Performance of classification systems for age-related macular degeneration in the rotterdam study

Purpose: To compare frequently used classification systems for age-related macular degeneration(AMD) in their abilty to predictlate AMD. Methods:Intotal,9066participantsfromthepopulation-basedRotterdamStudywere followedupforprogressionofAMDduringastudyperiodupto30years.AMDlesions weregradedoncolorfundusphotographsafterconfirmationonotherimagemodalities andgroupedatbaselineaccordingtosixclassificationsystems.LateAMDwasdefinedas geographicatrophyorchoroidalneovascularization.Incidencerate(IR)andcumulative incidence(CuI)oflateAMDwerecalculated,andKaplan-Meierplotsandareaunderthe operating characteristics curves(AUCs)wereconstructed. Results: A total of 186 persons developed incident late AMD during a mean follow-up timeof8.7years.TheAREDSsimplifiedscaleshowedthehighestIRforlateAMDat104 cases/1000 py for ages <75 years. The Rotterdam classification showed the highest IR at 89 cases/1000 py >75 years. The 3-Continent harmonization classification provided the most stable progression. Drusen area >10% ETDRS grid (hazard ratio 30.05, 95% confidence interval [CI] 19.25–46.91) was most prognostic of progression. The highest AUC of late AMD (0.8372, 95% CI: 0.8070-0.8673) was achieved when all AMD features present at base line were included. Conclusions: Highest turnover rates from intermediate to late AMD were provided by the AREDS simplified scale and the Rotterdam classification. The 3-Continent harmonization classification showed the most stable progression. All features, especially drusenarea,contribute to late AMD prediction. Translational Relevance: Findings will help stakeholders select appropriate classification systems for screening,deep learning algorithms, or trials.

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