Changes in Retinal Sensitivity in Geographic Atrophy Progression as Measured by Microperimetry

Meleth, Annal D.; Mettu, Priyatham S; Agrón, Elvira; Chew, Emily Y.; Sadda, Srinivas R; Ferris, Frederick L.; Wong, Wai T.

doi:10.1167/iovs.10-6075

Cited by 90 publications

(97 citation statements)

References 40 publications

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“…[4][5][6][7][8] However, this is the first study, to our knowledge, that examines whether micro- perimetry is useful for detecting functional changes in the early stages of AMD over a relatively short follow-up period of 12 months. In this present study, we found that microperimetry was able to detect changes in sensitivity to luminance increments over a 12-month period for eyes that either remained stable or showed disease progression in the early stages of AMD.…”

Section: Discussionmentioning

confidence: 99%

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Longitudinal Changes in Microperimetry and Low Luminance Visual Acuity in Age-Related Macular Degeneration

Ayton

Luu

et al. 2015

JAMA Ophthalmol

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IMPORTANCEThere is a need for more sensitive measures of disease in intermediate age-related macular degeneration (AMD) to evaluate novel interventions more effectively and expediently.OBJECTIVE To determine if microperimetry and low luminance visual acuity can detect functional changes over a short duration of follow-up. DESIGN, SETTING, AND PARTICIPANTSProspective longitudinal examination of 49 participants with consecutive AMD and 10 healthy participants in a research clinic from May 1, 2012, to December 31, 2013. Forty-one participants had intermediate AMD, 8 had nonfoveal geographic atrophy due to AMD. Participants underwent microperimetry examinations in 1 eye during a 12-month period at 6-month intervals for participants with AMD and at baseline and 12 months for control participants; low luminance visual acuity was performed at baseline and at 12 months for all participants. Changes in pathological features of intermediate AMD eyes were determined using side-by-side comparisons of color fundus photographs from the initial and final visit as remaining stable, progressed, or improved. MAIN OUTCOMES AND MEASURES Microperimetric sensitivity and low luminance visual acuity.RESULTS A reduction in mean (SE) microperimetric pointwise sensitivity was identified at 12 months compared with the baseline for intermediate AMD eyes graded as stable (−0.31 dB [0.10 dB]; P = .003) or worsened (−0.42 dB [0.12 dB]; P < .001) and an improvement in mean (SE) pointwise sensitivity was identified in eyes graded as improved (1.13 dB [0.23 dB]; P < .001). A reduction in mean (SE) pointwise sensitivity was identified in eyes with nonfoveal geographic atrophy at both 6 months (−1.41 dB [0.22 dB]; P < .001) and 12 months compared with the baseline (−2.56 dB [0.22 dB]; P < .001) while a change in mean (SE) pointwise sensitivity was not identified over the 12-month period for control participants (−0.11 dB [0.11 dB]; P = .34). No changes in best-corrected visual acuity or low luminance visual acuity were identified in all groups over the 12-month period (P Ն .07). CONCLUSIONS AND RELEVANCEMicroperimetry detected subtle changes in visual function over a 12-month period in eyes with intermediate AMD but visual acuity measures did not identify any such changes. These findings suggest that microperimetry is worth exploring as a method for assessing the efficacy of novel interventions for intermediate AMD potentially requiring a shorter duration of follow-up.

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Section: Discussionmentioning

confidence: 99%

“…Microperimetry has been used in the atrophic and neovascular stages of AMD. [4][5][6][7][8] In addition to other studies, we have…”

mentioning

confidence: 83%

Longitudinal Changes in Microperimetry and Low Luminance Visual Acuity in Age-Related Macular Degeneration

Ayton

Luu

et al. 2015

JAMA Ophthalmol

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“…[24][25][26][27][28][29][30][31][32][33] Microperimetry has detected photoreceptor abnormalities even before GA develops, and this strategy can also predict the area where existing GA will likely progress. [34][35][36][37][38][39][40] These histopathologic, electrophysiologic, and microperimetric findings in eyes with GA, along with the early visual function deficits and symptoms observed in patients even before GA develops, 41 suggest that photoreceptor dysfunction precedes the appearance and progression of GA in some eyes. These findings would also suggest that an anatomic correlate should exist away from the margin of GA that could be visualized using SD-OCT imaging.…”

Section: Introductionmentioning

confidence: 99%

Predicting the Progression of Geographic Atrophy in Age-Related Macular Degeneration With SD-OCT En Face Imaging of the Outer Retina

Nunes¹,

Gregori²,

Yehoshua³

et al. 2013

Ophthalmic Surg Lasers Imaging Retina

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BACKGROUND AND OBJECTIVE: Spectral-domain optical coherence tomography (SD-OCT) en face imaging was used to measure the growth of geographic atrophy (GA) and identify baseline anatomic changes in the outer retina in eyes with nonexudative age-related macular degeneration (AMD). PATIENTS AND METHODS: In this prospective study, eyes were imaged using 200 × 200 and 512 × 128 A-scan raster patterns. Outer retinal anatomy was visualized using en face imaging of a 20-μm thick slab encompassing the inner segment/outer segment (IS/OS) band. RESULTS: En face SD-OCT imaging of the IS/OS region revealed a bilaterally symmetrical pattern of outer retinal disruption extending beyond the borders of GA that accurately predicted the progression of GA over 1 year in 13 of 30 eyes (43.3%). In the remaining cases, the area of disruption was much larger than the area of progression. CONCLUSION: En face imaging of the outer retina can predict the growth of GA in some eyes. Due to the bilateral symmetry of these findings, this imaging strategy may identify a genetic subset of patients in whom photoreceptor loss precedes the progression of GA. These areas with outer retinal disruption should be followed in clinical trials designed to test treatments for dry AMD. [ Ophthalmic Surg Lasers Imaging Retina. 2013;44:344–359.]

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“…As a result of this limitation, current commercially available microperimeters display only crude normative data comparisons, such as global average sensitivity, and color code individual sensitivity estimates according to an arbitrary scale. Improved normative data comparison would assist clinicians in the detection and characterization of subtle visual defects outside of apparent retinal lesions that may precede further disease progression, 3,4 and in the detection of early functional impairments due to retinal lesions. 5 Such visual defects may indicate the necessity for treatment to prevent further vision loss.…”

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confidence: 99%

Spatial Interpolation Enables Normative Data Comparison in Gaze-Contingent Microperimetry

Denniss

Astle

2016

Invest. Ophthalmol. Vis. Sci.

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PURPOSE. To demonstrate methods that enable visual field sensitivities to be compared with normative data without restriction to a fixed test pattern.METHODS. Healthy participants (n ¼ 60, age 19-50) undertook microperimetry (MAIA-2) using 237 spatially dense locations up to 138 eccentricity. Surfaces were fit to the mean, variance, and 5th percentile sensitivities. Goodness-of-fit was assessed by refitting the surfaces 1000 times to the dataset and comparing estimated and measured sensitivities at 50 randomly excluded locations. A leave-one-out method was used to compare individual data with the 5th percentile surface. We also considered cases with unknown fovea location by adding error sampled from the distribution of relative fovea-optic disc positions to the test locations and comparing shifted data to the fixed surface.RESULTS. Root mean square (RMS) difference between estimated and measured sensitivities were less than 0.5 dB and less than 1.0 dB for the mean and 5th percentile surfaces, respectively. Root mean square differences were greater for the variance surface, median 1.4 dB, range 0.8 to 2.7 dB. Across all participants 3.9% (interquartile range, 1.8-8.9%) of sensitivities fell beneath the 5th percentile surface, close to the expected 5%. Positional error added to the test grid altered the number of locations falling beneath the 5th percentile surface by less than 1.3% in 95% of participants.CONCLUSIONS. Spatial interpolation of normative data enables comparison of sensitivity measurements from varied visual field locations. Conventional indices and probability maps familiar from standard automated perimetry can be produced. These methods may enhance the clinical use of microperimetry, especially in cases of nonfoveal fixation.

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Changes in Retinal Sensitivity in Geographic Atrophy Progression as Measured by Microperimetry

Abstract: Macular sensitivity and fixation quality undergo progressive change during the GA progression, reflecting alterations in macular function extending beyond the GA lesion proper. Microperimetric measurements may provide useful functional outcome measures for the clinical study of GA.

Cited by 90 publications

References 40 publications

Longitudinal Changes in Microperimetry and Low Luminance Visual Acuity in Age-Related Macular Degeneration

Longitudinal Changes in Microperimetry and Low Luminance Visual Acuity in Age-Related Macular Degeneration

Predicting the Progression of Geographic Atrophy in Age-Related Macular Degeneration With SD-OCT En Face Imaging of the Outer Retina

Spatial Interpolation Enables Normative Data Comparison in Gaze-Contingent Microperimetry

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