title: International photographic classification and grading system for myopic maculopathy.
abstract: OBJECTIVE
  To develop a classification and grading system for myopic maculopathy.
  
  
  METHODS
  Development and evaluation of a classification system for myopic maculopathy based on observational case series.
  
  
  METHODS
  A comprehensive set of myopic macular lesions was defined via literature review and through consensus meetings among retinal specialists and clinician scientists. A classification of myopic maculopathy was formulated based on fundus photographs and a modified Delphi process and consensus. Inter- and intraobserver reproducibility, assessed as agreement (%) and weighted kappa values, were evaluated. One hundred retinal photographs with myopia and myopic macular lesions were selected from case series at the High Myopia Clinic of the Tokyo Medical and Dental University, Tokyo, Japan.
  
  
  RESULTS
  We defined 5 categories of myopic maculopathy including "no myopic retinal degenerative lesion" (Category 0), "tessellated fundus" (Category 1), "diffuse chorioretinal atrophy" (Category 2), "patchy chorioretinal atrophy" (Category 3), and "macular atrophy" (Category 4). Three additional features to supplement these categories were defined as "plus" lesions, namely, lacquer cracks, myopic choroidal neovascularization, and Fuchs spot. Posterior staphyloma was considered as a further, important sign of myopic retinopathy. The intraobserver agreement was ≥85% and the corresponding weighted kappa statistic was ≥0.6 between observations. After a brief training session, interobserver kappa statistics reached the predefined satisfactory level (≥0.4), considered as above moderate agreement.
  
  
  CONCLUSIONS
  We propose a classification system for myopic maculopathy that was found to be reproducible. Applying a uniform classification in different studies will facilitate communication and comparison of findings from clinical trials and epidemiologic studies.
authors: Tokyo Medical and Dental University, Tokyo, Japan. Electronic address: k.ohno.oph@med.tmd.ac.jp.
authors: Kyoko
authors: K
authors: Ohno-Matsui
authors: Department of Public Health, Yamagata University, Yamagata, Japan.
authors: Ryo
authors: R
authors: Kawasaki
authors: Department of Ophthalmology of the Medical Faculty Mannheim of the Ruprecht-Karls-University, Heidelberg, Germany.
authors: Jost B
authors: JB
authors: Jonas
authors: Singapore Eye Research Institutes, National University of Singapore, Singapore.
authors: Chui Ming Gemmy
authors: CM
authors: Cheung
authors: Singapore Eye Research Institutes, National University of Singapore, Singapore.
authors: Seang-Mei
authors: SM
authors: Saw
authors: Department of Ophthalmology, Erasmus Medical Center, Rotterdam, Netherlands.
authors: Virginie J M
authors: VJ
authors: Verhoeven
authors: Department of Ophthalmology, Erasmus Medical Center, Rotterdam, Netherlands.
authors: Caroline C W
authors: CC
authors: Klaver
authors: Tokyo Medical and Dental University, Tokyo, Japan.
authors: Muka
authors: M
authors: Moriyama
authors: Tokyo Medical and Dental University, Tokyo, Japan.
authors: Kosei
authors: K
authors: Shinohara
authors: Department of Public Health, Yamagata University, Yamagata, Japan.
authors: Yumiko
authors: Y
authors: Kawasaki
authors: Tohoku Central Hospital, Yamagata, Japan.
authors: Mai
authors: M
authors: Yamazaki
authors: Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
authors: Stacy
authors: S
authors: Meuer
authors: Department of Ophthalmology, Kyusyu University, Fukuoka, Japan.
authors: Tatsuro
authors: T
authors: Ishibashi
authors: Department of Ophthalmology, Kyusyu University, Fukuoka, Japan.
authors: Miho
authors: M
authors: Yasuda
authors: Department of Ophthalmology, Yamagata University, Yamagata, Japan.
authors: Hidetoshi
authors: H
authors: Yamashita
authors: Department of Ophthalmology, Yamagata University, Yamagata, Japan.
authors: Akira
authors: A
authors: Sugano
authors: Centre for Vision Research, Department of Ophthalmology and Westmead Millennium Institute, University of Sydney, Sydney, Australia.
authors: Jie Jin
authors: JJ
authors: Wang
authors: Centre for Vision Research, Department of Ophthalmology and Westmead Millennium Institute, University of Sydney, Sydney, Australia.
authors: Paul
authors: P
authors: Mitchell
authors: Singapore Eye Research Institutes, National University of Singapore, Singapore.
authors: Tien Yin
authors: TY
authors: Wong
mesh_terms: D003941:Diagnostic Techniques, Ophthalmological / Q000145:classification*; D006801:Humans; D008875:Middle Aged; D047728:Myopia, Degenerative / Q000145:classification*; D015588:Observer Variation; D010781:Photography / Q000145:classification*; D015203:Reproducibility of Results; D012164:Retinal Diseases / Q000145:classification*; D014786:Vision Disorders / Q000145:classification*