Cologne Image Reading Center (CIRCL)

Das CIRCL Reading Center wurde 2008 von Prof. Dr. Sandra Liakopoulos gegründet. Prof. Dr. Sandra Liakopoulos war von 2006 bis 2007 am Doheny Image Reading Center (DIRC) in Los Angeles tätig und verantwortlich für die Auswertung bildgebender Befunde für klinische Studien zur altersbedingten Makuladegeneration und diabetischen Retinopathie.

Das CIRCL bietet qualitative und quantitative Auswertung von Farbaufnahmen des Augenhintergrundes, Angiographien und Spectral Domain OCT Scans im Rahmen klinischer Studien. Alle Bilder werden von zertifizierten Reading Center Gradern nach dem Standard Grading Protokoll des CIRCL befundet.

Zu den Schwerpunkten des Reading Centers zählen die Phänotypisierung für epidemiologische Studien (, die Analyse von bildgebenden Befunden als Endpunkte für pharmazeutische klinische Studien zur Sicherheit und Effektivität von neuen Therapien sowie die Validierung von nicht-invasiven Untersuchungsmethoden für das Monitoring und die Behandlung von retinalen Krankheitsbildern.


The Cologne Image Reading Center and Laboratory (CIRCL) was established in 2008 under the direction of Sandra Liakopoulos, MD. Prof. Dr. Liakopoulos was trained in image analysis at the Doheny Image Reading Center (DIRC) in Los Angeles under the direction of SriniVas R. Sadda, MD, and served as a senior grader for the DIRC from June 2006 till June 2007.

The CIRCL provides analysis of color fundus photography, fluorescein angiography, and optical coherence tomography (OCT) images in support of clinical research studies, with a focus on age-related macular degeneration. All images are graded according to the standard grading protocol of the CIRCL. Additional features or specific grading considerations may be defined in study specific grading protocols.

Among the goals of the Reading Center are the phenotyping for epidemiological studies, follow-up studies to demonstrate the safety and efficacy of potential new treatments and the validation of non-invasive imaging techniques in the monitoring and management of ophthalmic diseases.


CIRCL – Cologne Image Reading Center and Laboratory
Center for Ophthalmology
University Hospital of Cologne
Kerpener Str. 62
50924 Cologne, Germany

Team and Collaborations (alphabetical order)

Quality Assurance Responsible
Tina Schick, MD

Project Manager

Christina Aust, M.Sc.
Maren Piel
Laura Schöllhorn, Dr. nat. med.
Julia Stas, M.Sc.

Data Manager
Christina Aust, M.Sc.
Aileen Berghold, B.Sc.
Judith Pappe, Dipl. Des.
Maren Piel
Laura Schöllhorn, Dr. nat. med.
Julia Stas, M.Sc.
Melanie Winnen

Aileen Berghold, B.Sc.
Johannes Meuer
Christian Pape
Judith Pappe, Dipl.Des.
Tina Schick, MD
Laura Schöllhorn, Dr. nat. med.
Robert Siggel, MD
Nikolaus Stas
Stefanie Weise, MD
Melanie Winnen

IT Support
IT Department of theUniversty of Cologne
Herbert Kühner, Dr. rer. nat.

Doheny Image Reading Center (DIRC) Los Angeles
GRADE Reading Center Bonn (ORCA Studie)
M3 Reading Center Münster (ORCA Studie)
Radboud University Nijmegen Medical Centre (Euregio Genetic Database EUGENDA-study

Services provided by the CIRCL

  • Assistance with clinical protocol development, including reading center-related outcome parameters and inclusion / exclusion criteria
  • Development and provision of standardized photography protocols
  • Data transfer: instruction for clinical sites in methods for documenting and transmitting images captured for the study
  • Data storage: secure long-term archival of study materials, both digital and hardcopy
  • Development of case report forms (CRFs)
  • Application of the standard grading protocol of the CIRCL, and development of study-specific grading procedures and protocols when necessary
  • Assessment of each image set by two trained, certified graders
Selected Publications

Sadda SR, Guymer R, Holz FG, Schmitz-Valckenberg S, Curcio CA, Bird AC, Blodi BA, Bottoni F, Chakravarthy U, Chew EY, Csaky K, Danis R, Fleckenstein M, Freund KB, Grunwald J, Hoyng CB, Jaffe GJ, Liakopoulos S, Monés JM, Pauleikhoff D, Rosenfeld PJ, Sarraf D, Spaide RF, Tadayoni R, Tufail A, Wolf S, Staurenghi G. Consensus. Definition for Atrophy Associated with Age-Related Macular Degeneration on OCT: Classification of Atrophy Report 3. 2017 Oct.

Holz FG, Sadda SR, Staurenghi G, Lindner M, Bird AC, Blodi BA, Bottoni F, Chakravarthy U, Chew EY, Csaky K, Curcio CA, Danis R, Fleckenstein M, Freund KB, Grunwald J, Guymer R, Hoyng CB, Jaffe GJ, Liakopoulos S, Monés JM, Oishi A, Pauleikhoff D, Rosenfeld PJ, Sarraf D, Spaide RF, Tadayoni R, Tufail A, Wolf S, Schmitz-Valckenberg S; CAM group. Imaging Protocols in Clinical Studies in Advanced Age-Related Macular Degeneration: Recommendations from Classification of Atrophy Consensus Meetings. Ophthalmology. 2017 Jan 18.

Schmitz-Valckenberg S, Brinkmann CK, Fleckenstein M, Heimes B, Liakopoulos S, Spital G, Holz FG. [Pitfalls in retinal optical coherence tomography imaging]. Ophthalmologe. 2017 Feb 14.

Schick T, Ersoy L, Hoyng CB, Kirchhof B, Liakopoulos S. Phenotype Characteristics of Fellow Eyes in Patients With Early Onset of Neovascular Age-Related Macular Degeneration. Invest Ophthalmol Vis Sci. 2015 Nov;56(12):7269-73.

Ersoy L, Ristau T, Kirchhof B, Liakopoulos S. Response to anti-VEGF therapy in patients with subretinal fluid and pigment epithelial detachment on spectral-domain optical coherence tomography. Graefes Arch Clin Exp Ophthalmol. 2014 Jun;252(6):889-97.

Ristau T, Keane PA, Walsh AC, Engin A, Mokwa N, Kirchhof B, Sadda SR, Liakopoulos S. Relationship between visual acuity and spectral domain optical coherence tomography retinal parameters in neovascular age-related macular degeneration. Ophthalmologica. 2014;231(1):37-44.

Liakopoulos S, Keane PA, Ristau T, Kirchhof B, Walsh AC, Sadda SR. Atypical outer retinal fluid accumulation in choroidal neovascularization: a novel OCT finding. Ophthalmic Surg Lasers Imaging Retina. 2013 Nov-Dec;44(6 Suppl):S11-8.

Mokwa NF, Ristau T, Keane PA, Kirchhof B, Sadda SR, Liakopoulos S. Grading of Age-Related Macular Degeneration: Comparison between Color Fundus Photography, Fluorescein Angiography, and Spectral Domain Optical Coherence Tomography. J Ophthalmol. 2013;2013:385915.

Keane PA, Patel PJ, Liakopoulos S, Heussen FM, Sadda SR, Tufail A. Evaluation of age-related macular degeneration with optical coherence tomography. Surv Ophthalmol. 2012 Sep;57(5):389-414.

Keane PA, Liakopoulos S, Jivrajka RV, Chang KT, Alasil T, Walsh AC, Sadda SR. Evaluation of optical coherence tomography retinal thickness parameters for use in clinical trials for neovascular age-related macular degeneration. Invest Ophthalmol Vis Sci. 2009 Jul;50(7):3378-85.

EUGENDA Study Group

Ersoy L, Schick T, de Graft D, Felsch M, Hoyng CB, den Hollander AI, Kirchhof B, Fauser S, Liakopoulos S. Extramacular drusen are highly associated with age-related macular degeneration, but not with CFH and ARMS2 genotypes. Br J Ophthalmol. 2015 Nov 27. [Epub ahead of print]

Helgason H, Sulem P, Duvvari MR, Luo H, Thorleifsson G, Stefansson H, Jonsdottir I, Masson G, Gudbjartsson DF, Walters GB, Magnusson OT, Kong A, Rafnar T, Kiemeney LA, Schoenmaker-Koller FE, Zhao L, Boon CJ, Song Y, Fauser S, Pei M, Ristau T, Patel S, Liakopoulos S, van de Ven JP, Hoyng CB, Ferreyra H, Duan Y, Bernstein PS, Geirsdottir A, Helgadottir G, Stefansson E, den Hollander AI, Zhang K, Jonasson F, Sigurdsson H, Thorsteinsdottir U, Stefansson K. A rare nonsynonymous sequence variant in C3 is associated with high risk of age-related macular degeneration. Nat Genet. 2013 Nov;45(11):1371-4.

Van de Ven JP, Nilsson SC, Tan PL, Buitendijk GH, Ristau T, Mohlin FC, Nabuurs SB, Schoenmaker-Koller FE, Smailhodzic D, Campochiaro PA, Zack DJ, Duvvari MR, Bakker B, Paun CC, Boon CJ, Uitterlinden AG, Liakopoulos S, Klevering BJ, Fauser S, Daha MR, Katsanis N, Klaver CC, Blom AM, Hoyng CB, den Hollander AI. A functional variant in the CFI gene confers a high risk of age-related macular degeneration. Nat Genet. 2013 Jul;45(7):813-7.

Ristau T, Ersoy L, Hahn M, den Hollander AI, Kirchhof B, Liakopoulos S, Fauser S. Nongenetic risk factors for neovascular age-related macular degeneration. Invest Ophthalmol Vis Sci. 2014 Jul 29;55(8):5228-32.

ORCA Study Group

Heimes B, Schick T, Brinkmann CK, Wiedon A, Haegele B, Kirchhof B, Holz FG, Pauleikhoff D, Ziemssen F, Liakopoulos S, Spital G, Schmitz-Valckenberg S. [Design of the ORCA module in the OCEAN study: Evaluation of SD-OCT results in daily routine practice]. Ophthalmologe. 2016 Feb 11. [Epub ahead of print]

Ziemssen F, Bertelmann T, Hufenbach U, Scheffler M, Liakopoulos S, Schmitz-Valckenberg S. [Delayed treatment initiation of more than 2 weeks: Relevance for possible gain of visual acuity after anti-VEGF therapy under real life conditions (interim analysis of the prospective OCEAN study)]. Ophthalmologe. 2016 Feb;113(2):143-51.


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