New system classifies vitreomacular disease, provides common language

Boston-An international panel of ophthalmologists have developed a classification system of vitreomacular diseases, with the goals of objectivity based on optical coherence tomography (OCT) findings and ease of use.

The new imaging-based classification system was needed because the Gass classification for macular holes was outdated. The Gass system was devised decades before the introduction of spectral-domain OCT, which has provided a better understanding of the pathogenesis of diseases of the vitreomacular interface diseases and is predictive of surgical outcomes.

The classification system was also needed because of the recently FDA-approved ocriplasmin (Jetra, ThromboGenics), a new therapy for some diseases, said Jay Duker, MD, professor and chairman of ophthalmology, Tufts University School of Medicine, Boston.

“We wanted the system to be applicable to clinical practice, useful for clinical trials, and predictive of surgical outcomes,” Dr. Duker said. “The overall goal was for ophthalmologists to speak a common language about these diseases.”

One finding (vitreomacular adhesion) and four diseases (vitreomacular traction, full-thickness macular hole, lamellar macular hole, and epiretinal membrane) are included in the classification, which the panel published in Ophthalmology (2013;120:261119).

When converting from the old Gass classification system to the new international classification system:

·      Stage 0 macular hole is equivalent to vitreomacular adhesion in the contralateral eye

·      Stage 1 macular hole is equivalent to vitreomacular traction

·      Stage 2 macular hole is equivalent to full-thickness macular hole (small/medium hole with/without vitreomacular traction)

·      Stage 3 macular hole is equivalent to full-thickness macular hole (medium/large hole with/without vitreomacular traction)

·      Stage 4 macular hole is equivalent to full-thickness macular hole (vitreomacular traction released with any size macular hole)

“Vitreomacular adhesion is a normal stage of progression of posterior vitreous detachment,” Dr. Duker noted. “Abnormalities result from persistence of adhesion with traction (vitreomacular traction), which can lead to severe retinal anatomic abnormalities, full-thickness macular holes, epiretinal membranes, lamellar macular holes, and macular schisis.”

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