Within what zone are lesions graded in the Beckman classification of AMD?

The whole posterior pole to the arcades

Any area visible on widefield imaging

In the Beckman classification, which finding defines early AMD?

Medium drusen 63-125 microns without pigment change Early AMD is medium drusen of 63 to 125 microns without pigment abnormalities, and these patients usually keep good acuity.

Drupelets smaller than 63 microns

A single druse larger than 125 microns

When staging AMD at the slit lamp, which landmark approximates the 125-micron drusen threshold?

Diameter of the foveal avascular zone

Under the Beckman classification, an eye with only drupelets smaller than 63 microns is staged as what?

Normal aging changes Drupelets alone are normal aging changes with no clinically relevant risk, so these patients should not be given an AMD diagnosis.

In the Beckman classification, which single finding is enough for intermediate AMD?

One large druse within the macular zone One large druse within the macular zone qualifies as intermediate AMD, as do pigment changes with at least medium drusen.

Several drupelets near the fovea

Medium drusen without pigment change

Under the Beckman classification, how much geographic atrophy is needed to classify an eye as late AMD?

Atrophy of any size Late AMD includes neovascular AMD or geographic atrophy of any size; foveal involvement is recorded separately because atrophy can spare the center.

Atrophy involving the foveal center

Atrophy larger than one disc area

Across the Beckman AMD scale, roughly how much does the five-year risk of late AMD increase?

About 100-fold Five-year risk rises about 100-fold across the scale, from about 0.5% with normal aging changes to about 50% in the highest-risk group.

Which findings earn points on the AREDS simplified severity scale for AMD?

Drupelets and reticular pseudodrusen

Subretinal fluid and hemorrhage

Based on AREDS, which patients with AMD are suited to AREDS-type supplements?

Intermediate AMD or late AMD in one eye AREDS reduced progression in intermediate disease or late AMD in one eye, while early disease lacks comparable evidence, so the stage should be checked first.

Normal aging changes with drupelets

Early AMD with medium drusen only

Bilateral end-stage disciform scars only

In AREDS2, which nutrients were supported as a replacement for beta-carotene in AMD supplements?

Lutein and zeaxanthin AREDS2 supported lutein and zeaxanthin in place of beta-carotene; supplements slow risk modestly and do not reverse damage.

Beckman Classification (AMD Stages): Drusen and Counseling

The Beckman classification stages age-related macular degeneration (AMD) in people older than 55 years.

It uses drusen size and pigment changes within two disc diameters of the fovea.

Because it needs only a dilated examination or color photograph, it suits routine practice.

What the Beckman Classification Measures

An expert committee published the scale in 2013.

Two findings drive staging: the largest druse and any associated pigment change.

Late disease then adds neovascular AMD and geographic atrophy.

Measuring Drusen at the Slit Lamp

The scale uses two thresholds, 63 and 125 microns.

For example, 125 microns roughly matches the width of a large vein at the disc margin.

A druse about half that width approaches 63 microns.

However, magnification varies, so compare each druse with that vein.

Morphology adds information (see soft and hard drusen).

Test your knowledge 10 questions from this article

The Five Beckman Classification Stages

No aging changes: no drusen and no pigmentary abnormalities
Normal aging changes: only drupelets, smaller than 63 microns
Early AMD: medium drusen (63 to 125 microns) without pigment abnormalities
Intermediate AMD: large drusen, or pigment abnormalities with medium drusen
Late AMD: neovascular AMD or any geographic atrophy

Normal Aging and Early AMD

Drupelets are common in older eyes and carry no clinically relevant risk.

Therefore, avoid giving these patients an AMD diagnosis.

Medium drusen define early AMD, and patients usually keep good acuity.

Nevertheless, discuss smoking, diet and periodic examination.

Intermediate AMD in the Beckman Classification

One large druse within the macular zone qualifies.

Pigment changes with at least medium drusen also qualify.

Some patients notice slow dark adaptation despite good acuity.

However, risk varies widely, because bilateral findings carry more weight.

Late AMD: Neovascular Disease and Atrophy

Late AMD includes neovascular disease or geographic atrophy of any size.

Examiners may see subretinal fluid, hemorrhage or a sharply demarcated atrophic patch.

OCT then confirms fluid, neovascular tissue and outer retinal loss.

Foveal involvement is separate, because atrophy can spare the center.

Progression Risk in the Beckman Classification

Five-year risk of late AMD rises about 100-fold across the scale.

It ranges from about 0.5% with normal aging changes to about 50% in the highest-risk group.

These figures describe groups, so they cannot predict one patient’s course.

Comparison With the AREDS Simplified Scale

This scale gives one point per eye for large drusen and one for pigment abnormalities.

Thus, it refines risk within the broad intermediate stage.

Five-year risks for scores 0 to 4 are about 0.5%, 3%, 12%, 25% and 50%.

Supplements and Beckman Classification Stage

AREDS reduced progression in participants with intermediate disease or late AMD in one eye.

Therefore, AREDS-type supplements suit those patients, while early disease lacks comparable evidence.

AREDS2 then supported lutein and zeaxanthin in place of beta-carotene.

Finally, explain that supplements slow risk modestly and do not reverse damage.

Beckman Classification (AMD Stages): Drusen and Counseling

Management of Late Disease

Active neovascular AMD needs prompt anti-VEGF evaluation (see wet vs dry AMD).

Complement inhibitors may slow geographic atrophy growth in selected patients.

However, they do not restore lost vision.

Imaging Limits of the Beckman Classification

The scale predates modern multimodal grading.

Consequently, it does not stage reticular pseudodrusen, which OCT often reveals.

Consensus OCT definitions of atrophy now add structural detail.

Mimics That Distort Staging

For example, basal laminar drusen can appear as numerous small lesions in younger patients.

Pattern dystrophy and adult vitelliform lesions can also mislead.

Therefore, check age, family history, autofluorescence and OCT when the appearance is atypical.

Counseling Patients Using the Beckman Classification

Use plain language first, because many patients equate AMD with blindness.

AMD rarely causes complete blindness, although central vision can decline.

Next, name the stage and describe the approximate risk.

Also teach patients to report new distortion or sudden blur promptly.

At each visit, compare drusen, pigment and OCT with baseline.

Follow-Up After Staging

Examination intervals depend on stage, symptoms and fellow-eye status.

Patients with intermediate disease need clear self-monitoring instructions.

An Amsler grid may help, although a normal grid cannot exclude neovascularization.

Documenting the Beckman Classification Stage

Record the stage separately for each eye, because the fellow eye changes risk.

Also note the largest druse, pigment changes and the imaging used.

Then, compare the next visit with the same baseline photograph or OCT scan.

As a result, small changes become easier to recognize.

Risk Factors That Modify Staging Decisions

Smoking, which raises progression risk and is modifiable
Family history of AMD, because genetic risk is substantial
Older age, since progression risk rises over time
Fellow-eye late AMD, which increases risk in the second eye

Pitfalls to Avoid

Do not label drupelets as early AMD
Do not stage lesions outside the two-disc-diameter zone
Avoid estimating drusen size without a reference vessel
Do not assume geographic atrophy always involves the fovea
Never recommend supplements without checking the stage

References

Ferris FL 3rd, Wilkinson CP, Bird A, et al. Clinical classification of age-related macular degeneration. Ophthalmology. 2013;120:844-851.
Ferris FL, Davis MD, Clemons TE, et al. A simplified severity scale for age-related macular degeneration: AREDS report no. 18. Arch Ophthalmol. 2005;123:1570-1574.
Age-Related Eye Disease Study 2 Research Group. Lutein + zeaxanthin and omega-3 fatty acids for age-related macular degeneration. JAMA. 2013;309:2005-2015.
Sadda SR, Guymer R, Holz FG, et al. Consensus definition for atrophy associated with age-related macular degeneration on OCT. Ophthalmology. 2018;125:537-548.

Test yourself

A few questions straight from this article.

1 / 10 0 correct

Within what zone are lesions graded in the Beckman classification of AMD?
The Beckman scale grades drusen size and pigment changes within two disc diameters of the fovea, and lesions outside that zone should not be staged.
In the Beckman classification, which finding defines early AMD?
Early AMD is medium drusen of 63 to 125 microns without pigment abnormalities, and these patients usually keep good acuity.
When staging AMD at the slit lamp, which landmark approximates the 125-micron drusen threshold?
125 microns roughly matches the width of a large vein at the disc margin, and a druse about half that width approaches 63 microns.
Under the Beckman classification, an eye with only drupelets smaller than 63 microns is staged as what?
Drupelets alone are normal aging changes with no clinically relevant risk, so these patients should not be given an AMD diagnosis.
In the Beckman classification, which single finding is enough for intermediate AMD?
One large druse within the macular zone qualifies as intermediate AMD, as do pigment changes with at least medium drusen.
Under the Beckman classification, how much geographic atrophy is needed to classify an eye as late AMD?
Late AMD includes neovascular AMD or geographic atrophy of any size; foveal involvement is recorded separately because atrophy can spare the center.
Across the Beckman AMD scale, roughly how much does the five-year risk of late AMD increase?
Five-year risk rises about 100-fold across the scale, from about 0.5% with normal aging changes to about 50% in the highest-risk group.
Which findings earn points on the AREDS simplified severity scale for AMD?
The simplified scale gives one point per eye for large drusen and one for pigment abnormalities, refining risk within the intermediate stage.
Based on AREDS, which patients with AMD are suited to AREDS-type supplements?
AREDS reduced progression in intermediate disease or late AMD in one eye, while early disease lacks comparable evidence, so the stage should be checked first.
In AREDS2, which nutrients were supported as a replacement for beta-carotene in AMD supplements?
AREDS2 supported lutein and zeaxanthin in place of beta-carotene; supplements slow risk modestly and do not reverse damage.

Ahmed Ophthalmologist

Writes and reviews the clinical articles on Educate. Every post is checked against peer-reviewed sources before it goes live.