title: The design and validation of an optical coherence tomography-based classification system for focal vitreomacular traction.
abstract: OBJECTIVE
  To develop and validate a classification system for focal vitreomacular traction (VMT) with and without macular hole based on spectral domain optical coherence tomography (SD-OCT), intended to aid in decision-making and prognostication.
  
  
  METHODS
  A panel of retinal specialists convened to develop this system. A literature review followed by discussion on a wide range of cases formed the basis for the proposed classification. Key features on OCT were identified and analysed for their utility in clinical practice. A final classification was devised based on two sequential, independent validation exercises to improve interobserver variability.
  
  
  RESULTS
  This classification tool pertains to idiopathic focal VMT assessed by a horizontal line scan using SD-OCT. The system uses width (W), interface features (I), foveal shape (S), retinal pigment epithelial changes (P), elevation of vitreous attachment (E), and inner and outer retinal changes (R) to give the acronym WISPERR. Each category is scored hierarchically. Results from the second independent validation exercise indicated a high level of agreement between graders: intraclass correlation ranged from 0.84 to 0.99 for continuous variables and Fleiss' kappa values ranged from 0.76 to 0.95 for categorical variables.
  
  
  CONCLUSIONS
  We present an OCT-based classification system for focal VMT that allows anatomical detail to be scrutinised and scored qualitatively and quantitatively using a simple, pragmatic algorithm, which may be of value in clinical practice as well as in future research studies.
authors.affiliation: Sunderland Eye Infirmary, Sunderland, UK.|Institute of Genetic Medicine, Newcastle University, Newcastle Upon Tyne, UK.
authors.forename: D H W
authors.initials: DH
authors.lastname: Steel
authors.affiliation: Ophthalmology Department, Hull and East Yorkshire Eye Hospital, Hull and East Yorkshire NHS Trust, Hull, UK.
authors.forename: L
authors.initials: L
authors.lastname: Downey
authors.affiliation: Ophthalmology Department, Aberdeen Royal Infirmary, Aberdeen, UK.
authors.forename: K
authors.initials: K
authors.lastname: Greiner
authors.affiliation: St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK.
authors.forename: H
authors.initials: H
authors.lastname: Heimann
authors.affiliation: Department of Ophthalmology, School of Medicine, King's College London, London, UK.
authors.forename: T L
authors.initials: TL
authors.lastname: Jackson
authors.affiliation: Department of Ophthalmology, University Hospital Ayr, Ayr, UK.
authors.forename: Z
authors.initials: Z
authors.lastname: Koshy
authors.affiliation: Ophthalmology Department, St Thomas' Hospital, London, UK.
authors.forename: D A H
authors.initials: DA
authors.lastname: Laidlaw
authors.affiliation: Ophthalmology Department, Moorfields Eye Hospital, London, UK.
authors.forename: L
authors.initials: L
authors.lastname: Wickham
authors.affiliation: School of Life and Health Sciences, Aston University, Birmingham, UK.
authors.forename: Y
authors.initials: Y
authors.lastname: Yang
mesh_terms: D005584:Fovea Centralis; D006801:Humans; D012107:Research Design; D012160:Retina / Q000473:pathology*; D012164:Retinal Diseases / Q000145:classification*; D000267:Tissue Adhesions / Q000145:classification; D041623:Tomography, Optical Coherence / Q000145:classification*; D014792:Visual Acuity; D014822:Vitreous Body / Q000473:pathology*; D020255:Vitreous Detachment / Q000145:classification*