Original article
International Photographic Classification and Grading System for Myopic Maculopathy

https://doi.org/10.1016/j.ajo.2015.01.022Get rights and content

Purpose

To develop a classification and grading system for myopic maculopathy.

Design

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.

Section snippets

Methods

This study consisted of 2 phases: first, a consensus meeting to develop a classification system for myopic maculopathy; and second, assessment of the inter- and intraobserver agreement in applying the classification system to 100 selected fundus photographs of eyes with pathologic myopia, defined as having signs of myopic maculopathy in eyes with a myopic refractive error of greater than −8.0 diopters. This research adhered to the tenets of the Declaration of Helsinki, and the classification of

Formulation of Proposed Classification for Myopic Maculopathy and Related Lesions

We first identified 3 papers proposing classification for myopic maculopathy in detail. The first paper was by Curtin and Karlin9 and proposed 5 fundus changes associated with increased axial length of the eye, namely, optic nerve crescent, chorioretinal atrophy, central pigment spot (Fuchs spot), lacquer cracks, and posterior staphyloma. This classification has a limitation in that it does not cover all the myopic maculopathy lesions (eg, CNV), nor does it provide detailed differentiation

Discussion

There has been no widely used universal classification system of myopic maculopathy that allowed a reliable comparison of the prevalence, incidence, and patterns of these lesions between studies. We propose a simplified, uniform classification system for use in future studies on myopic maculopathy. We incorporated the results of previously published studies and adopted the concepts and classifications of these studies in developing this new classification of myopic maculopathy. We have also

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