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M.D. Davis, R.E. Gangnon, L.D. Hubbard, L. Lee, W.N. King, S.B. Bressler, E.Y. Chew, B.E. Klein, R. Klein, AREDS Research Group; A Severity Scale for Age-related Macular Degeneration (AMD) . Invest. Ophthalmol. Vis. Sci. 2003;44(13):2108.
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Purpose: To describe the AREDS severity scale for age-related macular degeneration (AMD). Methods: Drusen characteristics (size, area, type), pigmentary abnormalities (increased retinal pigment, RPE depigmentation), and non-central geographic atrophy were graded in baseline color stereo photographs of eyes free of advanced AMD at baseline in persons enrolled in AREDS. Gradings were repeated at the 2-year follow-up visit and annually thereafter. Development of advanced AMD, the study outcome, was defined as geographic atrophy involving the center of the macula or neovascular AMD (photographic evidence of subretinal hemorrhage or fibrosis or detachment of the sensory retina or retinal pigment epithelium; or application of photocoagulation). A total of 6,427 eyes of persons free of advanced AMD in both eyes were available for scale development and validation. Scale development was based on right eyes only; left eyes were used as a validation sample. Tree-structured regression models for the development of advanced AMD combined with clinical judgment were used to develop an initial AMD severity scale. Tree-structured regression models for progression along the initial scale combined with clinical judgment were used to develop a more detailed AMD severity scale. Event rates for both development of advanced AMD and progression along the detailed scale were calculated for left eyes and for the combined sample to validate the scale. The scale was also applied to participants with advanced AMD in one eye. Results: Drusen area was the most predictive drusen characteristic. In eyes free of pigmentary abnormalities, the 5-year risk of advanced AMD increased from 0.5% in 2,894 eyes with drusen area less than the area of 10 small (less than 63 microns in diameter) drusen to 13% in 315 eyes with drusen area 0.5 disc area or more. Within each drusen area category, the risks of developing advanced AMD approximately doubled if the eye also had either increased pigment or a small area of depigmentation. Further increases in risk were associated with larger areas of depigmentation and with any amount of non-central geographic atrophy. Presence of advanced AMD in the fellow eye increased the risk substantially. Conclusion: Preliminary evaluations suggest this AMD severity scale may be useful for clinical studies.
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