{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T11:31:24Z","timestamp":1774438284420,"version":"3.50.1"},"reference-count":21,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","license":[{"start":{"date-parts":[[2020,2,17]],"date-time":"2020-02-17T00:00:00Z","timestamp":1581897600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,11]]},"abstract":"<jats:sec>\n            <jats:title>Purpose:<\/jats:title>\n            <jats:p>To validate the recently developed ATN grading system for myopic maculopathy to classify eyes with pathologic myopia.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>Cross-sectional study. A series of consecutive eyes diagnosed with pathologic myopia and signs of myopic maculopathy (grade \u22651 for atrophic, tractional, or neovascular components of the ATN), with a refractive error &gt; \u22126.0 diopters (D), were included. All patients underwent complete ophthalmological examination including fundus photography and swept-source optical coherence tomography. Six observers graded each eye twice using the ATN system (\u226515 days between assessments) based only on the aforementioned data.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>Sixty eyes from 47 patients (61.7% female) were graded. Mean patient age was 63.2 \u00b1 11.7 years. The mean spherical equivalent was \u221213.8 \u00b1 6.5 D. Mean axial length was 28.6 \u00b1 2.16 mm. Overall, the mean intraobserver agreement (%) for the same image was 92.0%, and the mean interobserver agreement for the second image was 77.5%. The weighted Fleiss k showed excellent correlation (k &gt; 0.8) for the traction and neovascularization components and good correlation (0.75) for atrophy. Interobserver agreement for each of these three components was 95.2%, 98.4%, 95.0%, respectively.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion:<\/jats:title>\n            <jats:p>Application of the ATN resulted in high intraobserver and interobserver correlation, underscoring the reproducibility of the system.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/iae.0000000000002725","type":"journal-article","created":{"date-parts":[[2020,2,19]],"date-time":"2020-02-19T12:08:04Z","timestamp":1582114084000},"page":"2113-2118","source":"Crossref","is-referenced-by-count":31,"title":["VALIDATION OF THE RECENTLY DEVELOPED ATN CLASSIFICATION AND GRADING SYSTEM FOR MYOPIC MACULOPATHY"],"prefix":"10.1097","volume":"40","author":[{"given":"Jorge","family":"Ruiz-Medrano","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Puerta de Hierro-Majadahonda University Hospital, Madrid, Spain;"}]},{"given":"Ignacio","family":"Flores-Moreno","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Puerta de Hierro-Majadahonda University Hospital, Madrid, Spain;"}]},{"given":"Kyoko","family":"Ohno-Matsui","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Visual Science at Tokyo Medical and Dental University, Tokio, Japan;"}]},{"given":"Chui Ming Gemmy","family":"Cheung","sequence":"additional","affiliation":[{"name":"Singapore Eye Research Institute, Singapore National Eye Centre, Singapore;"}]},{"given":"Rufino","family":"Silva","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Coimbra (FMUC), Coimbra, Portugal;"},{"name":"Department of Ophthalmology, Centro Hospitalar e Universit\u00e1rio de Coimbra (CHUC), Coimbra, Portugal;"},{"name":"Association for Innovation and Biomedical Research on Light and Image (AIBILI), Coimbra, Portugal;"}]},{"given":"Jos\u00e9 M.","family":"Ruiz-Moreno","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Puerta de Hierro-Majadahonda University Hospital, Madrid, Spain;"},{"name":"Department of Ophthalmology, Castilla La Mancha University, Albacete, Spain;"},{"name":"Vissum Corporation, Spain; and"},{"name":"Red Tem\u00e1tica de Investigaci\u00f3n Cooperativa en Salud, Prevenci\u00f3n, Detecci\u00f3n Precoz, y Tratamiento de La Patolog\u00eda Ocular Prevalente, Degenerativa y Cr\u00f3nica (RD16\/0008\/0021), Spanish Ministry of Health, Instituto de Salud Carlos III, Madrid, Spain."}]}],"member":"276","published-online":{"date-parts":[[2020,2,17]]},"reference":[{"key":"R1-20230817","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/j.preteyeres.2018.10.005","article-title":"Myopic maculopathy: current status and proposal for a new classification and grading system (ATN)","volume":"69","author":"Ruiz-Medrano","year":"2019","journal-title":"Prog Retin Eye Res"},{"key":"R2-20230817","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1097\/IAE.0000000000001348","article-title":"What is the fundamental nature of pathologic myopia?","volume":"37","author":"Ohno-Matsui","year":"2017","journal-title":"Retina"},{"key":"R3-20230817","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1159\/000339893","article-title":"Myopic maculopathy: a review","volume":"228","author":"Silva","year":"2012","journal-title":"Ophthalmologica"},{"key":"R4-20230817","doi-asserted-by":"crossref","first-page":"682","DOI":"10.1016\/j.ophtha.2013.10.023","article-title":"RADIANCE: a randomized controlled study of ranibizumab in patients with choroidal neovascularization secondary to pathologic myopia","volume":"121","author":"Wolf","year":"2014","journal-title":"Ophthalmology"},{"key":"R5-20230817","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1016\/j.preteyeres.2017.09.004","article-title":"The epidemics of myopia: aetiology and prevention","volume":"62","author":"Morgan","year":"2018","journal-title":"Prog Retin Eye Res"},{"key":"R6-20230817","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1111\/j.1755-3768.1988.tb02681.x","article-title":"On the definition of pathologic myopia in group studies","volume":"66","author":"Tokoro","year":"1988","journal-title":"Acta Ophthalmol"},{"key":"R7-20230817","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/j.preteyeres.2015.12.001","article-title":"Updates of pathologic myopia","volume":"52","author":"Ohno-Matsui","year":"2016","journal-title":"Prog Retin Eye Res"},{"key":"R8-20230817","doi-asserted-by":"crossref","first-page":"1626","DOI":"10.1016\/j.ophtha.2011.01.018","article-title":"Topographic analyses of shape of eyes with pathologic myopia by high-resolution three-dimensional magnetic resonance imaging","volume":"118","author":"Moriyama","year":"2011","journal-title":"Ophthalmology"},{"key":"R9-20230817","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1016\/j.ajo.2015.11.016","article-title":"Clinical characteristics of posterior staphylomas in myopic eyes with axial length shorter than 26.5 millimeters","volume":"162","author":"Wang","year":"2016","journal-title":"Am J Ophthalmol"},{"key":"R10-20230817","doi-asserted-by":"crossref","first-page":"1739","DOI":"10.1016\/S0140-6736(12)60272-4","article-title":"Myopia","volume":"379","author":"Morgan","year":"2012","journal-title":"Lancet"},{"key":"R11-20230817","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1097\/APO.0000000000000230","article-title":"Pathologic myopia","volume":"5","author":"Ohno-Matsui","year":"2016","journal-title":"Asia-pacific J Ophthalmol"},{"key":"R12-20230817","doi-asserted-by":"crossref","first-page":"1354","DOI":"10.1016\/j.ophtha.2006.04.022","article-title":"Prevalence and causes of low vision and blindness in a Japanese adult population. 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