Age-related macular degeneration

Beckman classification of AMD[2]Ferris FL 3rd, Wilkinson CP, Bird A, et al; Beckman Initiative for Macular Research Classification Committee. Clinical classification of age-related macular degeneration. Ophthalmology. 2013 Apr;120(4):844-51. http://www.ncbi.nlm.nih.gov/pubmed/23332590?tool=bestpractice.com

No AMD

• No or a few small (<63 micrometres in diameter) drusen.

Early AMD[Figure caption and citation for the preceding image starts]: Early AMD (Age-Related Eye Disease Study Group [AREDS] category 2)Reproduced from Scheie Eye Institute's patient image database; used with permission [Citation ends].

• Intermediate-sized (63-124 micrometres in diameter) drusen.

Intermediate AMD[Figure caption and citation for the preceding image starts]: Intermediate AMD (Age-Related Eye Disease Study Group [AREDS] category 3)Reproduced from Scheie Eye Institute's patient image database; used with permission [Citation ends].

• Intermediate drusen and pigmentary changes, or at least one large (≥125 micrometres) druse.

Late AMD

• Geographic atrophy[Figure caption and citation for the preceding image starts]: Late AMD with central geographic atrophy (Age-Related Eye Disease Study Group [AREDS] category 4)Reproduced from Scheie Eye Institute's patient image database; used with permission [Citation ends].

• Choroidal neovascularisation (CNV) with signs including subretinal haemorrhage, serous retinal or retinal pigment epithelium detachments, lipid exudates, or fibrovascular scar.[Figure caption and citation for the preceding image starts]: Late AMD with choroidal neovascularisation with exudation (Age-Related Eye Disease Study Group [AREDS] category 4)Reproduced from Scheie Eye Institute's patient image database; used with permission [Citation ends].[Figure caption and citation for the preceding image starts]: Fibrovascular scar from end-stage AMD (Age-Related Eye Disease Study Group [AREDS] category 4)Reproduced from Scheie Eye Institute's patient image database; used with permission [Citation ends].

Age-Related Eye Disease Study Group (AREDS) classification[23]American Academy of Ophthalmology. Preferred practice pattern: age-related macular degeneration. Oct 2019 [internet publication]. https://www.aao.org/preferred-practice-pattern/age-related-macular-degeneration-ppp  

The AREDS study investigated the use of antioxidants and mineral supplementation to decrease the risk of AMD progression. In this study, AMD was classified as follows:[34]Age-Related Eye Disease Study Research Group. A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E, beta carotene, and zinc for age-related macular degeneration and vision loss: AREDS report no. 8. Arch Ophthalmol. 2001 Oct;119(10):1417-36. https://jamanetwork.com/journals/jamaophthalmology/fullarticle/268224 http://www.ncbi.nlm.nih.gov/pubmed/11594942?tool=bestpractice.com

No AMD (AREDS category 1)

• No or a few small (<63 micrometres in diameter) drusen.

Early AMD (AREDS category 2)[Figure caption and citation for the preceding image starts]: Early AMD (Age-Related Eye Disease Study Group [AREDS] category 2)Reproduced from Scheie Eye Institute's patient image database; used with permission [Citation ends].

• Many small drusen, or a few intermediate-sized (63-124 micrometres in diameter) drusen, or mild abnormalities of the retinal pigment epithelium (RPE).

Intermediate AMD (AREDS category 3)[Figure caption and citation for the preceding image starts]: Intermediate AMD (Age-Related Eye Disease Study Group [AREDS] category 3)Reproduced from Scheie Eye Institute's patient image database; used with permission [Citation ends].

• Extensive intermediate drusen, or at least one large (≥125 micrometres in diameter) druse, or geographic atrophy not involving the foveal centre.

Advanced AMD (AREDS category 4): one or more of the following in one eye (in the absence of other causes):

• Geographic atrophy involving the foveal centre (atrophic, or dry, AMD)[Figure caption and citation for the preceding image starts]: Late AMD with central geographic atrophy (Age-Related Eye Disease Study Group [AREDS] category 4)Reproduced from Scheie Eye Institute's patient image database; used with permission [Citation ends].

• Neovascular maculopathy (exudative, wet AMD), including CNV, serous and/or haemorrhagic detachment of the retina or RPE, retinal hard exudates, subretinal and sub-RPE fibrovascular proliferation, or disciform scar (subretinal fibrosis).[Figure caption and citation for the preceding image starts]: Late AMD with choroidal neovascularisation with exudation (Age-Related Eye Disease Study Group [AREDS] category 4)Reproduced from Scheie Eye Institute's patient image database; used with permission [Citation ends].[Figure caption and citation for the preceding image starts]: Fibrovascular scar from end-stage AMD (Age-Related Eye Disease Study Group [AREDS] category 4)Reproduced from Scheie Eye Institute's patient image database; used with permission [Citation ends].