An optical coherence tomography-based grading of diabetic maculopathy proposed by an international expert panel: The European School for Advanced Studies in Ophthalmology classification

Giacomo Panozzo*, Maria Vittoria Cicinelli, Albert J. Augustin, Maurizio Battaglia Parodi, Josè Cunha-Vaz, Giuseppe Guarnaccia, Laurent Kodjikian, Lee Merrill Jampol, Anselm Jünemann, Paolo Lanzetta, Anat Löwenstein, Edoardo Midena, Rafael Navarro, Giuseppe Querques, Federico Ricci, Ursula Schmidt-Erfurth, Rufino Martins da Silva, Sobha Sivaprasad, Monica Varano, Gianni VirgiliFrancesco Bandello

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Aims: To present an authoritative, universal, easy-to-use morphologic classification of diabetic maculopathy based on spectral domain optical coherence tomography. Methods: The first draft of the project was developed based on previously published classifications and a literature search regarding the spectral domain optical coherence tomography quantitative and qualitative features of diabetic maculopathy. This draft was sent to an international panel of retina experts for a first revision. The panel met at the European School for Advanced Studies in Ophthalmology headquarters in Lugano, Switzerland, and elaborated the final document. Results: Seven tomographic qualitative and quantitative features are taken into account and scored according to a grading protocol termed TCED-HFV, which includes foveal thickness (T), corresponding to either central subfoveal thickness or macular volume, intraretinal cysts (C), the ellipsoid zone (EZ) and/or external limiting membrane (ELM) status (E), presence of disorganization of the inner retinal layers (D), number of hyperreflective foci (H), subfoveal fluid (F), and vitreoretinal relationship (V). Four different stages of the disease, that is, early diabetic maculopathy, advanced diabetic maculopathy, severe diabetic maculopathy, and atrophic maculopathy, are based on the first four variables, namely the T, C, E, and D. The different stages reflect progressive severity of the disease. Conclusion: A novel grading system of diabetic maculopathy is hereby proposed. The classification is aimed at providing a simple, direct, objective tool to classify diabetic maculopathy (irrespective to the treatment status) even for non-retinal experts and can be used for therapeutic and prognostic purposes, as well as for correct evaluation and reproducibility of clinical investigations.

Original languageEnglish (US)
Pages (from-to)8-18
Number of pages11
JournalEuropean Journal of Ophthalmology
Volume30
Issue number1
DOIs
StatePublished - Jan 1 2020

Fingerprint

Optical Coherence Tomography
Ophthalmology
Switzerland
Retina
Cysts
Membranes
Therapeutics

Keywords

  • Classification
  • consensus
  • diabetic macular edema
  • diabetic maculopathy
  • optical coherence tomography
  • vitreomacular interface

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Panozzo, Giacomo ; Cicinelli, Maria Vittoria ; Augustin, Albert J. ; Battaglia Parodi, Maurizio ; Cunha-Vaz, Josè ; Guarnaccia, Giuseppe ; Kodjikian, Laurent ; Jampol, Lee Merrill ; Jünemann, Anselm ; Lanzetta, Paolo ; Löwenstein, Anat ; Midena, Edoardo ; Navarro, Rafael ; Querques, Giuseppe ; Ricci, Federico ; Schmidt-Erfurth, Ursula ; da Silva, Rufino Martins ; Sivaprasad, Sobha ; Varano, Monica ; Virgili, Gianni ; Bandello, Francesco. / An optical coherence tomography-based grading of diabetic maculopathy proposed by an international expert panel : The European School for Advanced Studies in Ophthalmology classification. In: European Journal of Ophthalmology. 2020 ; Vol. 30, No. 1. pp. 8-18.
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abstract = "Aims: To present an authoritative, universal, easy-to-use morphologic classification of diabetic maculopathy based on spectral domain optical coherence tomography. Methods: The first draft of the project was developed based on previously published classifications and a literature search regarding the spectral domain optical coherence tomography quantitative and qualitative features of diabetic maculopathy. This draft was sent to an international panel of retina experts for a first revision. The panel met at the European School for Advanced Studies in Ophthalmology headquarters in Lugano, Switzerland, and elaborated the final document. Results: Seven tomographic qualitative and quantitative features are taken into account and scored according to a grading protocol termed TCED-HFV, which includes foveal thickness (T), corresponding to either central subfoveal thickness or macular volume, intraretinal cysts (C), the ellipsoid zone (EZ) and/or external limiting membrane (ELM) status (E), presence of disorganization of the inner retinal layers (D), number of hyperreflective foci (H), subfoveal fluid (F), and vitreoretinal relationship (V). Four different stages of the disease, that is, early diabetic maculopathy, advanced diabetic maculopathy, severe diabetic maculopathy, and atrophic maculopathy, are based on the first four variables, namely the T, C, E, and D. The different stages reflect progressive severity of the disease. Conclusion: A novel grading system of diabetic maculopathy is hereby proposed. The classification is aimed at providing a simple, direct, objective tool to classify diabetic maculopathy (irrespective to the treatment status) even for non-retinal experts and can be used for therapeutic and prognostic purposes, as well as for correct evaluation and reproducibility of clinical investigations.",
keywords = "Classification, consensus, diabetic macular edema, diabetic maculopathy, optical coherence tomography, vitreomacular interface",
author = "Giacomo Panozzo and Cicinelli, {Maria Vittoria} and Augustin, {Albert J.} and {Battaglia Parodi}, Maurizio and Jos{\`e} Cunha-Vaz and Giuseppe Guarnaccia and Laurent Kodjikian and Jampol, {Lee Merrill} and Anselm J{\"u}nemann and Paolo Lanzetta and Anat L{\"o}wenstein and Edoardo Midena and Rafael Navarro and Giuseppe Querques and Federico Ricci and Ursula Schmidt-Erfurth and {da Silva}, {Rufino Martins} and Sobha Sivaprasad and Monica Varano and Gianni Virgili and Francesco Bandello",
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Panozzo, G, Cicinelli, MV, Augustin, AJ, Battaglia Parodi, M, Cunha-Vaz, J, Guarnaccia, G, Kodjikian, L, Jampol, LM, Jünemann, A, Lanzetta, P, Löwenstein, A, Midena, E, Navarro, R, Querques, G, Ricci, F, Schmidt-Erfurth, U, da Silva, RM, Sivaprasad, S, Varano, M, Virgili, G & Bandello, F 2020, 'An optical coherence tomography-based grading of diabetic maculopathy proposed by an international expert panel: The European School for Advanced Studies in Ophthalmology classification', European Journal of Ophthalmology, vol. 30, no. 1, pp. 8-18. https://doi.org/10.1177/1120672119880394

An optical coherence tomography-based grading of diabetic maculopathy proposed by an international expert panel : The European School for Advanced Studies in Ophthalmology classification. / Panozzo, Giacomo; Cicinelli, Maria Vittoria; Augustin, Albert J.; Battaglia Parodi, Maurizio; Cunha-Vaz, Josè; Guarnaccia, Giuseppe; Kodjikian, Laurent; Jampol, Lee Merrill; Jünemann, Anselm; Lanzetta, Paolo; Löwenstein, Anat; Midena, Edoardo; Navarro, Rafael; Querques, Giuseppe; Ricci, Federico; Schmidt-Erfurth, Ursula; da Silva, Rufino Martins; Sivaprasad, Sobha; Varano, Monica; Virgili, Gianni; Bandello, Francesco.

In: European Journal of Ophthalmology, Vol. 30, No. 1, 01.01.2020, p. 8-18.

Research output: Contribution to journalArticle

TY - JOUR

T1 - An optical coherence tomography-based grading of diabetic maculopathy proposed by an international expert panel

T2 - The European School for Advanced Studies in Ophthalmology classification

AU - Panozzo, Giacomo

AU - Cicinelli, Maria Vittoria

AU - Augustin, Albert J.

AU - Battaglia Parodi, Maurizio

AU - Cunha-Vaz, Josè

AU - Guarnaccia, Giuseppe

AU - Kodjikian, Laurent

AU - Jampol, Lee Merrill

AU - Jünemann, Anselm

AU - Lanzetta, Paolo

AU - Löwenstein, Anat

AU - Midena, Edoardo

AU - Navarro, Rafael

AU - Querques, Giuseppe

AU - Ricci, Federico

AU - Schmidt-Erfurth, Ursula

AU - da Silva, Rufino Martins

AU - Sivaprasad, Sobha

AU - Varano, Monica

AU - Virgili, Gianni

AU - Bandello, Francesco

PY - 2020/1/1

Y1 - 2020/1/1

N2 - Aims: To present an authoritative, universal, easy-to-use morphologic classification of diabetic maculopathy based on spectral domain optical coherence tomography. Methods: The first draft of the project was developed based on previously published classifications and a literature search regarding the spectral domain optical coherence tomography quantitative and qualitative features of diabetic maculopathy. This draft was sent to an international panel of retina experts for a first revision. The panel met at the European School for Advanced Studies in Ophthalmology headquarters in Lugano, Switzerland, and elaborated the final document. Results: Seven tomographic qualitative and quantitative features are taken into account and scored according to a grading protocol termed TCED-HFV, which includes foveal thickness (T), corresponding to either central subfoveal thickness or macular volume, intraretinal cysts (C), the ellipsoid zone (EZ) and/or external limiting membrane (ELM) status (E), presence of disorganization of the inner retinal layers (D), number of hyperreflective foci (H), subfoveal fluid (F), and vitreoretinal relationship (V). Four different stages of the disease, that is, early diabetic maculopathy, advanced diabetic maculopathy, severe diabetic maculopathy, and atrophic maculopathy, are based on the first four variables, namely the T, C, E, and D. The different stages reflect progressive severity of the disease. Conclusion: A novel grading system of diabetic maculopathy is hereby proposed. The classification is aimed at providing a simple, direct, objective tool to classify diabetic maculopathy (irrespective to the treatment status) even for non-retinal experts and can be used for therapeutic and prognostic purposes, as well as for correct evaluation and reproducibility of clinical investigations.

AB - Aims: To present an authoritative, universal, easy-to-use morphologic classification of diabetic maculopathy based on spectral domain optical coherence tomography. Methods: The first draft of the project was developed based on previously published classifications and a literature search regarding the spectral domain optical coherence tomography quantitative and qualitative features of diabetic maculopathy. This draft was sent to an international panel of retina experts for a first revision. The panel met at the European School for Advanced Studies in Ophthalmology headquarters in Lugano, Switzerland, and elaborated the final document. Results: Seven tomographic qualitative and quantitative features are taken into account and scored according to a grading protocol termed TCED-HFV, which includes foveal thickness (T), corresponding to either central subfoveal thickness or macular volume, intraretinal cysts (C), the ellipsoid zone (EZ) and/or external limiting membrane (ELM) status (E), presence of disorganization of the inner retinal layers (D), number of hyperreflective foci (H), subfoveal fluid (F), and vitreoretinal relationship (V). Four different stages of the disease, that is, early diabetic maculopathy, advanced diabetic maculopathy, severe diabetic maculopathy, and atrophic maculopathy, are based on the first four variables, namely the T, C, E, and D. The different stages reflect progressive severity of the disease. Conclusion: A novel grading system of diabetic maculopathy is hereby proposed. The classification is aimed at providing a simple, direct, objective tool to classify diabetic maculopathy (irrespective to the treatment status) even for non-retinal experts and can be used for therapeutic and prognostic purposes, as well as for correct evaluation and reproducibility of clinical investigations.

KW - Classification

KW - consensus

KW - diabetic macular edema

KW - diabetic maculopathy

KW - optical coherence tomography

KW - vitreomacular interface

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