Investigative Ophthalmology & Visual Science Cover Image for Volume 59, Issue 9
July 2018
Volume 59, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2018
Reproducibility of a Modified Dual Grading Model Applied to Fundus Autofluorescence Measurements in Macular Atrophy Secondary to Stargardt Disease
Cynthia S. Chan; Alexander Ho; Dennis Jenkins; Sean Pitetta; Manfred Li; Jennifer Tassy; Rupert Wolfgang Strauss; Hendrik P Scholl; Srinivas R. Sadda; Michael S Ip
Author Affiliations & Notes
  • Cynthia S. Chan
    Doheny Eye Institute, Los Angeles, California, United States
  • Alexander Ho
    Doheny Eye Institute, Los Angeles, California, United States
  • Dennis Jenkins
    Doheny Eye Institute, Los Angeles, California, United States
  • Sean Pitetta
    Doheny Eye Institute, Los Angeles, California, United States
  • Manfred Li
    Doheny Eye Institute, Los Angeles, California, United States
  • Jennifer Tassy
    Doheny Eye Institute, Los Angeles, California, United States
  • Rupert Wolfgang Strauss
    Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom
    Department of Ophthalmology, Medical University Graz and Johannes Kepler University Linz, Linz, Austria
  • Hendrik P Scholl
    Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, United States
    Department of Ophthalmology, University of Basel, Basel, Switzerland
  • Srinivas R. Sadda
    Doheny Eye Institute, Los Angeles, California, United States
    David Geffen School of Medicine, UCLA, Los Angeles, California, United States
  • Michael S Ip
    Doheny Eye Institute, Los Angeles, California, United States
    David Geffen School of Medicine, UCLA, Los Angeles, California, United States
  • Footnotes
    Commercial Relationships   Cynthia Chan, None; Alexander Ho, None; Dennis Jenkins, None; Sean Pitetta, None; Manfred Li, None; Jennifer Tassy, None; Rupert Strauss, None; Hendrik Scholl, None; Srinivas Sadda, Carl Zeiss Meditec (F), Centervue (C), Heidelberg Engineering (C), Optos (F), Optos (C), Topcon (R); Michael Ip, Allergan (C), Boehringer Ingelheim (C), Genentech (C), Omeros (C), Thrombogenics (C)
  • Footnotes
    Support  Foundation Fighting Blindness Clinical Research Institute and by a grant to that entity by the United States Department of Defense USAMRMC TATRC, Fort Meade, Maryland (grant nos.: W81-XWH-07-1-0720 and W81XWH-09-2-0189).
Investigative Ophthalmology & Visual Science July 2018, Vol.59, 3143. doi:
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      Cynthia S. Chan, Alexander Ho, Dennis Jenkins, Sean Pitetta, Manfred Li, Jennifer Tassy, Rupert Wolfgang Strauss, Hendrik P Scholl, Srinivas R. Sadda, Michael S Ip; Reproducibility of a Modified Dual Grading Model Applied to Fundus Autofluorescence Measurements in Macular Atrophy Secondary to Stargardt Disease. Invest. Ophthalmol. Vis. Sci. 2018;59(9):3143.

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Abstract

Purpose : Fundus autofluorescence (FAF) imaging is a noninvasive method for monitoring the progression of macular atrophy in patients with Stargardt disease (STGD1). The challenges of measuring areas of decreased autofluorescence (DAF) due to varying degrees of DAF and border definition of lesions have been previously explored. The purpose of this study was to investigate reproducibility of a longitudinal grading technique (referencing grading from a patient’s previous visits) for DAF area measurements in STGD1.

Methods : 57 eyes were randomly selected from 259 patients enrolled in a prospective multicenter natural history study of the progression of atrophy secondary to Stargardt disease (ProgStar). Each eye underwent two grading sessions, at least one month apart. In each grading session, two certified reading center graders used the semi-automated software tool, RegionFinder (Heidelberg Engineering), to quantify areas of definite DAF (DDAF, >90% blackness level of optic nerve head/vessels) and questionable DAF (QDAF, 50-90%). Graders referenced the gradings from the patient’s previous visits to assist the evaluation. Reproducibility of the final, dual grading consensus measurements collected using this longitudinal approach were evaluated by intraclass correlation coefficients (ICC) and Bland-Altman plots.

Results : The reproducibility of DAF measurements using this method was excellent. For DDAF, mean areas from the two gradings were 2.86 ± 3.76 mm2 (0.00-15.17 mm2) and 2.85 ± 3.70 mm2 (0.00-15.15 mm2), and ICC = 0.998 (95% CI 0.996-0.999). For QDAF, mean areas from the two gradings were 1.15 ± 1.54 mm2 (0.00-8.14 mm2) and 1.11 ± 1.59 mm2 (0.00-7.96 mm2), and ICC = 0.985 (95% CI 0.976-0.991). Bland-Altman plots (figures 1 and 2) did not indicate any apparent bias and mean differences were at or near zero.

Conclusions : Utilizing two graders referencing patients’ previous visit gradings resulted in comparably precise quantification of DAF areas in STGD1 patients, regardless of DAF type. These findings suggest this method of image grading may be useful in obtaining reliable FAF data in the context of monitoring STGD1 progression.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.

 

Figure 1. Example of DDAF grading (top) and Bland-Altman plot comparing grading session results (bottom); n=57.
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Figure 1. Example of DDAF grading (top) and Bland-Altman plot comparing grading session results (bottom); n=57.

Figure 1. Example of DDAF grading (top) and Bland-Altman plot comparing grading session results (bottom); n=57.

Figure 1. Example of DDAF grading (top) and Bland-Altman plot comparing grading session results (bottom); n=57.
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Figure 2. Example of QDAF grading (top) and Bland-Altman plot comparing grading session results (bottom); n=57.
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Figure 2. Example of QDAF grading (top) and Bland-Altman plot comparing grading session results (bottom); n=57.

Figure 2. Example of QDAF grading (top) and Bland-Altman plot comparing grading session results (bottom); n=57.

Figure 2. Example of QDAF grading (top) and Bland-Altman plot comparing grading session results (bottom); n=57.
View OriginalDownload Slide

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
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Copyright © 2025 Association for Research in Vision and Ophthalmology.
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