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V. Le Tien, E.H. Souied, W. Haddad, A. Zourdani, H. Mahiddine, P. D'Athis, G. Coscas, G. Soubrane; SPA–1: Semiology for Phenotyping AMD . Invest. Ophthalmol. Vis. Sci. 2005;46(13):218.
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Purpose: A reliable classification of AMD's subgroups is necessary prior to any genetic or clinical investigation. For this purpose, we attempted to establish and evaluate a selected list of items for AMD based on fluorescein and ICG angiographies.Our objective is to extract some homogeneous subgroup of AMD from our clinic. The first step is to evaluate the inter observer agreement for AMD's precursors. Methods: The 19 most relevant items were selected from the litterature. Similarly, items for the classification of choroidal new vessels and atrophy were listed. We selected 20 eyes from 20 patients affected by various forms of precursors from the NAT–2 study. Grading was based on color photographs, red–free frames and fluorescein angiography. For each item, 5 grids were filled by 4 independant experimented readers from our reading center and 1 expert (GC). Within patient variance was analyzed. Results: Within patient variance showed greatest agreement (from 0.000 to 0.200) between graders for "drusenoid pigment epithelial detachment", "basal laminar drusen", "pigment deposits", "less than 5 hard drusen", "reticular pseudo–drusen" and "calcified drusen". The worst value for within patient variance (0.255) was recorded for the item "intermediate drusen, between 63 and 125 µ" Conclusions: Our works describe an evaluation of our first grid for precursors of AMD. It shows a great agreement between graders for most of the items. Concerning items with lowest agreement, they would be modified according with comments of the physicians and the expert. This grid could be considered for phenotypic classification of AMD in clinical, genetic, environmental or therapeutic studies as well. Further evaluations in other referential departments would be however required.
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