Intra and interobserver agreement in the classification of fundus autofluorescence patterns in geographic atrophy secondary to age-related macular degeneration

Abstract

Although intraobserver reproducibility was high, interobserver agreement was variable. Clear descriptions and a uniform set of criteria to classify these patients are needed if fundus autofluorescence imaging is used to evaluate patients with geographic atrophy.

Visualizing Retinal Pigment Epithelium Phenotypes in the Transition to Geographic Atrophy in Age-Related Macular Degeneration

“…The current study replicates our finding of RPE dysmorphia in second set of GA eyes prepared with higher-resolution histology and analyzed with a more comprehensive grading system. We suggest that this mechanism be considered the leading hypothesis to explain focally increased FAF in GA. Our current data do not support a widely-cited 6, 12, 25, 36–41, 84, 86, 87, 90–94 suggestion of RPE death by lipofuscin engorgement, granule dispersion, and necrosis. 18 …”

The Project MACULA Retinal Pigment Epithelium Grading System for Histology and Optical Coherence Tomography in Age-Related Macular Degeneration

“…We found that in CNV eyes BLamD associated with Dissociated RPE was thicker than that associated with Entombed RPE (Figure 6), suggesting that Dissociated RPE, replete with RPE granules although degenerating, are more capable of maintaining BLamD than Entombed RPE, with fewer granules. Thick, intrinsically autofluorescent BLamD 120 could account for atrophy appearing homogeneously gray rather than black in autofluorescence imaging of rapidly progressing GA. 62,121,122 It is further possible that Dissociated RPE will be detectable as punctate hyperautofluorescent foci on that background.…”

Reappraisal of Geographic Atrophy Patterns Seen on Fundus Autofluorescence Using a Latent Class Analysis Approach

“…The agreement between the optometrist and three of the four retinal specialists had been previously shown to be similar to that among the retinal specialists between them. 22 Baseline FAF images were exported to PowerPoint (Microsoft, Redmond, WA, USA) slides and were randomly presented to each observer, who determined the specific pattern for each eye according to the classification used in the FAM Study. 11 Two to 3 weeks later, a second set of PowerPoint slides with the images of the last follow-up visit was sent to the observers for determination of the pattern.…”

“…In GA, the current classification based on FAF patterns predicts rates of growth. However, it was developed on subjective grounds 11,20,21 and is complex (with low to moderate interobserver agreement), 22 and histological or genetic correlation is still not available. Whether GA patterns are stable in a given individual across time is also currently unknown.…”