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A Simplified Classification for Age-Related Macular Degeneration Based on Optical Coherence Tomography.

Tsai-Chu Yeh^1,2,3, Jonathan B Lin², Prithvi Mruthyunjaya²

¹Molecular Surgery Laboratory, Stanford University, Palo Alto, CA.

Medrxiv : the Preprint Server for Health Sciences

|April 10, 2026

Summary

A new Stanford OCT-Based AMD Classification (SOAC) provides a standardized grading scheme for age-related macular degeneration (AMD) using optical coherence tomography (OCT) scans. This OCT-based AMD classification demonstrates excellent intergrader agreement, improving consistency in clinical and research settings.

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Published on: May 26, 2023

Area of Science:

Ophthalmology
Medical Imaging
Biomarker Discovery

Background:

Existing age-related macular degeneration (AMD) classifications rely on color fundus photography, inconsistently incorporating optical coherence tomography (OCT) biomarkers.
OCT offers superior resolution for detecting subclinical structural changes crucial for AMD staging.
There is a need for a simplified, OCT-based grading scheme for consistent AMD communication and research.

Purpose of the Study:

To establish a standardized OCT-based AMD classification (SOAC) balancing diagnostic accuracy and clinical practicality.
To enable physicians to grade AMD directly from OCT imaging, synchronizing communication.
To facilitate integration of OCT findings across clinical and translational research settings.

Main Methods:

Spectral-domain OCT scans from 109 eyes (108 patients) were independently graded by two retinal specialists using the proposed SOAC.
Discrepancies were adjudicated by a third specialist.
Intergrader agreement was assessed using weighted kappa coefficients.

Main Results:

The SOAC classified AMD stages including normal aging, early, intermediate, neovascular AMD (nAMD), geographic atrophy (GA), and combined nAMD/GA.
The Stanford OCT-Based AMD Classification (SOAC) demonstrated excellent intergrader reliability with a weighted kappa of 0.95.
This robust consistency validates the SOAC for standardized AMD staging.

Conclusions:

The SOAC offers a standardized, OCT-based framework for AMD grading with high intergrader agreement.
This OCT-based AMD classification supports reliable disease staging and facilitates integration into clinical studies and research.
SOAC serves as a common OCT reference for phenotype refinement and longitudinal AMD studies.