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Metrics and Acquisition Modes for Fixation Stability as a Visual Function Biomarker.

Etienne M Schönbach1, Mohamed A Ibrahim1, Xiangrong Kong1,2

  • 1Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States.

Investigative Ophthalmology & Visual Science
|October 4, 2017
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Summary

Fixation stability measurements in Stargardt disease patients differ based on testing duration. Continuous metrics like BCEA during macular sensitivity tests are recommended for this visual function biomarker.

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Area of Science:

  • Ophthalmology
  • Genetics
  • Visual Neuroscience

Background:

  • ABCA4-related Stargardt disease is a leading genetic cause of inherited macular degeneration.
  • Accurate assessment of visual function is crucial for monitoring disease progression and evaluating treatment efficacy.
  • Fixation stability is an emerging biomarker for visual function in retinal diseases.

Purpose of the Study:

  • To compare different metrics and acquisition modes for measuring fixation stability.
  • To evaluate fixation stability as a visual function biomarker in a large cohort of patients with ABCA4-related Stargardt disease.
  • To analyze data from the multicenter prospective ProgStar study.

Main Methods:

  • Fundus-tracking microperimetry (Nidek MP-1) was used to assess fixation.
  • Fixation was tested both during a dedicated fixation exam and dynamically during a sensitivity exam.
  • Data were analyzed using bivariate contour ellipse area (BCEA), the 2/4 degree method, and Fujii classification.

Main Results:

  • Mean BCEA was significantly larger when measured during the sensitivity exam (12.5 deg2) compared to the fixation task (4.6 deg2).
  • Correlations between the two testing methods were generally weak.
  • Fixation stability during the sensitivity test showed a significant correlation with visual acuity.

Conclusions:

  • Measurement of fixation stability is influenced by the duration of the measurement period.
  • Continuous metrics, such as BCEA, obtained during macular sensitivity testing appear most appropriate for this functional biomarker.
  • These findings have implications for the standardized assessment of visual function in Stargardt disease.