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Ronald Klein, MD, MPH; Stacy M. Meuer, BS; Scot E. Moss, MA; Barbara E. K. Klein, MD, MPH; Michael W. Neider, BA; Jennifer Reinke, BS

Arch Ophthalmol. 2004;122:1642-1646.

Objective  To compare gradings of lesions associated with age-related macular degeneration (AMD) from digital and stereoscopic film images.

Design  Instrument validation study.

Participants  Sixty-two subjects (124 eyes) with varying degrees of AMD, including no AMD.

Methods  Images of the optic disc and macula were taken using a 45° digital camera (6.3 megapixels) through dark-adapted pupils and pharmacologically dilated pupils. In addition, 30° stereoscopic retinal film images were taken through pharmacologically dilated pupils of the same eyes. All images were graded for drusen size, type, and area; pigmentary abnormalities; geographic atrophy; and neovascular lesions using the modified Wisconsin Age-Related Maculopathy Grading System. Exact agreement and unweighted scores were calculated for paired gradings resulting from digital and film images.

Main Outcome Measure  Agreement between gradings obtained from stereoscopic slide transparencies and digital nonstereoscopic images.

Results  Exact agreement between gradings of digital and stereoscopic film images taken through pharmacologically dilated pupils was 91% ( = 0.85) for the categories of none, early AMD, and late AMD. Exact agreement for gradings of digital images taken through dark-adapted pupils compared with gradings of film images was 80% ( = 0.69). Exact agreement for gradings of digital images captured through dark-adapted and pharmacologically dilated pupils was 86% ( = 0.78). In addition, scores for agreement between different approaches for individual lesions were moderate to almost perfect.

Conclusions  Gradings resulting from high-resolution digital images, especially when the pupil is pharmacologically dilated, are comparable with those resulting from film-based images. We conclude that digital imaging of the retina is useful for epidemiological studies of AMD.

Author Affiliations: Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison.

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