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Juan E. Grunwald, Ebenezer Daniel, Gui-shuang Ying, Maxwell Pistilli, Maureen Maguire, Judith Alexander, Stuart L. Fine, Daniel F. Martin, CATT Research Group; Photographic Assessment of Fundus Morphology in the Comparison of Age-related Macular Degeneration Treatments Trials (CATT). Invest. Ophthalmol. Vis. Sci. 2012;53(14):2896.
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To describe the methods used for assessment of baseline fundus characteristics from color photography and fluorescein angiography (FA) in the Comparison of the Age-Related Macular Degeneration Treatments Trials (CATT), and the relationship between these characteristics and baseline visual acuity.
Baseline stereoscopic color fundus photographs and FAs of 1185 participants in the CATT study were assessed at a central fundus photograph reading center by masked readers. Replicate assessments of random samples of photographs were performed to assess intra and inter grader agreements. The association of the characteristics with baseline visual acuity was assessed using ANOVA and correlation coefficients.
Intra and inter grader reproducibility showed agreements ranging from75% to 100% and weighted kappas ranging from 0.48 to 1.0 for qualitative determinations. The intra-class correlation coefficients were 0.96-0.97 for quantitative measurements of choroidal neovascularization (CNV) area and total area of CNV lesion. The mean visual acuity (SE) varied by the type of pathology in the foveal center: 64.5 (0.7) letters for fluid only, 59.0 (0.5) for CNV, and 58.7 (1.3) for hemorrhage (p<0.001). Fibrotic or atrophic scar present in the lesion but not under the center of the fovea was also associated with a markedly reduced visual acuity 48.4 (2.2), p<0.0001. Although total area of CNV lesion was weakly correlated with visual acuity (r=-0.16, p<0.001), the correlation was stronger within patients with predominantly classic lesions (r=-0.42, p<0.001).
Our results show that the methodology used for grading CATT fundus images has good reproducibility. As expected, larger total CNV lesion area, and pathologic findings such as hemorrhage, fibrosis and atrophy are associated with decreased visual acuity.
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