Fixation pattern and macular sensitivity in eyes with subfoveal choroidal neovascularization secondary to age-related macular degeneration. A microperimetry study

Abstract

Purpose. To investigate the effects of subfoveal choroidal neovascularizzation (CNV) secondary to age-related macular degeneration (AMD) on macular functional parameters quantified with an automatic fundus perimeter.Methods. 118 eyes of 98 consecutive patients with subfoveal CNV secondary to AMD were evaluated. Best corrected visual acuity (ETDRS charts), fundus photography, and fluorescein angiography were performed. Microperimetry (fundus-related perimetry) was used to quantify macular sensitivity and fixation pattern (location and stability).Results. Of 118 eyes: 26 (21.9%) had central, 18 (15.1%) poor central and 74 (63.0%) eccentric fixation; 31 (26.0%) had stable, 42 (35.6%) relatively unstable and 45 (38.4%) unstable fixation. In 75 eyes (63.4%) a dense central scotoma was found. Angiographic classification of subfoveal CNV (occult versus classic) was not significantly related to fixation pattern (location: P = 0.274; stability: P = 0.385), and presence of dense scotoma (P = 0.41).Conclusion. Microperimetric quantification of macular sensitivity and fixation pattern in eyes with subfoveal CNV secondary to AMD offers new data about the impact of visual impairment in these eyes. Moreover, microperimetry improves the functional evaluation of subfoveal CNV in AMD.

Quality of fixation in eyes with neovascular age-related macular degeneration treated with ranibizumab

“…Previous studies have shown that improvement in retinal sensitivity is a more reliable predictor of central and stable fixation compared with visual acuity. 12,13 A recent report indicated that the most pronounced effect of intravitreal ranibizumab on visual acuity and retinal sensitivity was at 1 week after first injection, and that the effect was less pronounced with the second and third injections of the loading phase.…”

Microperimetric changes in neovascular age-related macular degeneration treated with ranibizumab

“…The different retinal locations are mapped exactly in order to allow for subsequent comparisons. 7 The Macular Integrity Assessment Device (MAIA) system, a novel device that utilises scanning laser ophthalmoscope technology, is an advancement on the MP-1 device and has recently been introduced into clinical practice. MAIA is a third generation microperimetry system that measures visual sensitivity and fixation stability (FS) using 61 or 37 Goldmann style stimulus points within a 10-degree meridional grid centred on the fovea.…”

“…The value of such evaluations with the MP-1 microperimeter (Nidek, Gamagori, Japan) has been previously reported in AMD. [5][6][7][8] These non-invasive measurements allow an automated analysis of macular function with appropriate correction for eye movements, even when fixation is unstable. As such, the assessments are independent of fixation and eye movements.…”

Correlation between Spectral Domain Optical Coherence Tomography and Microperimetric Findings before and after Intravitreal Bevacizumab Injection in Wet Age Related Macular Degeneration

“…It also gives an idea about the fixation pattern and the preferred retinal loci (PRL) of patients. These PRL are mapped in relation to fixed anatomical landmarks, so they can be re-examined in subsequent examinations, a point which allows for future comparisons [5]. Incorporating microperimetry in the follow up of neovascular AMD, after anti VEGF injection could thus be a beneficial tool to evaluate retinal sensitivity even in cases with stable visual acuity and stable macular morphology on OCT. A previous study showed significant increase in mean retinal sensitivity with a decrease in absolute scotoma size 6 months after bevacizumab injection [6], a point which further encouraged us to use microperimetry in parallel with OCT in following up patients with neovascular AMD.…”

“…Several previous reports have highlighted the benefit of this structure-function correlation in cases of AMD [4]. Microperimetry allows for automated assessment of macular function as well as automated correction for eye movements, as unstable fixation [4,5]. It also gives an idea about the fixation pattern and the preferred retinal loci (PRL) of patients.…”