JORGE RUIZ-MEDRANO, MD, PHD, IGNACIO FLORES-MORENO, MD, PHD, KYOKO OHNO-MATSUI, MD, PHD, CHUI MING GEMMY CHEUNG, MD, PHD, RUFINO SILVA, MD, PHD, JOSÉ M. RUIZ-MORENO, MD, PHD
Purpose: To validate the recently developed ATN grading system for myopic
maculopathy to classify eyes with pathologic myopia.
Methods: Cross-sectional study. A series of consecutive eyes diagnosed with
pathologic myopia and signs of myopic maculopathy (grade $1 for atrophic, tractional,
or neovascular components of the ATN), with a refractive error . 26.0 diopters (D), were
included. All patients underwent complete ophthalmological examination including fundus
photography and swept-source optical coherence tomography. Six observers graded each
eye twice using the ATN system ($15 days between assessments) based only on the
aforementioned data.
Results: Sixty eyes from 47 patients (61.7% female) were graded. Mean patient age was
63.2 ± 11.7 years. The mean spherical equivalent was 213.8 ± 6.5 D. Mean axial length was
28.6 ± 2.16 mm. Overall, the mean intraobserver agreement (%) for the same image was
92.0%, and the mean interobserver agreement for the second image was 77.5%. The
weighted Fleiss k showed excellent correlation (k . 0.8) for the traction and neovascularization components, and good correlation (0.75) for atrophy. Interobserver agreement for
each of these three components was 95.2%, 98.4%, 95.0%, respectively.
Conclusion: Application of the ATN resulted in high intraobserver and interobserver
correlation, underscoring the reproducibility of the system.
RETINA 40:2113–2118, 2020
