English

Age Related Macular Degeneration Registry

1 forms  
Administrative Data
Description

Administrative Data

Alias
UMLS CUI-1
C1320722
Office Use:
Description

Office

Data type

text

Alias
UMLS CUI [1]
C0442603
Centre:
Description

undefined item

Data type

text

i) Hospital / Clinic:
Description

Hospital

Data type

text

Alias
UMLS CUI [1]
C0019994
ii) Date of Notification:
Description

Date of Notification

Data type

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0422202
Section 1: Demography
Description

Section 1: Demography

Alias
UMLS CUI-1
C0011298
1. Patient Name:
Description

Patient Name

Data type

text

Alias
UMLS CUI [1]
C1299487
2. Identification Card Number :
Description

Identification Number

Data type

text

Alias
UMLS CUI [1]
C1300638
Old IC
Description

Identification Number

Data type

text

Alias
UMLS CUI [1]
C1300638
Other ID document No
Description

Specific type (eg passport of armed forces ID )

Data type

text

Alias
UMLS CUI [1]
C1300638
3. Address (Postcode):
Description

Postcode

Data type

text

Alias
UMLS CUI [1]
C0421454
3. Address (Town/ City)
Description

Town

Data type

text

Alias
UMLS CUI [1]
C1555315
3. Address (State):
Description

State

Data type

text

Alias
UMLS CUI [1]
C1442792
4. Date of Birth:
Description

Date of Birth

Data type

date

Alias
UMLS CUI [1]
C0421451
5. Age at presentation:
Description

in years and months

Data type

text

Alias
UMLS CUI [1]
C0001779
6. Gender
Description

Gender

Data type

text

Alias
UMLS CUI [1]
C0079399
7. Ethnicity
Description

Ethnicity

Data type

text

Alias
UMLS CUI [1]
C0015031
Section 2: Risk Factors
Description

Section 2: Risk Factors

Alias
UMLS CUI-1
C0035648
1. Risk factors-None
Description

None

Data type

boolean

Alias
UMLS CUI [1]
C0549184
1. Risk factors- Diabetes Mellitus (DM)
Description

Diabetes Mellitus

Data type

boolean

Alias
UMLS CUI [1]
C0011849
1. Risk factors- Hypertension (HPT)
Description

Hypertension

Data type

boolean

Alias
UMLS CUI [1]
C0020538
1. Risk factors- Past Stroke
Description

Stroke

Data type

boolean

Alias
UMLS CUI [1]
C0038454
1. Risk factors- Ischemic Heart Disease (IHD)
Description

Myocardial Ischemia

Data type

boolean

Alias
UMLS CUI [1]
C0151744
1. Risk factors- Hypercholesterolemia
Description

Hypercholesterolemia

Data type

boolean

Alias
UMLS CUI [1]
C0020443
1. Risk factors- Smoking
Description

Smoking

Data type

boolean

Alias
UMLS CUI [1]
C1519384
If yes,
Description

smoking

Data type

text

Alias
UMLS CUI [1]
C1519384
1. Risk factors- Myopia right eye
Description

Myopia right eye

Data type

boolean

Alias
UMLS CUI [1,1]
C0027092
UMLS CUI [1,2]
C0229089
If yes, myopia right eye
Description

Myopia right eye

Data type

text

Alias
UMLS CUI [1,1]
C0027092
UMLS CUI [1,2]
C0229089
1. Risk factors- Myopia left eye
Description

Myopia left eye

Data type

boolean

Alias
UMLS CUI [1,1]
C0027092
UMLS CUI [1,2]
C0229090
If yes, myopia left eye
Description

Myopia left eye

Data type

text

Alias
UMLS CUI [1,1]
C0027092
UMLS CUI [1,2]
C0229090
1. Risk factors- Cataract surgery within last 3 months prior to onset of symptoms in the affected eye(s)
Description

Cataract surgery

Data type

boolean

Alias
UMLS CUI [1]
C2939459
If yes, cataract surgery of
Description

Cataract surgery

Data type

text

Alias
UMLS CUI [1]
C2939459
Section 3: Quality of Life
Description

Section 3: Quality of Life

Alias
UMLS CUI-1
C0034380
i) Are you currently driving, at least once a while?
Description

driving

Data type

boolean

Alias
UMLS CUI [1]
C0004379
If yes, do you have difficulty driving during daytime in familiar places
Description

difficulty driving during daytime in familiar places

Data type

boolean

Alias
UMLS CUI [1]
C3174290
If no, reason:
Description

reason

Data type

text

Alias
UMLS CUI [1]
C0566251
ii) Because of your eye sight, do you have difficulty reading ordinary print in newspaper?
Description

difficulty reading ordinary print in newspaper

Data type

boolean

Alias
UMLS CUI [1]
C3176682
Section 4: Medical History
Description

Section 4: Medical History

Alias
UMLS CUI-1
C0262926
i) Metamorphopsia
Description

Metamorphopsia

Data type

boolean

Alias
UMLS CUI [1]
C0271185
ii) Scotoma
Description

Scotoma

Data type

boolean

Alias
UMLS CUI [1]
C0036454
iii) Blurring of vision
Description

Blurred vision

Data type

boolean

Alias
UMLS CUI [1]
C0344232
iv) Duration of symptoms
Description

Duration of symptoms

Data type

text

Alias
UMLS CUI [1,1]
C0449238
UMLS CUI [1,2]
C1457887
v) Previous treatment for AMD:
Description

Therapy AMD

Data type

boolean

Alias
UMLS CUI [1,1]
C0087111
UMLS CUI [1,2]
C0242383
If yes, what treatment
Description

Therapy AMD

Data type

text

Alias
UMLS CUI [1,1]
C0087111
UMLS CUI [1,2]
C0242383
Section 5: Clinical features
Description

Section 5: Clinical features

Alias
UMLS CUI-1
C3554759
1. Affected eye
Description

Affected eye

Data type

text

Alias
UMLS CUI [1,1]
C0449642
UMLS CUI [1,2]
C0015392
2. Vision right eye
Description

Vision right eye

Data type

text

Alias
UMLS CUI [1,1]
C0042789
UMLS CUI [1,2]
C0229089
2. Vision left eye
Description

Vision left eye

Data type

text

Alias
UMLS CUI [1,1]
C0042789
UMLS CUI [1,2]
C0229090
3) Fundus Finding right eye- i) Type of AMD
Description

Age related macular degeneration

Data type

text

Alias
UMLS CUI [1]
C0242383
3) Fundus Finding right eye- ii) Presence of Drusen
Description

Drusen

Data type

boolean

Alias
UMLS CUI [1]
C0035312
If Yes,
Description

Retinal Drusen

Data type

text

Alias
UMLS CUI [1]
C0035312
3) Fundus Finding right eye- iii) Presence of Central Geographic Atrophy
Description

Geographic Atrophy

Data type

boolean

Alias
UMLS CUI [1]
C1536085
3) Fundus Finding right eye- iv) Presence of Pigment Epithelial Detachment
Description

Pigment Epithelial Detachment

Data type

boolean

Alias
UMLS CUI [1]
C0339546
3) Fundus Finding right eye- v) Presence of Subretinal Hemorrhage
Description

Subretinal Hemorrhage

Data type

boolean

Alias
UMLS CUI [1]
C0271049
3) Fundus Finding right eye- vi) Presence of Disciform Scar:
Description

Disciform Scar

Data type

boolean

Alias
UMLS CUI [1]
C4476587
3) Fundus Finding left eye- i) Type of AMD
Description

Age related macular degeneration

Data type

text

Alias
UMLS CUI [1]
C0242383
3) Fundus Finding left eye- ii) Presence of Drusen
Description

Drusen

Data type

boolean

Alias
UMLS CUI [1]
C0035312
If Yes,
Description

Retinal Drusen

Data type

text

Alias
UMLS CUI [1]
C0035312
3) Fundus Finding left eye- iii) Presence of Central Geographic Atrophy
Description

Geographic Atrophy

Data type

boolean

Alias
UMLS CUI [1]
C1536085
3) Fundus Finding left eye- iv) Presence of Pigment Epithelial Detachment
Description

Pigment Epithelial Detachment

Data type

boolean

Alias
UMLS CUI [1]
C0339546
3) Fundus Finding left eye- v) Presence of Subretinal Hemorrhage
Description

Subretinal Hemorrhage

Data type

boolean

Alias
UMLS CUI [1]
C0271049
3) Fundus Finding left eye- vi) Presence of Disciform Scar:
Description

Disciform Scar

Data type

boolean

Alias
UMLS CUI [1]
C4476587
Section 6: Investigation
Description

Section 6: Investigation

Alias
UMLS CUI-1
C0220825
1. OCT Right eye
Description

OCT Right eye

Data type

text

Alias
UMLS CUI [1,1]
C0920367
UMLS CUI [1,2]
C0229089
If done, findings
Description

OCT

Data type

text

Alias
UMLS CUI [1]
C0920367
Others, specify
Description

specify

Data type

text

Alias
UMLS CUI [1]
C1521902
1. OCT left eye +
Description

OCT left eye

Data type

text

Alias
UMLS CUI [1,1]
C0920367
UMLS CUI [1,2]
C0229090
If done, findings
Description

OCT

Data type

text

Alias
UMLS CUI [1]
C0920367
Others, specify
Description

specify

Data type

text

Alias
UMLS CUI [1]
C1521902
2. FFA right eye
Description

Fluorescence Angiography right eye

Data type

text

Alias
UMLS CUI [1,1]
C0086305
UMLS CUI [1,2]
C0229089
If done, findings:
Description

Fluorescence Angiography

Data type

text

Alias
UMLS CUI [1]
C0086305
ii) Type of choroidal neovascularization (CNV)
Description

Choroidal Neovascularization

Data type

text

Alias
UMLS CUI [1]
C0600518
iii) Location of CNV
Description

Location CNV

Data type

text

Alias
UMLS CUI [1,1]
C1515974
UMLS CUI [1,2]
C0600518
2. FFA left eye
Description

Fluorescence Angiography left eye

Data type

text

Alias
UMLS CUI [1,1]
C0086305
UMLS CUI [1,2]
C0229090
If done, findings:
Description

Fluorescence Angiography

Data type

text

Alias
UMLS CUI [1]
C0086305
ii) Type of choroidal neovascularization (CNV)
Description

Choroidal Neovascularization

Data type

text

Alias
UMLS CUI [1]
C0600518
iii) Location of CNV
Description

Location CNV

Data type

text

Alias
UMLS CUI [1,1]
C1515974
UMLS CUI [1,2]
C0600518
3. ICG right eye
Description

Indocyanine green angiography right eye

Data type

text

Alias
UMLS CUI [1,1]
C0430879
UMLS CUI [1,2]
C0229089
3. If done, findings:
Description

Indocyanine green angiography right eye

Data type

text

Alias
UMLS CUI [1,1]
C0430879
UMLS CUI [1,2]
C0229089
3. ICG left eye
Description

Indocyanine green angiography left eye

Data type

text

Alias
UMLS CUI [1,1]
C0430879
UMLS CUI [1,2]
C0229090
3. If done, findings:
Description

Indocyanine green angiography left eye

Data type

text

Alias
UMLS CUI [1,1]
C0430879
UMLS CUI [1,2]
C0229090
Section 7: Diagnosis
Description

Section 7: Diagnosis

Alias
UMLS CUI-1
C0011900
a) Diagnosis Right eye
Description

Diagnosis Right eye

Data type

integer

Alias
UMLS CUI [1,1]
C0011900
UMLS CUI [1,2]
C0229089
Others, specify
Description

Specify

Data type

text

Alias
UMLS CUI [1]
C1521902
b) Diagnosis left eye +
Description

Diagnosis left eye

Data type

integer

Alias
UMLS CUI [1,1]
C0011900
UMLS CUI [1,2]
C0229090
Others, specify
Description

Specify

Data type

text

Alias
UMLS CUI [1]
C1521902
Section 8: Treatment
Description

Section 8: Treatment

Alias
UMLS CUI-1
C0087111
a) Right eye: Treatment?
Description

Therapy Right eye

Data type

boolean

Alias
UMLS CUI [1,1]
C0087111
UMLS CUI [1,2]
C0229089
If yes, type of treatment
Description

Therapy

Data type

integer

Alias
UMLS CUI [1]
C0087111
Others, specify
Description

specify

Data type

text

Alias
UMLS CUI [1]
C1521902
b) Left eye: Treatment? +
Description

Therapy Left eye

Data type

boolean

Alias
UMLS CUI [1,1]
C0087111
UMLS CUI [1,2]
C0229090
If yes, type of treatment
Description

Therapy

Data type

integer

Alias
UMLS CUI [1]
C0087111
Others, specify
Description

specify

Data type

text

Alias
UMLS CUI [1]
C1521902
Form filled by:
Description

Form filled by

Data type

text

Alias
UMLS CUI [1]
C3273494
Form filled by:
Description

Form filled by

Data type

text

Alias
UMLS CUI [1]
C3273494
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Similar models

Age Related Macular Degeneration Registry

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Administrative Data
C1320722 (UMLS CUI-1)
Office
Item
Office Use:
text
C0442603 (UMLS CUI [1])
undefined item
Item
Centre:
text
Hospital
Item
i) Hospital / Clinic:
text
C0019994 (UMLS CUI [1])
Date of Notification
Item
ii) Date of Notification:
date
C0011008 (UMLS CUI [1,1])
C0422202 (UMLS CUI [1,2])
Item Group
Section 1: Demography
C0011298 (UMLS CUI-1)
Patient Name
Item
1. Patient Name:
text
C1299487 (UMLS CUI [1])
Identification Number
Item
2. Identification Card Number :
text
C1300638 (UMLS CUI [1])
Identification Number
Item
Old IC
text
C1300638 (UMLS CUI [1])
Identification Number
Item
Other ID document No
text
C1300638 (UMLS CUI [1])
Postcode
Item
3. Address (Postcode):
text
C0421454 (UMLS CUI [1])
Town
Item
3. Address (Town/ City)
text
C1555315 (UMLS CUI [1])
State
Item
3. Address (State):
text
C1442792 (UMLS CUI [1])
Date of Birth
Item
4. Date of Birth:
date
C0421451 (UMLS CUI [1])
Age
Item
5. Age at presentation:
text
C0001779 (UMLS CUI [1])
Item
6. Gender
text
C0079399 (UMLS CUI [1])
undefined item
Code List
6. Gender
CL Item
Male (Male)
C0086582 (UMLS CUI-1)
(Comment:en)
CL Item
Female (Female)
C0086287 (UMLS CUI-1)
(Comment:en)
Item
7. Ethnicity
text
C0015031 (UMLS CUI [1])
undefined item
Code List
7. Ethnicity
CL Item
Malay (Malay)
C0024549 (UMLS CUI-1)
(Comment:en)
CL Item
Chinese (Chinese)
C0152035 (UMLS CUI-1)
(Comment:en)
CL Item
Indian (Indian)
C1524069 (UMLS CUI-1)
(Comment:en)
CL Item
Orang Asli (Orang Asli)
C3875078 (UMLS CUI-1)
(Comment:en)
CL Item
Melanau (Melanau)
C3875090 (UMLS CUI-1)
(Comment:en)
CL Item
Kadazan/Murut /Bajau (Kadazan/Murut /Bajau)
C3875081 (UMLS CUI-1)
(Comment:en)
CL Item
Iban (Iban)
C3875071 (UMLS CUI-1)
(Comment:en)
CL Item
Bidayuh (Bidayuh)
C3875070 (UMLS CUI-1)
(Comment:en)
CL Item
Others (Others)
C0205394 (UMLS CUI-1)
(Comment:en)
Item Group
Section 2: Risk Factors
C0035648 (UMLS CUI-1)
None
Item
1. Risk factors-None
boolean
C0549184 (UMLS CUI [1])
Diabetes Mellitus
Item
1. Risk factors- Diabetes Mellitus (DM)
boolean
C0011849 (UMLS CUI [1])
Hypertension
Item
1. Risk factors- Hypertension (HPT)
boolean
C0020538 (UMLS CUI [1])
Stroke
Item
1. Risk factors- Past Stroke
boolean
C0038454 (UMLS CUI [1])
Myocardial Ischemia
Item
1. Risk factors- Ischemic Heart Disease (IHD)
boolean
C0151744 (UMLS CUI [1])
Hypercholesterolemia
Item
1. Risk factors- Hypercholesterolemia
boolean
C0020443 (UMLS CUI [1])
Smoking
Item
1. Risk factors- Smoking
boolean
C1519384 (UMLS CUI [1])
Item
If yes,
text
C1519384 (UMLS CUI [1])
undefined item
Code List
If yes,
CL Item
Current (Current)
C0521116 (UMLS CUI-1)
(Comment:en)
CL Item
Past (Past)
C1444637 (UMLS CUI-1)
(Comment:en)
Myopia right eye
Item
1. Risk factors- Myopia right eye
boolean
C0027092 (UMLS CUI [1,1])
C0229089 (UMLS CUI [1,2])
Item
If yes, myopia right eye
text
C0027092 (UMLS CUI [1,1])
C0229089 (UMLS CUI [1,2])
undefined item
Code List
If yes, myopia right eye
CL Item
<2 d (<2 d)
CL Item
2-8 d (2-8 d)
CL Item
>8 d (>8 d)
Myopia left eye
Item
1. Risk factors- Myopia left eye
boolean
C0027092 (UMLS CUI [1,1])
C0229090 (UMLS CUI [1,2])
Item
If yes, myopia left eye
text
C0027092 (UMLS CUI [1,1])
C0229090 (UMLS CUI [1,2])
undefined item
Code List
If yes, myopia left eye
CL Item
<2 d  (<2 d)
CL Item
2-8 d  (2-8 d)
CL Item
>8 d (>8 d)
Cataract surgery
Item
1. Risk factors- Cataract surgery within last 3 months prior to onset of symptoms in the affected eye(s)
boolean
C2939459 (UMLS CUI [1])
Item
If yes, cataract surgery of
text
C2939459 (UMLS CUI [1])
Cataract surgery
Code List
If yes, cataract surgery of
CL Item
Right eye (Right eye)
C0229089 (UMLS CUI-1)
(Comment:en)
CL Item
Left eye (Left eye)
C0229090 (UMLS CUI-1)
(Comment:en)
Item Group
Section 3: Quality of Life
C0034380 (UMLS CUI-1)
driving
Item
i) Are you currently driving, at least once a while?
boolean
C0004379 (UMLS CUI [1])
difficulty driving during daytime in familiar places
Item
If yes, do you have difficulty driving during daytime in familiar places
boolean
C3174290 (UMLS CUI [1])
Item
If no, reason:
text
C0566251 (UMLS CUI [1])
reason
Code List
If no, reason:
CL Item
never drive (never drive)
(Comment:en)
CL Item
gave up because of poor eye sight (gave up because of poor eye sight)
C0042798 (UMLS CUI-1)
(Comment:en)
CL Item
others (others)
C0205394 (UMLS CUI-1)
(Comment:en)
difficulty reading ordinary print in newspaper
Item
ii) Because of your eye sight, do you have difficulty reading ordinary print in newspaper?
boolean
C3176682 (UMLS CUI [1])
Item Group
Section 4: Medical History
C0262926 (UMLS CUI-1)
Metamorphopsia
Item
i) Metamorphopsia
boolean
C0271185 (UMLS CUI [1])
Scotoma
Item
ii) Scotoma
boolean
C0036454 (UMLS CUI [1])
Blurred vision
Item
iii) Blurring of vision
boolean
C0344232 (UMLS CUI [1])
Duration of symptoms
Item
iv) Duration of symptoms
text
C0449238 (UMLS CUI [1,1])
C1457887 (UMLS CUI [1,2])
Therapy AMD
Item
v) Previous treatment for AMD:
boolean
C0087111 (UMLS CUI [1,1])
C0242383 (UMLS CUI [1,2])
Item
If yes, what treatment
text
C0087111 (UMLS CUI [1,1])
C0242383 (UMLS CUI [1,2])
undefined item
Code List
If yes, what treatment
CL Item
PDT (PDT)
C0750653 (UMLS CUI-1)
(Comment:en)
CL Item
Anti VEGF (Anti VEGF)
(Comment:en)
CL Item
PDT + Anti VEGF (PDT + Anti VEGF)
(Comment:en)
CL Item
Intravitral Triamcinolone (Intravitral Triamcinolone)
C0040864 (UMLS CUI-1)
C1554888 (UMLS CUI-2)
(Comment:en)
CL Item
Argon Laser (Argon Laser)
C0392247 (UMLS CUI-1)
(Comment:en)
Item Group
Section 5: Clinical features
C3554759 (UMLS CUI-1)
Item
1. Affected eye
text
C0449642 (UMLS CUI [1,1])
C0015392 (UMLS CUI [1,2])
Affected eye
Code List
1. Affected eye
CL Item
Right eye (Right eye)
C0229089 (UMLS CUI-1)
(Comment:en)
CL Item
Left eye (Left eye)
C0229090 (UMLS CUI-1)
(Comment:en)
CL Item
Both eyes (Both eyes)
C0229118 (UMLS CUI-1)
(Comment:en)
Item
2. Vision right eye
text
C0042789 (UMLS CUI [1,1])
C0229089 (UMLS CUI [1,2])
Vision right eye
Code List
2. Vision right eye
CL Item
Unaided (Unaided)
CL Item
With glasses/ Pin hole (With glasses/ Pin hole)
Item
2. Vision left eye
text
C0042789 (UMLS CUI [1,1])
C0229090 (UMLS CUI [1,2])
Vision right eye
Code List
2. Vision left eye
CL Item
Unaided (Unaided)
CL Item
With glasses/ Pin hole (With glasses/ Pin hole)
Item
3) Fundus Finding right eye- i) Type of AMD
text
C0242383 (UMLS CUI [1])
Age related macular degeneration
Code List
3) Fundus Finding right eye- i) Type of AMD
CL Item
Exudative (Exudative)
C0271084 (UMLS CUI-1)
(Comment:en)
CL Item
Nonexudative (Nonexudative)
C0271083 (UMLS CUI-1)
(Comment:en)
Drusen
Item
3) Fundus Finding right eye- ii) Presence of Drusen
boolean
C0035312 (UMLS CUI [1])
Item
If Yes,
text
C0035312 (UMLS CUI [1])
Retinal Drusen
Code List
If Yes,
CL Item
Soft (Soft)
C1720452 (UMLS CUI-1)
(Comment:en)
CL Item
Hard (Hard)
C1719777 (UMLS CUI-1)
(Comment:en)
Geographic Atrophy
Item
3) Fundus Finding right eye- iii) Presence of Central Geographic Atrophy
boolean
C1536085 (UMLS CUI [1])
Pigment Epithelial Detachment
Item
3) Fundus Finding right eye- iv) Presence of Pigment Epithelial Detachment
boolean
C0339546 (UMLS CUI [1])
Subretinal Hemorrhage
Item
3) Fundus Finding right eye- v) Presence of Subretinal Hemorrhage
boolean
C0271049 (UMLS CUI [1])
Disciform Scar
Item
3) Fundus Finding right eye- vi) Presence of Disciform Scar:
boolean
C4476587 (UMLS CUI [1])
Item
3) Fundus Finding left eye- i) Type of AMD
text
C0242383 (UMLS CUI [1])
Age related macular degeneration
Code List
3) Fundus Finding left eye- i) Type of AMD
CL Item
Exudative (Exudative)
C0271084 (UMLS CUI-1)
(Comment:en)
CL Item
Nonexudative (Nonexudative)
C0271083 (UMLS CUI-1)
(Comment:en)
Drusen
Item
3) Fundus Finding left eye- ii) Presence of Drusen
boolean
C0035312 (UMLS CUI [1])
Item
If Yes,
text
C0035312 (UMLS CUI [1])
Retinal Drusen
Code List
If Yes,
CL Item
Soft (Soft)
C1720452 (UMLS CUI-1)
(Comment:en)
CL Item
Hard (Hard)
C1719777 (UMLS CUI-1)
(Comment:en)
Geographic Atrophy
Item
3) Fundus Finding left eye- iii) Presence of Central Geographic Atrophy
boolean
C1536085 (UMLS CUI [1])
Pigment Epithelial Detachment
Item
3) Fundus Finding left eye- iv) Presence of Pigment Epithelial Detachment
boolean
C0339546 (UMLS CUI [1])
Subretinal Hemorrhage
Item
3) Fundus Finding left eye- v) Presence of Subretinal Hemorrhage
boolean
C0271049 (UMLS CUI [1])
Disciform Scar
Item
3) Fundus Finding left eye- vi) Presence of Disciform Scar:
boolean
C4476587 (UMLS CUI [1])
Item Group
Section 6: Investigation
C0220825 (UMLS CUI-1)
Item
1. OCT Right eye
text
C0920367 (UMLS CUI [1,1])
C0229089 (UMLS CUI [1,2])
OCT Right eye
Code List
1. OCT Right eye
CL Item
done (done)
CL Item
not done (not done)
Item
If done, findings
text
C0920367 (UMLS CUI [1])
OCT
Code List
If done, findings
CL Item
Subretinal fluid (Subretinal fluid)
C2721564 (UMLS CUI-1)
(Comment:en)
CL Item
Pigment epithelial detachment (Pigment epithelial detachment)
C0339546 (UMLS CUI-1)
(Comment:en)
CL Item
others (others)
C0205394 (UMLS CUI-1)
(Comment:en)
specify
Item
Others, specify
text
C1521902 (UMLS CUI [1])
Item
1. OCT left eye +
text
C0920367 (UMLS CUI [1,1])
C0229090 (UMLS CUI [1,2])
OCT Right eye
Code List
1. OCT left eye +
CL Item
done (done)
CL Item
not done (not done)
Item
If done, findings
text
C0920367 (UMLS CUI [1])
OCT
Code List
If done, findings
CL Item
Subretinal fluid (Subretinal fluid)
C2721564 (UMLS CUI-1)
(Comment:en)
CL Item
Pigment epithelial detachment (Pigment epithelial detachment)
C0339546 (UMLS CUI-1)
(Comment:en)
CL Item
others (others)
C0205394 (UMLS CUI-1)
(Comment:en)
specify
Item
Others, specify
text
C1521902 (UMLS CUI [1])
Item
2. FFA right eye
text
C0086305 (UMLS CUI [1,1])
C0229089 (UMLS CUI [1,2])
OCT Right eye
Code List
2. FFA right eye
CL Item
done (done)
CL Item
not done (not done)
Item
If done, findings:
text
C0086305 (UMLS CUI [1])
Fluorescence Angiography
Code List
If done, findings:
CL Item
CNV (CNV)
C0600518 (UMLS CUI-1)
(Comment:en)
CL Item
Scar (Scar)
C0271036 (UMLS CUI-1)
(Comment:en)
CL Item
PED (PED)
C3840040 (UMLS CUI-1)
(Comment:en)
Item
ii) Type of choroidal neovascularization (CNV)
text
C0600518 (UMLS CUI [1])
Choroidal Neovascularization
Code List
ii) Type of choroidal neovascularization (CNV)
CL Item
Classic (Classic)
C1282040 (UMLS CUI-1)
(Comment:en)
CL Item
Minimally classic (Minimally classic)
(Comment:en)
CL Item
Predominantly classic (Predominantly classic)
(Comment:en)
CL Item
Occult (Occult)
C2174712 (UMLS CUI-1)
(Comment:en)
Item
iii) Location of CNV
text
C1515974 (UMLS CUI [1,1])
C0600518 (UMLS CUI [1,2])
Location CNV
Code List
iii) Location of CNV
CL Item
Subfoveal (Subfoveal)
C0442185 (UMLS CUI-1)
(Comment:en)
CL Item
Juxtafoveal (Juxtafoveal)
C2932677 (UMLS CUI-1)
(Comment:en)
CL Item
Extrafoveal (Extrafoveal )
C0442088 (UMLS CUI-1)
(Comment:en)
Item
2. FFA left eye
text
C0086305 (UMLS CUI [1,1])
C0229090 (UMLS CUI [1,2])
OCT Right eye
Code List
2. FFA left eye
CL Item
done (done)
CL Item
not done (not done)
Item
If done, findings:
text
C0086305 (UMLS CUI [1])
Fluorescence Angiography
Code List
If done, findings:
CL Item
CNV (CNV)
C0600518 (UMLS CUI-1)
(Comment:en)
CL Item
Scar (Scar)
C0271036 (UMLS CUI-1)
(Comment:en)
CL Item
PED (PED)
C3840040 (UMLS CUI-1)
(Comment:en)
Item
ii) Type of choroidal neovascularization (CNV)
text
C0600518 (UMLS CUI [1])
Choroidal Neovascularization
Code List
ii) Type of choroidal neovascularization (CNV)
CL Item
Classic (Classic)
C1282040 (UMLS CUI-1)
(Comment:en)
CL Item
Minimally classic (Minimally classic)
(Comment:en)
CL Item
Predominantly classic (Predominantly classic)
(Comment:en)
CL Item
Occult (Occult)
C2174712 (UMLS CUI-1)
(Comment:en)
Item
iii) Location of CNV
text
C1515974 (UMLS CUI [1,1])
C0600518 (UMLS CUI [1,2])
Location CNV
Code List
iii) Location of CNV
CL Item
Subfoveal (Subfoveal)
C0442185 (UMLS CUI-1)
(Comment:en)
CL Item
Juxtafoveal (Juxtafoveal)
C2932677 (UMLS CUI-1)
(Comment:en)
CL Item
Extrafoveal (Extrafoveal )
C0442088 (UMLS CUI-1)
(Comment:en)
Item
3. ICG right eye
text
C0430879 (UMLS CUI [1,1])
C0229089 (UMLS CUI [1,2])
OCT Right eye
Code List
3. ICG right eye
CL Item
done (done)
CL Item
not done (not done)
Item
3. If done, findings:
text
C0430879 (UMLS CUI [1,1])
C0229089 (UMLS CUI [1,2])
undefined item
Code List
3. If done, findings:
CL Item
Polyps (Polyps)
C0032584 (UMLS CUI-1)
(Comment:en)
CL Item
Plaque (Plaque)
C0332461 (UMLS CUI-1)
(Comment:en)
CL Item
No Abnormality (No Abnormality)
C1298908 (UMLS CUI-1)
C1704258 (UMLS CUI-2)
(Comment:en)
Item
3. ICG left eye
text
C0430879 (UMLS CUI [1,1])
C0229090 (UMLS CUI [1,2])
OCT Right eye
Code List
3. ICG left eye
CL Item
done (done)
CL Item
not done (not done)
Item
3. If done, findings:
text
C0430879 (UMLS CUI [1,1])
C0229090 (UMLS CUI [1,2])
undefined item
Code List
3. If done, findings:
CL Item
Polyps (Polyps)
C0032584 (UMLS CUI-1)
(Comment:en)
CL Item
Plaque (Plaque)
C0332461 (UMLS CUI-1)
(Comment:en)
CL Item
No Abnormality (No Abnormality)
C1298908 (UMLS CUI-1)
C1704258 (UMLS CUI-2)
(Comment:en)
Item Group
Section 7: Diagnosis
C0011900 (UMLS CUI-1)
Item
a) Diagnosis Right eye
integer
C0011900 (UMLS CUI [1,1])
C0229089 (UMLS CUI [1,2])
Diagnosis Right eye
Code List
a) Diagnosis Right eye
CL Item
Early AMD (1)
C4231168 (UMLS CUI-1)
(Comment:en)
CL Item
Intermediate AMD (2)
(Comment:en)
CL Item
Advanced AMD: Geographic Atrophy  (3)
C1536085 (UMLS CUI-1)
(Comment:en)
CL Item
Advanced AMD: Disciform Scar (4)
C4476587 (UMLS CUI-1)
(Comment:en)
CL Item
Polypoidal choroidal vasculopathy (PCV) (5)
C1504336 (UMLS CUI-1)
(Comment:en)
CL Item
Choroidal Neovascularization (CNV): Active (6)
C4272907 (UMLS CUI-1)
(Comment:en)
CL Item
Choroidal Neovascularization (CNV): Resolved (7)
(Comment:en)
CL Item
Others (8)
C0205394 (UMLS CUI-1)
(Comment:en)
Specify
Item
Others, specify
text
C1521902 (UMLS CUI [1])
Item
b) Diagnosis left eye +
integer
C0011900 (UMLS CUI [1,1])
C0229090 (UMLS CUI [1,2])
Diagnosis Right eye
Code List
b) Diagnosis left eye +
CL Item
Early AMD (1)
C4231168 (UMLS CUI-1)
(Comment:en)
CL Item
Intermediate AMD (2)
(Comment:en)
CL Item
Advanced AMD: Geographic Atrophy  (3)
C1536085 (UMLS CUI-1)
(Comment:en)
CL Item
Advanced AMD: Disciform Scar (4)
C4476587 (UMLS CUI-1)
(Comment:en)
CL Item
Polypoidal choroidal vasculopathy (PCV) (5)
C1504336 (UMLS CUI-1)
(Comment:en)
CL Item
Choroidal Neovascularization (CNV): Active (6)
C4272907 (UMLS CUI-1)
(Comment:en)
CL Item
Choroidal Neovascularization (CNV): Resolved (7)
(Comment:en)
CL Item
Others (8)
C0205394 (UMLS CUI-1)
(Comment:en)
Specify
Item
Others, specify
text
C1521902 (UMLS CUI [1])
Item Group
Section 8: Treatment
C0087111 (UMLS CUI-1)
Therapy Right eye
Item
a) Right eye: Treatment?
boolean
C0087111 (UMLS CUI [1,1])
C0229089 (UMLS CUI [1,2])
Item
If yes, type of treatment
integer
C0087111 (UMLS CUI [1])
Therapy
Code List
If yes, type of treatment
CL Item
PDT (1)
C0750653 (UMLS CUI-1)
(Comment:en)
CL Item
Anti VEGF (2)
(Comment:en)
CL Item
PDT + Anti VEGF (3)
(Comment:en)
CL Item
Intravitral Triamcinolone (4)
C0040864 (UMLS CUI-1)
C1554888 (UMLS CUI-2)
(Comment:en)
CL Item
Argon Laser (5)
C0392247 (UMLS CUI-1)
(Comment:en)
CL Item
Other (6)
C0205394 (UMLS CUI-1)
(Comment:en)
specify
Item
Others, specify
text
C1521902 (UMLS CUI [1])
Therapy Left eye
Item
b) Left eye: Treatment? +
boolean
C0087111 (UMLS CUI [1,1])
C0229090 (UMLS CUI [1,2])
Item
If yes, type of treatment
integer
C0087111 (UMLS CUI [1])
Therapy
Code List
If yes, type of treatment
CL Item
PDT (1)
C0750653 (UMLS CUI-1)
(Comment:en)
CL Item
Anti VEGF (2)
(Comment:en)
CL Item
PDT + Anti VEGF (3)
(Comment:en)
CL Item
Intravitral Triamcinolone (4)
C0040864 (UMLS CUI-1)
C1554888 (UMLS CUI-2)
(Comment:en)
CL Item
Argon Laser (5)
C0392247 (UMLS CUI-1)
(Comment:en)
CL Item
Other (6)
C0205394 (UMLS CUI-1)
(Comment:en)
specify
Item
Others, specify
text
C1521902 (UMLS CUI [1])
Item
Form filled by:
text
C3273494 (UMLS CUI [1])
Form filled by
Code List
Form filled by:
CL Item
Medical Retinal (MR) Specialist (Medical Retinal (MR) Specialist)
CL Item
Vitreo- Retinal (VR) Specialist (Vitreo- Retinal (VR) Specialist)
CL Item
MR or VR fellow (MR or VR fellow)
CL Item
Other specialist (Other specialist)
CL Item
Medical officer (Medical officer)
Item
Form filled by:
text
C3273494 (UMLS CUI [1])
Form filled by
Code List
Form filled by:
CL Item
Medical Retinal (MR) Specialist (Medical Retinal (MR) Specialist)
CL Item
Vitreo- Retinal (VR) Specialist (Vitreo- Retinal (VR) Specialist)
CL Item
MR or VR fellow (MR or VR fellow)
CL Item
Other specialist (Other specialist)
CL Item
Medical officer (Medical officer)
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