Presymptomatic Retinal Sensitivity Changes in Intermediate Age-Related Macular Degeneration Associated With New Retinal Fluid

Wightman, Antony J.; Abbott, Carla J; McGuinness, Myra B; Caruso, Emily; Guymer, Robyn H.; Luu, Chi D

doi:10.1167/tvst.8.6.3

Cited by 8 publications

(9 citation statements)

References 57 publications

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“…Instead, improved methods of risk stratification to identify individuals at a high risk of developing nAMD that require more frequent monitoring using OCT imaging may be a more effective approach, given the effectiveness of this imaging modality for the early detection of nAMD. 10 In particular, the introduction of OCT angiography into most commercial OCT systems may enable the identification of those with subclinical, nonexudative neovascularization that confer a high risk of developing exudation that warrant such increased monitoring frequency. 31 Technological advances leading to the development of low-cost OCT imaging systems could also enable self-monitoring in high-risk individuals as well.…”

Section: Discussionmentioning

confidence: 99%

“…Although microperimetric sensitivity is reduced over regions with the earliest signs of late AMD (including nAMD 9,10 and atrophic AMD 12 ), such reductions may also occur in regions affected by intermediate AMD lesions, such as large retinal pigment epithelium elevation, 8,22,23 marked ellipsoid zone disruptions, 8,23 or numerous hyperreflective foci on OCT imaging. 24 Along with the known test-retest variability of microperimetry testing, 19 detecting the earliest onset of late AMD is expected to be challenging and was reflected in the poor performance of microperimetry in this study.…”

Section: Discussionmentioning

confidence: 99%

“…Microperimetry, or fundus-tracked perimetry, shows promise as a potentially useful visual function test for the detection of nAMD onset because it can detect subtle visual function abnormalities both at and outside the fovea. 7,8 Functional abnormalities have been noted when testing areas over features of nAMD (including intraretinal and subretinal fluid) 9,10 and also atrophic AMD. 11,12 However, the performance of using microperimetry to detect nAMD or atrophic AMD onset at the individual level remains to be established.…”

mentioning

confidence: 99%

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Using Microperimetry and Low-Luminance Visual Acuity to Detect the Onset of Late Age-Related Macular Degeneration

Luu

Hodgson

et al. 2021

Retina

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To evaluate the performance of microperimetry and low-luminance visual acuity for detecting late age-related macular degeneration (AMD) onset.Methods: Two hundred ninety-two individuals with bilateral large drusen in the Laser Intervention in the Early Stages of AMD study underwent best-corrected visual acuity, lowluminance visual acuity, and microperimetry testing as well as multimodal imaging to detect late (neovascular or atrophic) AMD onset. The performance of the change in the measurement from baseline of each of visual function test for detecting late AMD onset was compared.Results: The area under the receiver operating characteristic curve for detecting neovascular and atrophic AMD onset was not significantly different for low-luminance visual acuity (area under the receiver operating characteristic curve = 0.71 and 0.56, respectively) and microperimetry (area under the receiver operating characteristic curve = 0.82 and 0.62, respectively) compared with best-corrected visual acuity (area under the receiver operating characteristic curve = 0.57 and 0.56, respectively; P $ 0.126 for all). There was also only a fair degree of agreement between the three visual function measures for detecting the onset of neovascular and atrophic AMD (k $ 0.24).Conclusion: Microperimetry, low-luminance visual acuity, and best-corrected visual acuity demonstrate limited performance for detecting the earliest onset of late AMD. It remains to be established whether they perform better than current methods designed to enable self-detection of neovascular AMD onset, such as Amsler grid testing.RETINA 41:1094-1101, 2021N eovascular age-related macular degeneration (nAMD) often develops spontaneously in at-risk individuals with the asymptomatic, early signs of AMD. It is now well recognized that long-term visual acuity outcomes of antivascular endothelial growth factor treatments are highly dependent on presenting visual acuity. [1][2][3] Unfortunately, those that are symptomatic at onset of nAMD present with loss of vision at a level that may not be recoverable despite treatment with the current generation of biologicals.A major barrier for the early detection of nAMD is the lack of sufficiently accurate and appropriate self-monitoring tools. Although conventional Amsler grid testing has a sensitivity of 78% for detecting nAMD with relatively severe visual acuity loss, 4 it can only detect one-third of nAMD eyes with a median pretreatment visual acuity of 20/50. 5 Other visual function tests such as preferential hyperacuity perimetry have been developed in an attempt to overcome this important limitation. A randomized trial demonstrated those randomized to self-monitoring with preferential hyperacuity perimetry led to a median of 4 letters improvement in visual acuity at the time nAMD was first detected compared with those randomized to standard care 1094

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Using Microperimetry and Low-Luminance Visual Acuity to Detect the Onset of Late Age-Related Macular Degeneration

Luu

Hodgson

et al. 2021

Retina

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“…In this respect, SRF might be interpreted more as a biomarker of efficient disease management preventing IRF and bleeding, and less as a by itself protective factor. On the contrary, the sole appreciation of visual acuity might represent an only partial view on visual function; several studies have recently shown that sub-retinal fluid significantly reduces retinal sensitivity, which might impair visual performance especially under low-luminance 34,35 .…”

Section: Discussionmentioning

confidence: 99%

Impact of Sub-Retinal Fluid on the Long-Term Incidence of Macular Atrophy in Neovascular Age-related Macular Degeneration under Treat & Extend Anti-Vascular Endothelial Growth Factor Inhibitors

Fischer

Schworm

Kreutzer

et al. 2020

Sci Rep

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Sub-retinal fluid (SRF) has been discussed as a protective factor against macular atrophy in eyes with neovascular age-related macular degeneration (nAMD).To gauge the impact of SRF on macular atrophy, a database of 310 nAMD eyes was screened for eyes manifesting an SRF-only phenotype under treat & extend anti-VEGF treatment, defined as nAMD expressing CNV exudation beyond the three monthly anti-VEGF loading doses by SRF only without any signs of exudative intra-retinal fluid (IRF) for ≥3 years. incidence of macular atrophy and treatment responses were evaluated on multimodal imaging, including optical coherence tomography (OCT), blue autofluorescence (BAF) and near-infrared (NIR) confocal scanning laser ophthalmoscopy and fluorescence and indocyanine green angiography (FAG/ ICGA). In total, 27 eyes (8.7%) of 26 patients with a mean follow-up of 4.2 ± 0.9 (3-5) years met the inclusion criteria. Mean age was 72 ± 6 (range: 61-86) years. The SRF only phenotype was seen from baseline in 14 eyes (52%), and in 13 eyes (48%) after a mean 1.0 ± 1.3 (1-3) injections. In years 1 to 5, mean 7.5, 5.9, 6.1, 6.1 and 7.0 anti-VEGF injections were given (p = 0.33). Cumulative macular atrophy incidence was 11.5% at year 1, 15.4% throughout years 2 to 4, and 22.4% at year 5. In conclusion, eyes manifesting activity by SRf only in treat & extend anti-VeGf regimen for nAMD seem to exhibit rather low rates of macular atrophy during long-term follow-up. SRf might be an indicator of a more benign form of nAMD. The introduction of anti-vascular endothelial growth factor (VEGF) therapy in neovascular age-related macular degeneration (nAMD) has improved visual acuity and quality of life for millions of patients worldwide 1. In the era of anti-VEGF, the long-term maintenance of visual acuity is now challenged less by fibrovascular, and more by atrophic scars 2. Incidence and growth of macular atrophy are strongly dependent on CNV activity and resulting anti-VEGF therapy 2. CNV activity and the need for retreatment are mostly defined by the presence of macular fluid, i.e. intra-retinal fluid (IRF), sub-retinal fluid (SRF), and, less prominently, sub-pigment epithelium fluid 3. While many studies have shown a robust association of IRF with worsening visual acuity and increasing rates of macular atrophy 4-6 , subretinal fluid presence has paradoxically been shown to correlate with better visual acuity as compared to a completely dry macula, especially if located sub-foveally 7,8. The reasons for the documented beneficial effects of sub-retinal fluid on visual acuity are largely unclear. The most common hypothesis concludes that SRF presence reduces the risk of vision-threatening macular atrophy 9. Therefore, new modified treat & extend regimen tolerating SRF are currently being investigated 10. However,

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“…36 Given that the retinal sensitivity may be a useful parameter for assessing the functional status of the retina in AMD, 37 1 might predict that MP may be able to detect decreased retinal sensitivity in areas that would develop subretinal fluid and/or intraretinal fluid, and subsequent visual acuity reductions. Wightman et al 38 reported that MP could detect localized loss of retinal sensitivities in regions with fluid without any apparent change in the best-corrected visual acuity (BCVA) or the Amsler grid findings. This would then highlight the possibility of MP in detecting these early subtle functional alterations before the development of the exudations (Fig.…”

Section: Neovascular Amdmentioning

confidence: 99%

Microperimetry in Retinal Diseases

Horie

Corradetti

Esmaeilkhanian

et al. 2023

Asia-Pacific Journal of Ophthalmology

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Retinal microperimetry (MP) is a procedure that assesses the retinal sensitivity while the fundus is directly observed, and an eye tracker system is active to compensate for involuntary eye movements during testing. With this system, the sensitivity of a small locus can be accurately determined, and it has become an established ophthalmic test for retinal specialists. Macular diseases are characterized by chorioretinal changes; therefore, the condition of the retina and choroid requires careful and detailed evaluations to perform effective therapy. Age-related macular degeneration is a representative retinal disease in which the macular function has been evaluated by the visual acuity throughout the course of the disease process. However, the visual acuity represents the physiological function of only the central fovea, and the function of the surrounding macular area has not been sufficiently evaluated throughout the different stages of the macula disease process. The new technique of MP can compensate for such limitations by being able to test the same sites of the macular area repeatedly. This is especially useful in the recent management of age-related macular degeneration or diabetic macular edema during anti-vascular endothelial growth factor treatments because MP can assess the effectiveness of the treatment. MP examinations are also valuable in diagnosing Stargardt disease as they can detect visual impairments before any abnormalities are found in the retinal images. The visual function needs to be carefully assessed along with morphologic observations by optical coherence tomography. In addition, the assessment of retinal sensitivity is useful in the presurgical or postsurgical evaluations.

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Presymptomatic Retinal Sensitivity Changes in Intermediate Age-Related Macular Degeneration Associated With New Retinal Fluid

Cited by 8 publications

References 57 publications

Using Microperimetry and Low-Luminance Visual Acuity to Detect the Onset of Late Age-Related Macular Degeneration

Using Microperimetry and Low-Luminance Visual Acuity to Detect the Onset of Late Age-Related Macular Degeneration

Impact of Sub-Retinal Fluid on the Long-Term Incidence of Macular Atrophy in Neovascular Age-related Macular Degeneration under Treat & Extend Anti-Vascular Endothelial Growth Factor Inhibitors

Microperimetry in Retinal Diseases

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