Inter- and intra-observer variability in grading lesions of age-related maculopathy and macular degeneration

Hendrik P.N. Scholl, Tunde Peto, Samantha Dandekar, Catey Bunce, Wen Xing, Sharon Jenkins, Alan C. Bird

Research output: Contribution to journalArticle


Purpose: To introduce a revised version of the grading system established by the International ARM Epidemiological Study Group for identifying and quantifying abnormalities of age-related maculopathy (ARM) and age-related degeneration (AMD) and to investigate its reliability, specifically the inter- and intra-observer variability. Methods: Fifty eyes of 25 patients with ARM or AMD in at least one eye were randomly selected from a large ongoing collection of clinical data and DNA in a tertiary referral UK population. Stereoscopic color fundus photographs were taken with a 30° fundus camera and were centered on the macula. Presence and severity of fundus abnormalities in ARM and AMD were graded using a grid to define macular subfields and standard circles to define the size of lesions. Inter-observer variability was assessed by having three retinal specialists evaluate the color slides and intra-observer variability by regrading the same set. Results: The inter-observer agreement for all subfields was fair to substantial for small hard drusen (70-89%; κ=0.26-0.63) and intermediate soft drusen (76-94%; κ=0.27-0.69). Agreement ranged between 87% and 100%, between 50% and 92%, and between 78% and 100% for larger drusen, the presence of hyperpigmentation, and the presence of hypopigmentation, respectively. Agreement was moderate to almost perfect for the presence of geographic atrophy (88-98%; κ=0.60-0.95) and substantial to almost perfect for the presence of choroidal neovascularization (84-100%; κ=0.62-1.00). The intra-observer variability for the grading of drusen characteristics and pigmentary changes was similar in magnitude, but slightly greater for features of advanced AMD. Conclusion: Reproducibility was achieved using a revised version of the grading system established by the International ARM Epidemiological Study Group. This grading system may therefore be used for phenotyping of ARM and AMD.

Original languageEnglish (US)
Pages (from-to)39-47
Number of pages9
JournalGraefe's Archive for Clinical and Experimental Ophthalmology
Issue number1
StatePublished - Jan 1 2003


ASJC Scopus subject areas

  • Ophthalmology
  • Sensory Systems
  • Cellular and Molecular Neuroscience

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