AREDS PQ and PG Form, FPRC

Fundus Photograph Reading Center

AREDS Photographic Quality and Preliminary Assessment - RIGHT EYE

	Photog./# (F) ________________ /___ ___ - ___ ___
Place label here	Photog./# (N) ________________ /___ ___ - ___ ___
	Photog./# (SL) ________________ /___ ___ - ___ ___
Name Code ___ ___ ___ ___ ___ ___	Reviewer:____________ Date __ __ /__ __ /__ __

		LENS STATUS:⁽¹²¹⁰⁾ Phakic⁽¹⁾ Aphakic⁽²⁾®STOP Pseudophakic⁽³⁾®STOP
FUNDUS		NEITZ	SLIT LAMP⁽¹³¹¹⁾
F1M⁽¹¹¹¹⁾ F2⁽¹¹¹²⁾ F3M⁽¹¹¹³⁾ Rflx⁽¹¹¹⁴⁾		Ant.⁽¹²¹¹⁾ Post.⁽¹²¹²⁾
Present?⁽¹⁾ ____ ____ ____ ____		Present?⁽¹⁾ ____ ____	Present?⁽¹⁾ ____
Absent?⁽⁰⁾____ ____ ____ ____		Absent?⁽⁰⁾____ ____	Absent?⁽⁰⁾____
OVERALL QUALITY⁽¹¹²⁰⁾		OVERALL QUALITY⁽¹²²⁰⁾	OVERALL QUALITY⁽¹³²⁰⁾
E⁽⁰⁾ G⁽¹⁾ F⁽²⁾ B₁⁽³⁾ B₂⁽⁴⁾ U₁⁽⁵⁾ U₂⁽⁶⁾		G⁽¹⁾ F⁽²⁾ B⁽³⁾ U⁽⁴⁾ Abs.⁽⁹⁾	G⁽¹⁾ F⁽²⁾ B⁽³⁾ U⁽⁴⁾ Abs.⁽⁹⁾
Quality if < G, reason:⁽¹¹²¹⁾		Quality if < G, reason:	Zone of Focus:⁽¹³²¹⁾
Focus/Clarity⁽¹⁾ Stereo⁽²⁾ Fld. Location⁽³⁾		Incorrect Focus:⁽¹²²¹⁾	1 2 3 4 5 CG⁽⁸⁾
		1. Anterior
		2. Posterior Too Deep	Quality if < G, reason:⁽¹³²²⁾
Do opacities interfere with photo quality?⁽¹¹²²⁾		3. Posterior Too Anterior	1. Focus problem
N⁽⁰⁾ Q⁽¹⁾ Lens⁽²⁾ Oth.⁽³⁾ CG⁽⁸⁾		Other:⁽¹²²³⁾	Beam Placement:
		1. See Other Problem Areas #_____	2. <10:30, >1:30
		or Comments ________________	3. Left/Right
RED REFLEX:⁽¹¹³⁰⁾	G⁽¹⁾ F⁽²⁾ U⁽³⁾ Abs.⁽⁹⁾		4. High/Low
		Reported Distance:⁽¹²²⁵⁾ ___.___ ___	Other:⁽¹³²³⁾
If pres. and < G indicate reason:⁽¹¹³¹⁾			1. See Other Problem Areas #__ #___
Focus⁽¹⁾ Stereo⁽²⁾ Magnific.⁽³⁾ Oth.⁽⁴⁾		PUPILLARY SIZE (mm):⁽¹²³⁵⁾	or Comments _____________
		<5⁽⁵⁾ <6⁽⁶⁾ >6⁽⁷⁾ CG⁽⁸⁾

RETAKES?⁽¹¹⁴⁰⁾ N⁽⁰⁾ Y⁽¹⁾		RETAKES?⁽¹²⁴⁰⁾ N⁽⁰⁾ Y⁽¹⁾	RETAKES?⁽¹³⁴⁰⁾ N⁽⁰⁾ Y⁽¹⁾

OTHER PROBLEM AREAS⁽¹¹⁹⁹⁾		OTHER PROBLEM AREAS⁽¹²⁹⁹⁾	OTHER PROBLEM AREAS⁽¹³⁹⁹⁾
1. labelling		1. labelling	1. labelling
2. mounting		2. mounting	2. mounting
3. lids/lashes		3. lids/lashes	3. lids/lashes
4. illumination		4. illumination	4. illumination
5. pupil size		5. pupil size	5. pupil size
6. reverse stereo		6. gaze eccentric	6. gaze eccentric
7. dust/smudges		7. tear meniscus
		8. questionable distance
10. OTHER		10. OTHER	10. OTHER

⁽¹⁴¹⁰⁾Probable AMD level RE: 1 2 3 4 InEL⁽⁵⁾ CG⁽⁸⁾ ® ⁽¹⁴¹¹⁾List reason(s): _______________________________

⁽¹⁴¹²⁾Poorest visual acuity readily explained by abnormalities of AMD: >20/32⁽¹⁾ >20/200⁽²⁾ <20/200⁽³⁾ CG⁽⁸⁾

⁽¹⁴¹³⁾Are you ( <50%⁽¹⁾, <90%⁽²⁾, >90%⁽³⁾, CG⁽⁸⁾ ) sure that macular abnormalities are principally due to AMD?

⁽¹⁹⁹⁹⁾COMMENTS ________________________________________________________________________________________________

______________________________________________________________________________________________________

AREDS Photographic Quality and Preliminary Assessment - LEFT EYE

		LENS STATUS:⁽²²¹⁰⁾ Phakic⁽¹⁾ Aphakic⁽²⁾®STOP Pseudophakic⁽³⁾®STOP
FUNDUS		NEITZ	SLIT LAMP⁽²³¹¹⁾
F1M⁽²¹¹¹⁾ F2⁽²¹¹²⁾ F3M⁽²¹¹³⁾ Rflx⁽²¹¹⁴⁾		Ant.⁽²²¹¹⁾ Post.⁽²²¹²⁾
Present?⁽¹⁾ ____ ____ ____ ____		Present?⁽¹⁾ ____ ____	Present?⁽¹⁾ ____
Absent?⁽⁰⁾____ ____ ____ ____		Absent?⁽⁰⁾____ ____	Absent?⁽⁰⁾____
OVERALL QUALITY⁽²¹²⁰⁾		OVERALL QUALITY⁽²²²⁰⁾	OVERALL QUALITY⁽²³²⁰⁾
E⁽⁰⁾ G⁽¹⁾ F⁽²⁾ B₁⁽³⁾ B₂⁽⁴⁾ U₁⁽⁵⁾ U₂⁽⁶⁾		G⁽¹⁾ F⁽²⁾ B⁽³⁾ U⁽⁴⁾ Abs.⁽⁹⁾	G⁽¹⁾ F⁽²⁾ B⁽³⁾ U⁽⁴⁾ Abs.⁽⁹⁾
Quality if < G, reason:⁽²¹²¹⁾		Quality if < G, reason:	Zone of Focus:⁽²³²¹⁾
Focus/Clarity⁽¹⁾ Stereo⁽²⁾ Fld. Location⁽³⁾		Incorrect Focus:⁽²²²¹⁾	1 2 3 4 5 CG⁽⁸⁾
		1. Anterior
		2. Posterior Too Deep	Quality if < G, reason:⁽²³²²⁾
Do opacities interfere with photo quality?⁽²¹²²⁾		3. Posterior Too Anterior	1. Focus problem
N⁽⁰⁾ Q⁽¹⁾ Lens⁽²⁾ Oth.⁽³⁾ CG⁽⁸⁾		Other:⁽²²²³⁾	Beam Placement:
		1. See Other Problem Areas #_____	2. <10:30, >1:30
		or Comments ________________	3. Left/Right
RED REFLEX:⁽²¹³⁰⁾	G⁽¹⁾ F⁽²⁾ U⁽³⁾ Abs.⁽⁹⁾		4. High/Low
		Reported Distance:⁽²²²⁵⁾ ___.___ ___	Other:⁽²³²³⁾
If pres. and < G indicate reason:⁽²¹³¹⁾			1. See Other Problem Areas #__ #__6
Focus⁽¹⁾ Stereo⁽²⁾ Magnific.⁽³⁾ Oth.⁽⁴⁾		PUPILLARY SIZE (mm):⁽²²³⁵⁾	or Comments _____________
		<5⁽⁵⁾ <6⁽⁶⁾ >6⁽⁷⁾ CG⁽⁸⁾
RETAKES?⁽²¹⁴⁰⁾ N⁽⁰⁾ Y⁽¹⁾		RETAKES?⁽²²⁴⁰⁾ N⁽⁰⁾ Y⁽¹⁾	RETAKES?⁽²³⁴⁰⁾ N⁽⁰⁾ Y⁽¹⁾

OTHER PROBLEM AREAS⁽²¹⁹⁹⁾		OTHER PROBLEM AREAS⁽²²⁹⁹⁾	OTHER PROBLEM AREAS⁽²³⁹⁹⁾
1. labelling		1. labelling	1. labelling
2. mounting		2. mounting	2. mounting
3. lids/lashes		3. lids/lashes	3. lids/lashes
4. illumination		4. illumination	4. illumination
5. pupil size		5. pupil size	5. pupil size
6. reverse stereo		6. gaze eccentric	6. gaze eccentric
7. dust/smudges		7. tear meniscus
		8. questionable distance
10. OTHER		10. OTHER	10. OTHER

(2410)Probable AMD level LE: 1 2 3 4 InEL⁽⁵⁾ CG⁽⁸⁾ ® ⁽²⁴¹¹⁾List reason(s): _______________________________

⁽²⁴¹²⁾Poorest visual acuity readily explained by abnormalities of AMD: >20/32⁽¹⁾ >20/200⁽²⁾ <20/200⁽³⁾ CG⁽⁸⁾

⁽²⁴¹³⁾Are you ( <50%⁽¹⁾, <90%⁽²⁾, >90%⁽³⁾, CG⁽⁸⁾ ) sure that macular abnormalities are principally due to AMD?

Eligible Ineligible

⁽³⁴¹⁰⁾PARTICIPANT AMD CATEGORY: 1 2 3a 3b 4 AMD⁽⁵⁾ Oth.⁽⁶⁾ Aphakic OU^*(7) CG⁽⁸⁾

(2999)COMMENTS ________________________________________________________________________________________________

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

*Participant not eligible if lens removed OU and AMD < Category 3.

Return to Grading Protocol

29Feb2000