title: A Population-Based Ultra-Widefield Digital Image Grading Study for Age-Related Macular Degeneration-Like Lesions at the Peripheral Retina.
abstract: OBJECTIVE
  Our understanding of the relevance of peripheral retinal abnormalities to disease in general and in age-related macular degeneration (AMD) in particular is limited by the lack of detailed peripheral imaging studies. The purpose of this study was to develop image grading protocols suited to ultra-widefield imaging (UWFI) in an aged population.
  
  
  METHODS
  A cross-sectional study of a random population sample in which UWFI was introduced at the 12-year review of the Reykjavik Eye Study in Iceland.
  
  
  METHODS
  Five hundred seventy-six subjects 62 years of age or older.
  
  
  METHODS
  Ultra-widefield (up to 200°) color and autofluorescence images were obtained using the Optos P200CAF laser scanning ophthalmoscope (Optos plc, Dunfermline, Scotland). The images were graded at Moorfields Eye Hospital Reading Centre primarily based on the International Classification for AMD. Macular and peripheral changes were graded using a standardized grid developed for this imaging method.
  
  
  METHODS
  Presence or absence of hard, crystalline, and soft drusen; retinal pigment epithelial changes; choroidal neovascularization (CNV); atrophy; and hypoautofluorescence and hyperautofluorescence were graded in the peripheral retina.
  
  
  RESULTS
  Of the eyes examined, 81.1% had AMD-like changes in the macula alone (13.6%), periphery alone (10.1%), and both periphery and macula (57.4%). There was no AMD-like CNV or pigment epithelial detachment in the periphery except in those cases in which these clearly originated from the macula. Seven patients had AMD-like atrophy in the periphery without end-stage disease in the macula. One patient with end-stage disease in the macula had normal periphery results on the color images. While analyzing the eyes, we detected pathologic appearances that were very reliably identified by graders.
  
  
  CONCLUSIONS
  Phenotyping the retinal periphery using the categories defined by the International Classification confirmed the presence of wide-ranging AMD-like pathologic changes even in those without central sight-threatening macular disease. Based on our observations, we propose here new, reliably identifiable grading categories that may be more suited for population-based UWFI.
authors: UCL Institute of Ophthalmology, University College London, London, United Kingdom.
authors: Imre
authors: I
authors: Lengyel
authors: NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom; Department of Ophthalmology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
authors: Adrienne
authors: A
authors: Csutak
authors: UCL Institute of Ophthalmology, University College London, London, United Kingdom; NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom.
authors: Daniela
authors: D
authors: Florea
authors: NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom.
authors: Irene
authors: I
authors: Leung
authors: UCL Institute of Ophthalmology, University College London, London, United Kingdom.
authors: Alan C
authors: AC
authors: Bird
authors: Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
authors: Fridbert
authors: F
authors: Jonasson
authors: NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom. Electronic address: Tunde.Peto@moorfields.nhs.uk.
authors: Tunde
authors: T
authors: Peto
mesh_terms: D000368:Aged; D020256:Choroidal Neovascularization / Q000145:classification / Q000175:diagnosis; D003430:Cross-Sectional Studies; D003952:Diagnostic Imaging / Q000145:classification*; D005260:Female; D005451:Fluorescein Angiography / Q000379:methods*; D006801:Humans; D008268:Macular Degeneration / Q000145:classification* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D009887:Ophthalmoscopy; D012160:Retina / Q000473:pathology*; D015593:Retinal Drusen / Q000145:classification / Q000175:diagnosis; D055213:Retinal Pigment Epithelium / Q000473:pathology