Scotopic and Photopic Microperimetry in Patients With Reticular Drusen and Age-Related Macular Degeneration

Abstract

IMPORTANCE Clinical observations suggest that patients with age-related macular degeneration (AMD) have vision problems, particularly in dim light conditions. Previous studies on structural-functional analysis in patients with AMD with reticular drusen (RDR) have focused on photopic sensitivity testing but have not specifically assessed scotopic function. OBJECTIVE To evaluate retinal function by scotopic and photopic microperimetry in patients with AMD and a well-demarcated area of RDR. DESIGN, SETTING, AND PARTICIPANTS Prospective case series in a referral center of 22 eyes from 18 patients (mean age, 74.7 years; range, 62-87 years). The study was conducted from June 1, 2014, to October 31, 2014. INTERVENTIONS With the use of combined confocal scanning laser ophthalmoscopy and spectral-domain optical coherence tomography imaging, retinal areas with RDR (category 1) and no visible pathologic alterations (category 2) were identified in each eye. Scotopic and photopic microperimetry (MP-1S; Nidek Technologies) was performed using a grid with 56 stimulus points. MAIN OUTCOMES AND MEASURES Comparison of mean threshold sensitivities for each category for scotopic and photopic microperimetry. RESULTS In all eyes, areas of category 1 showed a relative and sharply demarcated reduction of scotopic threshold values compared with areas of category 2, but only less-pronounced differences were seen for photopic testing. Statistical analysis in the 18 eyes in which the 1.0-log unit neutral density filter was applied revealed a difference of scotopic threshold values in areas of category 1 (mean, 13.5 dB [95% CI, 12.1-15.0]) vs category 2 (mean, 18.3 dB; [95% CI, 17.4-19.3] (P Յ .001). For photopic testing, the mean threshold values were 16.8 dB (95% CI, 15.5-18.2) in category 1 and 18.4 dB (95% CI, 17.1-19.6) in category 2 (P = .03). CONCLUSIONS AND RELEVANCE The results of this study suggest that rod function is more severely affected than cone function in retinal areas with RDR. This differential structural-functional correlation underscores the functional relevance of RDR in patients with AMD.

Test-Retest Reliability of Scotopic and Mesopic Fundus-Controlled Perimetry Using a Modified MAIA (Macular Integrity Assessment) in Normal Eyes

“…Later, it was demonstrated that scotopic sensitivity loss exceeded photopic sensitivity impairment in areas with increased levels of fundus autofluorescence [31] . Secondly, the no longer commercially available scanning laser ophthalmoscope (SLO 101, Rodenstock, Ottobrunn, Germany) has been used for scotopic FCP; however, only a single congress abstract has been available so far to the best of our knowledge [ While many reports on mesopic function with the MP-1 device are available, only a few reports have been published on scotopic FCP using the MP-1S [20,21,24,[32][33][34][35] . For example, we have recently shown that the presence of reticular drusen is spatially confined to outer retinal thinning and impairment of scotopic function [21] .…”

“…Another modified version of MP-1 has also been used for fundus-controlled two-color perimetry and dark adaptometry [36,37] . However, the dynamic range of the stimulus-presenting LCD display of the MP-1 (20 dB) is considered to be low and prone to ceiling and floor effects in both mesopic and scotopic examinations [20,32,33] . Moreover, the quality of the reference image (infrared fundus camera) has been reported to be low, making reliable detection of retinal pathologies and test pattern placement challenging [38] .…”

Subretinal Drusenoid Deposits and the Loss of Rod Function in Intermediate Age-Related Macular Degeneration

“…16,[19][20][21] In these studies, rod function was assessed after a period of dark-adaptation either with or without preceding photobleach. Given that there is increased interests in using a scotopic perimeter for monitoring AMD progression in clinical studies and drug trials it is important to determine which perimetric testing method is superior in detecting rod abnormality and functionally characterizing the disease phenotype in eyes with AMD.…”

MACUSTAR: Development and Clinical Validation of Functional, Structural, and Patient-Reported Endpoints in Intermediate Age-Related Macular Degeneration

“…In a recent, exploratory study of 20 patients with advanced AMD, they found scotopic microperimetry to be the best predictor of patient-reported difficulties under low light as measured by the Low Luminance Questionnaire (LLQ). In patients with iAMD, localized scotopic dysfunction is more pronounced compared to mesopic dysfunction in areas with reticular drusen, a risk factor for AMD progression [22]. Preparatory assessments showed that where early scotopic microperimeters had problems with testing accuracy, speed, and acceptability to patients, the scotopic MAIA (S-MAIA, Centervue, Italy) is easier to operate, with less operator-induced variability.…”