Original article
Comparison of Exudative Age-related Macular Degeneration Subtypes in Japanese and French Patients: Multicenter Diagnosis With Multimodal Imaging

https://doi.org/10.1016/j.ajo.2014.05.004Get rights and content

Purpose

To compare and analyze differences and similarities between Japanese and French patients in subtype diagnosis of exudative age-related macular degeneration (AMD) as determined by fundus photography (FP) and fluorescein angiography (FA), and a multimodal imaging involving FP, FA, indocyanine green angiography (ICGA), and optical coherence tomography (OCT).

Design

Retrospective chart review.

Methods

We determined the subtype diagnosis for 99 consecutive Japanese eyes and 94 consecutive French eyes with exudative AMD. The first-step diagnosis was made using FP and FA, while the second-step diagnosis was made using FP, FA/ICGA, and OCT. The diagnoses made by Japanese and French physicians were compared, and when the diagnoses differed, a third institute was consulted to arrive at a final consensus and diagnosis.

Results

The first-step diagnosis showed 20%-30% disagreement against the final diagnosis, but the second-step diagnosis showed only 10% disagreement. Polypoidal choroidal vasculopathy (PCV) was observed more in Japanese patients (48%) than in French (9%), and the rate of PCV with type 1 or 2 choroidal neovascularization (CNV) was extremely low: 3% in Japanese and 0% in French. Type 1 CNV was found significantly more in French cases (53.3% vs 35.1%, P = .018), while the rate of eyes with type 2 CNV only or chorioretinal anastomosis was similar between populations.

Conclusions

Multimodality imaging significantly improved the sub-classification of AMD. There were significant differences between the 2 series in the proportions of type 1 CNV and PCV, while the proportions of type 2 CNV only and chorioretinal anastomosis were similar between groups.

Section snippets

Methods

We retrospectively reviewed the medical records of 99 eyes of 99 consecutive patients who visited the Department of Ophthalmology, Kyoto University Hospital with a tentative diagnosis of neovascular AMD (Kyoto cases) and 95 eyes of 85 patients with presumed neovascular AMD at Centre d’Ophtalmologie de Paris (Paris cases). All patients underwent comprehensive ophthalmic examinations, including the measurement of best-corrected visual acuity, intraocular pressure testing, indirect ophthalmoscopy,

Results

This study consisted of 99 consecutive eyes of 99 Japanese patients and 95 consecutive eyes of 85 French patients with presumed neovascular AMD. One eye from among the French was excluded from the study because of angiographic images of low quality. The mean age of the 99 Japanese patients (70 men and 29 women) was 74.0 ± 8.9 years, and all patients were ethnically Japanese. The mean age of the 85 French patients (45 men and 40 women) was 73.5 ± 7.9 years, and 98% were white.

The “first-step

Discussion

In the present study, we addressed several gaps in the literature. First, our initial purpose was to try to determine whether the subtype diagnosis of exudative AMD can be made based on the results of fundus photography and FA only, and whether current multimodality diagnostic devices could help to enhance the accuracy of subtype diagnosis. We compared the results of “first-step diagnosis” with fundus photography and FA only to the results of “second-step diagnosis” with multimodality

Gabriel Coscas was trained at University of Paris, established the Department of Ophthalmology in University Paris XII, and served as Professor and Chairman until 1999. He devoted most of his activity on macular diseases. President of French Retina Society. He organized the first randomized clinical trial on macular photocoagulation for age-related macular degeneration in France. Author and co-author of over 450 peer-review papers and a founding member of Global Alliance against Trachoma at WHO.

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  • Cited by (0)

    Gabriel Coscas was trained at University of Paris, established the Department of Ophthalmology in University Paris XII, and served as Professor and Chairman until 1999. He devoted most of his activity on macular diseases. President of French Retina Society. He organized the first randomized clinical trial on macular photocoagulation for age-related macular degeneration in France. Author and co-author of over 450 peer-review papers and a founding member of Global Alliance against Trachoma at WHO.

    Kenji Yamashiro is an Assistant Professor of Ophthalmology at Kyoto University, Kyoto, Japan. He received MD and PhD from Kyoto University, and joined Dr Anthony Adamis' lab in Massachusetts Eye and Ear Infirmary in Boston from 2001 to 2003. He is an author and co-author of over 100 peer-review papers and currently the chief of the Macula Service of Kyoto University Hospital. His interests include clinical and genetic research on macular diseases.

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