York, New York. 12. Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania. 13. Department of Ophthalmology, Radboud University Medical Center, Nijmegen, The Netherlands. 14. Department of Ophthalmology, Duke University, Durham, North Carolina. 15. Department of Ophthalmology, Cologne Image Reading Center (CIRCL), University of Cologne, Cologne, Germany. 16. Institut de la Màcula and Barcelona Macula Foundation, Barcelona, Spain. 17. Department of Ophthalmology, St. Franziskus Hospital, Münster, Germany. 18. Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida. 19. Stein Eye Institute, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California. 20. Department of Ophthalmology, Hôpital Lariboisière, AP-HP, Université Paris 7-Sorbonne Paris Cité, Paris, France. 21. Institute of Ophthalmology, University College London, London, United Kingdom; Moorfields Eye Hospital, NHS Trust, London, United Kingdom. 22. Department of Ophthalmology, University Hospital Bern, University of Bern, Bern, Switzerland.
Abstract
PURPOSE: To develop consensus terminology and criteria for defining atrophy based on OCT findings in the setting of age-related macular degeneration (AMD). DESIGN: Consensus meeting. PARTICIPANTS: Panel of retina specialists, image reading center experts, retinal histologists, and optics engineers. METHODS: As part of the Classification of Atrophy Meetings (CAM) program, an international group of experts surveyed the existing literature, performed a masked analysis of longitudinal multimodal imaging for a series of eyes with AMD, and reviewed the results of this analysis to define areas of agreement and disagreement. Through consensus discussions at 3 meetings over 12 months, a classification system based on OCT was proposed for atrophy secondary to AMD. Specific criteria were defined to establish the presence of atrophy. MAIN OUTCOME MEASURES: A consensus classification system for atrophy and OCT-based criteria to identify atrophy. RESULTS: OCT was proposed as the reference standard or base imaging method to diagnose and stage atrophy. Other methods, including fundus autofluorescence, near-infrared reflectance, and color imaging, provided complementary and confirmatory information. Recognizing that photoreceptor atrophy can occur without retinal pigment epithelium (RPE) atrophy and that atrophy can undergo an evolution of different stages, 4 terms and histologic candidates were proposed: complete RPE and outer retinal atrophy (cRORA), incomplete RPE and outer retinal atrophy, complete outer retinal atrophy, and incomplete outer retinal atrophy. Specific OCT criteria to diagnose cRORA were proposed: (1) a region of hypertransmission of at least 250 μm in diameter, (2) a zone of attenuation or disruption of the RPE of at least 250 μm in diameter, (3) evidence of overlying photoreceptor degeneration, and (4) absence of scrolled RPE or other signs of an RPE tear. CONCLUSIONS: A classification system and criteria for OCT-defined atrophy in the setting of AMD has been proposed based on an international consensus. This classification is a more complete representation of changes that occur in AMD than can be detected using color fundus photography alone. Longitudinal information is required to validate the implied risk of vision loss associated with these terms. This system will enable such future studies to be undertaken using consistent definitions.
PURPOSE: To develop consensus terminology and criteria for defining atrophy based on OCT findings in the setting of age-related macular degeneration (AMD). DESIGN: Consensus meeting. PARTICIPANTS: Panel of retina specialists, image reading center experts, retinal histologists, and optics engineers. METHODS: As part of the Classification of Atrophy Meetings (CAM) program, an international group of experts surveyed the existing literature, performed a masked analysis of longitudinal multimodal imaging for a series of eyes with AMD, and reviewed the results of this analysis to define areas of agreement and disagreement. Through consensus discussions at 3 meetings over 12 months, a classification system based on OCT was proposed for atrophy secondary to AMD. Specific criteria were defined to establish the presence of atrophy. MAIN OUTCOME MEASURES: A consensus classification system for atrophy and OCT-based criteria to identify atrophy. RESULTS: OCT was proposed as the reference standard or base imaging method to diagnose and stage atrophy. Other methods, including fundus autofluorescence, near-infrared reflectance, and color imaging, provided complementary and confirmatory information. Recognizing that photoreceptor atrophy can occur without retinal pigment epithelium (RPE) atrophy and that atrophy can undergo an evolution of different stages, 4 terms and histologic candidates were proposed: complete RPE and outer retinal atrophy (cRORA), incomplete RPE and outer retinal atrophy, complete outer retinal atrophy, and incomplete outer retinal atrophy. Specific OCT criteria to diagnose cRORA were proposed: (1) a region of hypertransmission of at least 250 μm in diameter, (2) a zone of attenuation or disruption of the RPE of at least 250 μm in diameter, (3) evidence of overlying photoreceptor degeneration, and (4) absence of scrolled RPE or other signs of an RPE tear. CONCLUSIONS: A classification system and criteria for OCT-defined atrophy in the setting of AMD has been proposed based on an international consensus. This classification is a more complete representation of changes that occur in AMD than can be detected using color fundus photography alone. Longitudinal information is required to validate the implied risk of vision loss associated with these terms. This system will enable such future studies to be undertaken using consistent definitions.
Authors: Robyn H Guymer; Philip J Rosenfeld; Christine A Curcio; Frank G Holz; Giovanni Staurenghi; K Bailey Freund; Steffen Schmitz-Valckenberg; Janet Sparrow; Richard F Spaide; Adnan Tufail; Usha Chakravarthy; Glenn J Jaffe; Karl Csaky; David Sarraf; Jordi M Monés; Ramin Tadayoni; Juan Grunwald; Ferdinando Bottoni; Sandra Liakopoulos; Daniel Pauleikhoff; Sergio Pagliarini; Emily Y Chew; Francesco Viola; Monika Fleckenstein; Barbara A Blodi; Tock Han Lim; Victor Chong; Jerry Lutty; Alan C Bird; Srinivas R Sadda Journal: Ophthalmology Date: 2019-09-30 Impact factor: 12.079
Authors: Tiarnan D Keenan; Elvira Agrón; Amitha Domalpally; Traci E Clemons; Freekje van Asten; Wai T Wong; Ronald G Danis; SriniVas Sadda; Philip J Rosenfeld; Michael L Klein; Rinki Ratnapriya; Anand Swaroop; Frederick L Ferris; Emily Y Chew Journal: Ophthalmology Date: 2018-07-27 Impact factor: 12.079
Authors: Yue Yu; Eric M Moult; Siyu Chen; Qiushi Ren; Philip J Rosenfeld; Nadia K Waheed; James G Fujimoto Journal: Biomed Opt Express Date: 2020-08-20 Impact factor: 3.732
Authors: Karl G Csaky; Praveen J Patel; Yasir J Sepah; David G Birch; Diana V Do; Michael S Ip; Robyn H Guymer; Chi D Luu; Shamika Gune; Hugh Lin; Daniela Ferrara Journal: Surv Ophthalmol Date: 2019-01-28 Impact factor: 6.048