Abstract
Abstract: :
Purpose: To assess the validity of self–reported history and clinical examination when compared to masked grading of fundus photographs for the diagnosis of AMD in an epidemiological study. Methods: The Los Angeles Latino Eye Study (LALES) is a population–based study of eye disease in Latinos aged 40 years and older. History of AMD was obtained by interview. A complete ophthalmologic examination, including direct binocular ophthalmoscopy performed at the slit lamp with a 90 Diopter lens and stereoscopic macular photographs were obtained from each participant. Photographs were graded in a masked manner using the Wisconsin Age–related Maculopathy Grading System. Early AMD was defined as the presence of soft indistinct or reticular drusen, or hard or soft distinct drusen with RPE depigmentation or increased retinal pigment. Late AMD was defined as the presence of geographic atrophy or exudative AMD. Kappa scores assessed agreement between self–reported history, clinical examination at the slit lamp, and photographic grading. Results: 6027 participants with completed home questionnaire, clinical examination, and fundus photograph grading were included in this analysis. Of the 549 participants with early AMD on photographic grading, 83(15%) were diagnosed on the clinical examination and 8(1%) self–reported a history of AMD. For early AMD, there was poor agreement between clinical examination and photographic grading (large drusen k = 0.03; increased retinal pigment k = 0.05; decreased retinal pigment k = 0.18). Of the 25 participants with advanced AMD on photographic grading, 17(68%) were diagnosed on the clinical examination and 9(36%) reported a history of AMD. While agreement between clinical examination and photographic grading for advanced AMD was moderate (k=0.51), the agreement for geographic atrophy was fair (k=0.25) and the agreement for exudative AMD was moderate (k=0.54). Conclusions: These data suggest that self–reported history or clinical examination alone should not be used to obtain estimates of the prevalence of AMD in epidemiological studies. Standardized grading of macular photographs is necessary to obtain an accurate estimate of the prevalence of AMD, particularly early AMD.
Keywords: age–related macular degeneration