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Cited by 739Retinal Diseases and TreatmentsRetinal Imaging and AnalysisOcular Diseases and Behçet’s Syndrome

The Age-Related Eye Disease Study Severity Scale for Age-Related Macular Degeneration: AREDS Report No. 17

Open access
Age-Related Eye Disease Study Research Group·2005·Archives of Ophthalmology
DOI 10.1001/archopht.123.11.1484PMC PMC1472813
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Abstract

OBJECTIVE: To develop a fundus photographic severity scale for age-related macular degeneration (AMD). METHODS: In the Age-Related Eye Disease Study, stereoscopic color fundus photographs were taken at baseline, at the 2-year follow-up visit, and annually thereafter. Photographs were graded for drusen characteristics (size, type, area), pigmentary abnormalities (increased pigment, depigmentation, geographic atrophy), and presence of abnormalities characteristic of neovascular AMD (retinal pigment epithelial detachment, serous or hemorrhagic sensory retinal detachment, subretinal or sub-retinal pigment epithelial hemorrhage, subretinal fibrous tissue). Advanced AMD was defined as presence of 1 or more neovascular AMD abnormalities, photocoagulation for AMD, or geographic atrophy involving the center of the macula. We explored associations among right eyes of 3212 participants between severity of drusen characteristics and pigmentary abnormalities at baseline and development of advanced AMD within 5 years of follow-up. RESULTS: A 9-step severity scale that combines a 6-step drusen area scale with a 5-step pigmentary abnormality scale was developed, on which the 5-year risk of advanced AMD increased progressively from less than 1% in step 1 to about 50% in step 9. Among the 334 eyes that had at least a 3-step progression on the scale between the baseline and 5-year visits, almost half showed stepwise progression through intervening severity levels at intervening visits. Replicate gradings showed agreement within 1 step on the scale in 87% of eyes. CONCLUSIONS: The scale provides convenient risk categories and has acceptable reproducibility. Progression along it may prove to be useful as a surrogate for progression to advanced AMD.

AI snapshot

Written from the paper’s full text.

TL;DR

AREDS developed a 9-step fundus photographic severity scale for AMD by combining a 6-step drusen area scale with a 5-step pigmentary abnormality scale, on which 5-year risk of advanced AMD rose from less than 1% in step 1 to about 50% in step 9. The scale showed acceptable reproducibility, and progression along it may prove useful as a surrogate for progression to advanced AMD.

Key findings

  • The 9-step scale combined drusen area and pigmentary abnormalities; 5-year risk of advanced AMD increased progressively from less than 1% in step 1 to about 50% in step 9.
  • Among 334 eyes with at least a 3-step progression between baseline and 5-year visits, 47% showed stepwise progression through intervening severity levels, 31% were abrupt, and the remainder had reversals.
  • Replicate gradings showed complete agreement in 63.4% of eyes, agreement within 1 step in 86.6%, and agreement within 2 steps in 93.6%; unweighted κ was 0.58 and weighted κ was 0.73.
  • Presence of neovascular AMD in one eye increased the risk of its development in the fellow eye by a factor ranging from 2 for eyes in step 8 to about 20 for eyes in steps 1 and 2.

Methods

  • AREDS was a multicenter prospective cohort study; 4757 people aged 55 to 80 years were enrolled between 1992 and 1998. Stereoscopic color fundus photographs were taken at baseline, at the 2-year visit, and annually thereafter and graded for drusen characteristics, pigmentary abnormalities, and neovascular AMD abnormalities.
  • Analyses explored associations among right eyes of 3212 participants without advanced AMD in either eye at baseline and development of advanced AMD within 5 years, using cross-tabulations and tree-structured models; scale performance was also examined in left eyes and in the eye with nonadvanced AMD of participants who had advanced AMD in one eye at baseline.
  • Reproducibility was assessed by applying the scale to duplicate gradings carried out periodically as part of quality control (total number of eyes, 1225).

Limitations

  • The paper states that many subgroups combined to produce the scale steps were small and outcome rates were low, so biologic or grading variability could have had large effects.
  • The paper states that participants were mostly non-Hispanic whites, and age, sex, race, and other risk factors were not considered; some predictive power may have been lost by excluding drusen size and/or predominance of soft indistinct drusen.
  • Evident from the text: scale development was based primarily on right eyes, and although left-eye results were similar, basing the grouping on left eyes could have led to several differences; the CGA fellow-eye analysis included only 57 participants, and treatment-effect analyses had few events through step 4.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1001/archopht.123.11.1484

Cites

15 of 15 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 24 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Preliminary analyses showed that development of CGA was more frequent in eyes with noncentral GA at baseline than in eyes with depigmentation not meeting the GA definition.

    “Preliminary analyses showed that development of CGA was more frequent in these eyes than in eyes with depigmentation not meeting the GA definition”
    Quote in the paperSubstantial claim
  • Findingown data

    Presence of neovascular AMD in one eye of an individual increases the risk of its development in the fellow eye by a factor that ranges from 2 for eyes in step 8 to about 20 for eyes in steps 1 and 2, as compared with an eye in an individual free of neovascular AMD in both eyes.

    “presence of neovascular AMD in one eye of an individual increases the risk of its development in the fellow eye by a factor that ranges from 2 for eyes in step 8 to about 20 for eyes in steps 1 and 2, as compared with an eye in an individual free of neovascular AMD in both eyes.”
    Quote in the paperSubstantial claim
  • Findingown data

    The weighted kappa statistic for reproducibility of the scale, giving 75% credit for 1-step disagreement, was 0.73 (SE 0.013).

    “An unweighted statistic (SE) was 0.58 (0.015), and weighted to give 75% credit for 1-step disagreement was 0.73 (0.013).”
    Quote in the paperSubstantial claim
  • Findingown data

    A 9-step severity scale that combines a 6-step drusen area scale with a 5-step pigmentary abnormality scale was developed.

    “A 9-step severity scale that combines a 6-step drusen area scale with a 5-step pigmentary abnormality scale was developed”
    • Also stated in: § COMMENT · plain
      “we developed a 9-step severity scale that combines a 6-step drusen area scale with a 5-step pigmentary abnormality scale”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Occurrence of increased pigment and depigmentation in one or more of the 4 outer subfields only might frequently represent a disorder other than AMD.
    • The authors state this as an assumption: The diameter of the optic disc is 1500 µm.
    • Rests on an assumption: The 4 groups used to categorize participants at entry into AREDS were not based on an analysis of outcome data.
  • Findingown data

    Among the remaining 381 eyes in column 1, which had any degree of increased pigmentation but no depigmentation, 67 (18%) developed advanced AMD.

    “Among the remaining 381 eyes in column 1, which had any degree of increased pigmentation but no depigmentation, 67 (18%) developed advanced AMD.”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 6
  • May combine two claims. 24
  • The quote only partly states this claim. 2

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Only 52 eyes had depigmentation without accompanying increased pigment.

    “Only 52 eyes had depigmentation without accompanying increased pigment (row 1, columns 2-7).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Among the 2412 eyes with no pigmentary abnormalities, 38 (1.6%) developed neovascular AMD and none developed CGA.

    “among them, 38 (1.6%) developed neovascular AMD and none developed CGA.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The predictive power of drusen area was stronger and more consistent than that of predominance of soft indistinct drusen.

    “The predictive power of drusen area was stronger and more consistent than that of predominance of soft indistinct drusen.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Progression to steps 7 to 9 increased across steps 1 to 6, although there was little difference between steps 2 and 3.

    “progression to steps 7 to 9 increased across steps 1 to 6, although there was little difference between steps 2 and 3”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Within drusen size categories, the risk of developing advanced AMD generally increases with increasing drusen area, although there is little or no increase between the 2 largest area categories.

    “Within drusen size categories, the risk of developing advanced AMD generally increases with increasing drusen area, although there is little or no increase between the 2 largest area categories”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The data for the first and last drusen area categories of Table 6 demonstrate the close association of pigmentary abnormalities with large drusen area; 6% of eyes with drusen area less than C-1 had pigmentary abnormalities, compared with 67% of eyes with drusen area of 0.5 DA or greater.

    “The data for the first and last drusen area categories of Table 6 demonstrate the close association of pigmentary abnormalities with large drusen area; 6% of eyes with drusen area less than C-1 had pigmentary abnormalities, compared with 67% of eyes with drusen area of 0.5 DA or greater.”
    Quote in the paperNot a substantial claim

  • May combine two claims. The quote only partly states this claim.

    Findingown data

    In the 16 participants with CGA in one eye and fellow eye in steps 1 to 6 at baseline, 1 eye developed neovascular AMD and 1 developed CGA (total, 12.5%).

    “In the former group, 1 eye developed neovascular AMD and 1 developed CGA (total, 12.5%)”
    Quote in the paperSubstantial claim

  • May combine two claims. The quote only partly states this claim.

    Findingown data

    In the 41 participants with CGA in one eye and fellow eye in steps 7 to 9 at baseline, 7 developed neovascular AMD, 13 developed CGA, and 2 developed both (total, 53.7%).

    “while in the latter group, 7 developed neovascular AMD, 13 developed CGA, and 2 developed both (total, 53.7%).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    For both neovascular AMD and CGA, risk increased progressively except for the decrease in risk of neovascular AMD in eyes that had previously developed noncentral GA (step 5).

    “For both neovascular AMD and CGA, risk increased progressively except for the decrease in risk of neovascular AMD in eyes that had previously developed noncentral GA (step 5).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The risk of neovascular AMD increased from steps 1 through 8 and then decreased in step 9.

    “The risk of neovascular AMD increased from steps 1 through 8 and then decreased in step 9”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Progression to advanced AMD increased across all 9 steps of the scale, although there was little change between steps 4 and 5.

    “Progression to advanced AMD increased across all 9 steps of the scale, al-though there was little change between steps 4 and 5”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    The Rotterdam study combined drusen type and presence or absence of pigmentary abnormalities to create a 4-step scale based on 5-year risk of GA or neovascular AMD; rates ranged from less than 0.2% for persons with no abnormalities other than hard drusen to 30% in persons with soft indistinct drusen and pigmentary abnormalities.

    “The Rotterdam study combined drusen type and presence or absence of pigmentary abnormalities to create a 4-step scale based on 5-year risk of GA or neovascular AMD.Rates ranged from less than 0.2% for persons with no abnormalities other than hard drusen to 30% in persons with soft indistinct drusen and pigmentary abnor-malities.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9]

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    As events and rates increased thereafter, trends consistent with the beneficial treatment effect previously reported were seen in steps 5 through 9 and when steps 2 through 9 were pooled.

    “As events and rates increased thereafter, trends consistent with the beneficial treatment effect previously reported were seen in steps 5 through 9 and when steps 2 through 9 were pooled.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Drusen area was reported for all types and sizes combined in the Rotterdam study and in AREDS; progression rates in the largest category were 26% in both.

    “Drusen area was reported for all types and sizes combined in the Rotterdam study and in AREDS; progression rates in the largest category were 26% in both.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9]

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    In participants without advanced AMD in either eye, eyes with drusen area of 0.5 DA or greater and without pigmentary abnormalities had a 5-year risk of advanced AMD of about 12%; adding increased pigment (any amount) and/or mild depigmentation (less than circle I-2, about 0.25 DD) doubled the risk; adding more extensive depigmentation or noncentral GA doubled the risk again.

    “In participants without advanced AMD in either eye, eyes with drusen area of 0.5 DA or greater and without pigmentary abnormalities had a 5-year risk of advanced AMD of about 12%; adding increased pigment (any amount) and/or mild depigmentation (less than circle I-2, about 0.25 DD) doubled the risk; adding more extensive depigmentation or noncentral GA doubled the risk again (Table 6, bottom row).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    A similar analysis in the Beaver Dam cohort limited to eyes with soft indistinct drusen gave similar results; 5-year rates ranged from 0% of 140 eyes with drusen area less than 0.1 DA to 30% of 50 eyes with drusen area of 0.1 DA or greater and pigmentary abnormalities; the 10-year rate in the latter category approached 60%.

    “A similar analysis in the Beaver Dam cohort that was limited to eyes with soft indistinct drusen gave similar results.Five-year rates ranged from 0% of 140 eyes with drusen area less than 0.1 DA (with or without pigmentary abnormalities) to 30% of 50 eyes with drusen area of 0.1 DA or greater and pigmentary abnormalities; the 10-year rate in the latter category approached 60%.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [10]

      Not checked in the free run.

    • cites [11]

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In the Beaver Dam and Blue Mountains studies, drusen area was reported only within drusen type (Beaver Dam) or drusen size (Blue Mountains); rates in the largest categories were 18% and 31%, respectively. Corresponding rates in AREDS were 24% and 26%, respectively.

    “In the Beaver Dam and Blue Mountains studies, drusen area was reported only within drusen type (Beaver Dam) or drusen size (Blue Mountains); rates in the largest categories were 18% and 31%, respectively.Corresponding rates in AREDS were 24% and 26%, respectively.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [10]

      Not checked in the free run.

    • cites [11]

      Not checked in the free run.

    • cites [12]

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Progression rates for eyes with soft indistinct drusen in the Blue Mountains and Rotterdam studies (23% and 18%, respectively) were somewhat higher than the AREDS rate (14%), while the Beaver Dam rate (6%) was somewhat lower.

    “Progression rates for eyes with soft indistinct drusen in the Blue Mountains and Rotterdam studies (23% and 18%, respectively) were somewhat higher than the AREDS rate (14%), while the Beaver Dam rate (6%) was somewhat lower.”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [12]

      Not checked in the free run.

    • cites [9]

      Not checked in the free run.

    • cites [10]

      Not checked in the free run.

    • cites [11]

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    Events were few, and there was no suggestion of a treatment effect through step 4.

    “Events were few, and there was no suggestion of a treatment effect through step 4.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In participants with large drusen in only one eye, drusen area was 0.5 DA or greater in that eye in 10%, while in participants with large drusen in both eyes, drusen area was 0.5 DA or greater in at least one eye in 71%.

    “In participants with large drusen in only one eye, drusen area was 0.5 DA or greater in that eye in 10%, while in participants with large drusen in both eyes, drusen area was 0.5 DA or greater in at least one eye in 71% (data not shown).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    In both the Beaver Dam Eye Study and AREDS, drusen size was reported in 4 categories; progression rates were somewhat higher in AREDS in all categories.

    “In both the Beaver Dam study and AREDS, drusen size was reported in 4 categories; progression rates were somewhat higher in AREDS in all categories.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [10]

      Not checked in the free run.

    • cites [11]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    The increase in outcome in step 9 is due exclusively to CGA.

    “The bar representing step 9 is offset to emphasize that the increase in outcome in this step is due exclusively to CGA.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationown data

    Presence of questionable or definite noncentral GA within the grid was added as the highest step of a combined depigmentation-GA scale.

    “Consequently, presence of questionable or definite noncentral GA (within the grid) was added as the highest step of a combined depigmentation (within the inner zone)-GA scale”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductnone given

    The scale-building data set was selected before publication of AREDS results, and analyses were carried out without knowledge of treatment assignment.

    “The scale-building data set was selected before publication of AREDS results, and analyses were carried out without knowledge of treatment assignment.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Photographs from each visit were graded independently of those from all other visits.

    “Photographs from each visit were graded independently of those from all other visits.3”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [3]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationown data

    Inspection of Table 13 and underlying cross-tabulations does not suggest any change in the definitions of scale steps.

    “Inspection of Table 13, and of the under- lying cross-tabulations of drusen area by pigment abnormalities from which individual cells were combined to create Table 13 (data not shown), does not suggest any change in the definitions of scale steps.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    A similar analysis for the eye at risk in participants with neovascular AMD in the fellow eye at baseline demonstrated treatment effect more clearly and suggested that risks for untreated eyes in steps 1 to 7 were somewhat higher than those given by the scale.

    “A similar analysis for the eye at risk in participants with neovascular AMD in the fellow eye at baseline demonstrated treatment effect more clearly and suggested that risks for untreated eyes in steps 1 to 7 were somewhat higher than those given by the scale”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    The scale is based on assessment of good-quality stereoscopic photographs by trained graders using a detailed protocol and measuring grids.

    “The scale is based on assessment of good-quality stereoscopic photographs by trained graders using a detailed protocol and measuring grids (Figure 1).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductcitation

    Participants were mostly non-Hispanic whites, and age, sex, race, and other risk factors were not considered.

    “Participants were mostly non-Hispanic whites, and age, sex, race, and other risk factors were not considered.8,16”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [8]

      Not checked in the free run.

    • cites [16]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Large drusen size, extensive drusen area, soft indistinct drusen, and pigmentary abnormalities have all been recognized previously as risk factors for progression to advanced AMD.

    “Large drusen size, extensive drusen area, soft indistinct drusen, and pigmentary abnormalities have all been recognized previously as risk factors for progression to advanced AMD, both in persons free of advanced AMD in both eyes and in the second eye of individuals in whom advanced AMD has already developed in the first eye.8”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [8]

      Not checked in the free run.

30 of 30

  • The authors state this as an assumption.

    Occurrence of increased pigment and depigmentation in one or more of the 4 outer subfields only might frequently represent a disorder other than AMD.

    “because we anticipated that occurrence of these abnormalities in 1 or more of the 4 outer subfields only might frequently represent a disorder other than AMD.”

  • The authors state this as an assumption.

    The diameter of the optic disc is 1500 µm.

    “When the diameter of the optic disc is assumed to be 1500 µm”

  • The paper relies on this without support.

    The 4 groups used to categorize participants at entry into AREDS were not based on an analysis of outcome data.

    “believe it will be more useful in future analyses than the 4 groups used to categorize participants at entry into AREDS, which were not based on an analysis of outcome data.”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • In both classification schemes, the risk of developing advanced age-related macular degeneration is directly associated with the extent of drusen and the amount of hypopigmentary or hyperpigmentary changes of the retinal pigment epithelial layer.

    “In both schemes the risk of developing the advanced forms of age-related macular degeneration is directly associated with the extent of the drusen and the amount of hypopigmentary or hyperpigmentary changes of the retinal pigment epithelial layer.”

    From Age-related macular degeneration (2008) · cites this paper as [7]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Pigment-scale steps are assigned to the wrong Table 4 columns

    Minor

    Table 4 has seven depigmentation columns. Step 4 corresponds to column 6 (depigmentation ≥0.5 DA), and step 5 to column 7 (GA), not columns 5 and 6 as stated.

  • Incorrect percentage for neovascular AMD in pigment-scale step 5

    Minor

    Table 5 reports 2 neovascular AMD cases among 35 eyes in step 5 as 5.2%; the percentage is 5.7% to one decimal place.

    Reported 5.2 · recomputed 5.714286

2 of 2

Cites

Flagged first, then by citations

Research works printed but not linked: 2

  1. Clark LA, Pregibon D. Tree-based models. In: Chambers JM, Hastie TJ, eds. Sta- tistical Models in S. Pacific Grove, Calif: Wadsworth & Brooks/Cole; 1992:377- 420.
  2. Klein R, Klein BEK, Tomany SC, Meuer SM, Huang G-H. Ten-year incidence and progression of age-related maculopathy: the Beaver Dam Eye Study. Ophthalmology. 2002;109:1767-1779.

Cited by

Sorted by citations

Related

Authors
Age-Related Eye Disease Study Research Group
Affiliations
Emmes (United States) (US)
Corresponding author
Age-Related Eye Disease Study Research Group
Venue
Archives of Ophthalmology
Publisher
American Medical Association (AMA)
Published
2005-11-01
Volume
123
Issue
11
Pages
1484
ISSN
0003-9950 (ISSN-L)
DOI
10.1001/archopht.123.11.1484
PMC
PMC1472813
OpenAlex
W159419684
Semantic Scholar
99651e191631e8bf84a10da2cf8d08e2b6fbb5a6
Cited by
739
References
15
Citations by year
2026: 37 · 2025: 40 · 2024: 48 · 2023: 42 · 2022: 63 · 2021: 48 · 2020: 48 · 2019: 32 · 2018: 34 · 2017: 39 · 2016: 40 · 2015: 37 · 2014: 40 · 2013: 45 · 2012: 36
FWCI
13.76
Type
journal article
Language
en
Open access
Locations
  • Archives of Ophthalmology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (1z01ey000394-01)
  • National Eye Institute (Z01 EY000394-03)
Topics
  • Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Retinal Imaging and Analysis
  • Health Sciences › Medicine › Ophthalmology › Ocular Diseases and Behçet’s Syndrome
Keywords
age-related macular degeneration, severity scale, drusen, pigmentary abnormalities, geographic atrophy, neovascular AMD, fundus photography grading, disease progression, risk prediction, retinal pigment epithelium
MeSH terms
Atrophy, Humans, Macular Degeneration, Photography, Retina, Retinitis Pigmentosa, Severity of Illness Index, Reproducibility of Results, Retinal Drusen, Randomized Controlled Trials as Topic, Disease Progression

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

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