用于根据照片对白内障进行分类的年龄相关性眼病研究（AREDS）系统：AREDS第4号报告
The age-related eye disease study (AREDS) system for classifying cataracts from photographs: AREDS report no. 4.
出版信息
Am J Ophthalmol. 2001 Feb;131(2):167-75. doi: 10.1016/s0002-9394(00)00732-7.
PURPOSE
To describe the system for grading cataracts from photographs in the Age-Related Eye Disease Study (AREDS).
METHODS
The system for grading cataracts in AREDS uses photographs taken in a standardized fashion with specially modified cameras at 11 clinical centers. The photographs are evaluated by graders for quality and cataract severity at a central reading center. The area of lens involvement is used to assess the severity of cortical and posterior subcapsular opacities. Optical density of nuclear opacity is graded against a series of seven standard photographs. Contemporaneous variability in grading is evaluated periodically by having a second examiner regrade a subset of the photographs. Temporal variability is assessed by annually regrading a subset of photographs.
RESULTS
Photographs of 925 eyes, most with no or early lens opacities, were regraded to assess intergrader reliability. For cortical opacities, there was an absolute difference of 10% or greater of area involved in 1.9% of the replicate gradings. For posterior subcapsular opacities an absolute difference of 5% of area involved was noted in 2.8% of the regraded photographs. For nuclear opacities, absolute differences of 1.5 or more steps were observed in 0.6% of eyes. There was little evidence of temporal drift in grading any of the three types of opacity during four annual regrades.
CONCLUSIONS
We have demonstrated a high degree of reliability in grading the severity of lens opacities in a large study cohort with mostly early lens changes, the type of cohort most likely to be entered in clinical trials involving cataract prevention. The Age-Related Eye Disease Study System for Classifying Cataracts From Photographs could be useful in studies where there is a need to standardize data collection over time and across different data collection sites. Limitations of the system include the cost of implementation and, currently, the limited amount of data on grading reproducibility for more advanced lens opacities.
目的
描述年龄相关性眼病研究（AREDS）中基于照片对白内障进行分级的系统。
方法
AREDS中白内障分级系统使用在11个临床中心用经过特殊改装的相机以标准化方式拍摄的照片。这些照片由分级人员在中央阅片中心评估质量和白内障严重程度。晶状体受累面积用于评估皮质性和后囊下混浊的严重程度。核混浊的光学密度对照一系列七张标准照片进行分级。通过让第二位检查人员对一部分照片重新分级来定期评估分级过程中的同期变异性。通过每年对一部分照片重新分级来评估时间变异性。
结果
对925只眼睛的照片进行重新分级以评估分级人员间的可靠性，这些眼睛大多没有或仅有早期晶状体混浊。对于皮质性混浊，在1.9%的重复分级中，受累面积的绝对差异为10%或更大。对于后囊下混浊，在2.8%的重新分级照片中，受累面积的绝对差异为5%。对于核混浊，在0.6%的眼睛中观察到绝对差异为1.5步或更多步。在四次年度重新分级中，几乎没有证据表明这三种类型混浊的分级存在时间漂移。
结论
在一个大多为早期晶状体改变的大型研究队列中，我们已证明在对晶状体混浊严重程度进行分级方面具有高度可靠性，这种队列类型最有可能纳入涉及白内障预防的临床试验。年龄相关性眼病研究中基于照片的白内障分类系统在需要随时间和跨不同数据收集地点标准化数据收集的研究中可能有用。该系统的局限性包括实施成本，以及目前关于更晚期晶状体混浊分级可重复性的数据量有限。
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