AMD Fundus Grading Scales Underrepresent Intermediate Disease Cases

The AREDS AMD severity scale, which typically only uses five levels but has 10 in this study to represent advanced AMD stages, is a measurement of AMD progression based on pigment and large drusen changes. Photo: Carolyn Majcher, OD. Click image to enlarge. The landmark AREDS2 study, published 13 years ago today, still continues to provide insights into AMD development and protocols for treatment. A new analysis of AREDS2 data presented on Sunday at the annual ARVO meeting in Denver shows the greater sensitivity to be had from OCT biomarkers rather than fundus examination alone. The researchers said in their abstract that they found an increased prevalence of intermediate AMD in particular when using OCT scans rather than color photography alone.This study evaluated baseline data from a cohort of patients who took the AREDS2 nutritional supplement, meant to slow AMD progression, to compare traditional color photograph–based AMD severity grading with OCT biomarkers. A total of 579 eyes from 319 participants were included, with disease severity categorized using the AREDS AMD scale, which uses a range of one to 10.The majority of eyes fell within intermediate stages. A total of 26.8% were categorized as levels one through six, 29.9% were in level seven and 8.8% were in level eight. The researchers noted that eyes with neovascular AMD were excluded from biomarker correlations. They analyzed several OCT features, including incomplete and complete RPE and outer retinal atrophy (iRORA and cRORA), hyperreflective foci (HRF), hyporeflective core drusen, calcified drusen, drusenoid pigment epithelial detachments and reticular pseudodrusen (RPD).The results showed a consistent increase in OCT biomarker prevalence as AMD severity worsened. Hyporeflective core drusen rose from 13.5% in levels one through six to 25.4% in level seven and 60.8% in level eight. Similarly, calcified drusen increased from 8.4% to 21.4% and then 45.1% across those same stages. RPD prevalence also increased from 27.7% to 38.2% and 47.1%. HRF demonstrated a notable rise, increasing from 18.7% in earlier stages to 50.3% of eyes in level seven and 64.7% in level eight.These findings indicated that OCT biomarkers were closely related to disease progression and had the potential to identify pathologic changes that color imaging severity could not find alone. “This suggests that OCT can detect important retinal damage earlier than traditional imaging, and that combining both approaches may improve how we identify patients at highest risk of progression to blindness,” they wrote.Original abstracts ©2026 Association for Research in Vision and Ophthalmology. Click here for the source. Domalpally A, Pak J W, Heathcote J, et al. Oct biomarkers in intermediate AMD in AREDS2. ARVO 2026 annual meeting.This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.