ARMD Grading using Fundus Images

The assessment of ARMD was done by fundus images and graded by the modified Wisconsin Age-Related Maculopathy Grading Classification Scheme [28 (link),29 (link)]. Early ARMD was defined by the presence of numerous small (<63 µm) or intermediate (63–125 µm) drusen. Intermediated ARMD was characterized by either extensive drusen of small or intermediate size, or any large size (≥125 µm) drusen. Late ARMD was characterized by the presence of geographic atrophy or exudative macular degeneration or both. All fundus images were captured by an ophthalmic digital imaging system (CR6–45NM; Canon USA, Inc) and digital camera (EOS 10D; Canon USA, Inc). These images were graded by at least two trained examiners. If the first two examiners did not agree on a diagnosis, a third senior examiner could adjudicate any disagreements.