The Alabama Age-Related Macular Degeneration Grading System for donor eyes.
OBJECTIVE
To develop a systematic method for identifying and grading age-related macular degeneration (ARMD) in human donor eyes, postmortem fundus appearance was compared with histopathologic assessment in eyes with a spectrum of age-related macular change.


METHODS
Eyes without grossly visible, late ARMD were obtained from 8 cancer patients and 26 donors older than 50 years. Postmortem fundus appearance was graded for drusen and pigmentary change, using stereo color photographs. Eyes were processed and sectioned at 1 microm for histopathologic evaluation of macular retinal pigment epithelium-Bruch's membrane complex. The histologic diagnosis was compared with gross fundus appearance, clinical ophthalmic histories (n = 25), and clinical fundus photographs that were graded using the Wisconsin Age-related Maculopathy Grading System (n = 5).


RESULTS
Ten eyes met histopathologic criteria for early ARMD. A similar proportion of eyes (27%-32%) was identified as affected by ARMD by other published histopathologic criteria. By choosing eyes with at least one druse larger than 125 microm in diameter or an area of pigment-clumping 500 microm in diameter that was visible in the postmortem fundus, ARMD cases were identified with 90% sensitivity and 95% specificity.


CONCLUSIONS
The Alabama ARMD Grading System permits rational and standardized use of donor eyes in studies that are directed toward understanding the pathogenesis of ARMD.
Curcio
C A
CA
Department of Ophthalmology, University of Alabama at Birmingham, 35294-0009, USA.
Medeiros
N E
NE
Millican
C L
CL
D000368:Aged; D000369:Aged, 80 and over; D000407:Alabama; D016570:Bruch Membrane / Q000473:pathology; D005260:Female; D005654:Fundus Oculi; D006801:Humans; D008266:Macula Lutea / Q000473:pathology; D008268:Macular Degeneration / Q000145:classification* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010781:Photography; D010857:Pigment Epithelium of Eye / Q000473:pathology; D015593:Retinal Drusen / Q000145:classification / Q000473:pathology; D012174:Retinitis Pigmentosa / Q000145:classification / Q000473:pathology; D012680:Sensitivity and Specificity; D014019:Tissue Donors; D014792:Visual Acuity