Original articleClinical Classification of Age-related Macular Degeneration
Section snippets
Current Classification System Issues
The purpose of this report is to describe the modified Delphi process used to arrive at common terminology for a clinical classification system for AMD.11, 12 This process is intended as a consensus-establishing technique that combines the scientific literature with expert opinion.13, 14
Early stages of AMD usually are asymptomatic and have been characterized, across various classification systems, by the presence of drusen and pigmentary alterations within 2 disc diameters of the fovea.
Materials and Methods
The first steps in this process were to assemble a working group made up of 7 experts who were attending the January 2011 Arnold and Mabel Beckman Initiative for Macular Research conference to discuss how the process might move forward and to make specific recommendations regarding the next appropriate steps. These included a review of prior AMD classifications, a selection of additional experts in the field to establish a formal AMD classification committee, an agreement to use a modified
Results
In the original survey, a score of 7 through 9 indicating agreement for inclusion for a clinical staging system was achieved for 22 (28%) of 79 of statements, although consensus was noted in only 1 of these cases, with 21 being rated as equivocal and 0 rated as nonconsensus. Four statements were rated as inappropriate (median, 1–3) with consensus in 1 and equivocal in the 3 other statements. In the remaining 53 instances, agreement for inclusion was rated as uncertain (median, 4–6) with 9
Discussion
Using a modified Delphi technique, the committee developed a 5-stage AMD classification scale (Table 2). This approach has been used in many fields to attempt to establish consensus regarding important questions, including classification systems.16, 17, 18, 19 The process facilitates communication among a panel of experts regarding areas in which existing evidence-based information may be incomplete or unavailable. The focus of the technique is on the reliability of the expert group's opinion
Acknowledgment
The authors thank Dr. Ronald Klein, Madison, Wisconsin, and Dr. Johanna Seddon, Boston, Massachusetts, for their helpful review and advice for this manuscript.
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Manuscript no. 2012-944.
A list of all members of the Arnold and Mabel Beckman Initiative for Macular Research Classification Committee with affiliations can be found in Appendix 1.
Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Supported by the Arnold and Mabel Beckman Initiative for Macular Research, Irvine, California.
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Group members listed after the references in Appendix 1.