The Alabama Age-Related Macular Degeneration Grading System for donor eyes

Invest Ophthalmol Vis Sci. 1998 Jun;39(7):1085-96.


Purpose: To develop a systematic method for identifying and grading age-related macular degeneration (ARMD) in human donor eyes, postmortem fundus appearance was compared with histopathologic assessment in eyes with a spectrum of age-related macular change.

Methods: Eyes without grossly visible, late ARMD were obtained from 8 cancer patients and 26 donors older than 50 years. Postmortem fundus appearance was graded for drusen and pigmentary change, using stereo color photographs. Eyes were processed and sectioned at 1 microm for histopathologic evaluation of macular retinal pigment epithelium-Bruch's membrane complex. The histologic diagnosis was compared with gross fundus appearance, clinical ophthalmic histories (n = 25), and clinical fundus photographs that were graded using the Wisconsin Age-related Maculopathy Grading System (n = 5).

Results: Ten eyes met histopathologic criteria for early ARMD. A similar proportion of eyes (27%-32%) was identified as affected by ARMD by other published histopathologic criteria. By choosing eyes with at least one druse larger than 125 microm in diameter or an area of pigment-clumping 500 microm in diameter that was visible in the postmortem fundus, ARMD cases were identified with 90% sensitivity and 95% specificity.

Conclusions: The Alabama ARMD Grading System permits rational and standardized use of donor eyes in studies that are directed toward understanding the pathogenesis of ARMD.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Alabama
  • Bruch Membrane / pathology
  • Female
  • Fundus Oculi
  • Humans
  • Macula Lutea / pathology
  • Macular Degeneration / classification*
  • Macular Degeneration / pathology
  • Male
  • Middle Aged
  • Photography
  • Pigment Epithelium of Eye / pathology
  • Retinal Drusen / classification
  • Retinal Drusen / pathology
  • Retinitis Pigmentosa / classification
  • Retinitis Pigmentosa / pathology
  • Sensitivity and Specificity
  • Tissue Donors*
  • Visual Acuity