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Microperimetry Reliability Assessed From Fixation Performance.

Amandeep Singh Josan1,2, Isabella Farrance1, Laura J Taylor1,2

  • 1Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, NIHR Oxford Biomedical Research Centre, Oxford, UK.

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Summary

Microperimetry reliability is linked to fixation performance, not just fixation losses. Bivariate contour ellipse area (BCEA95) is a better indicator of test accuracy for retinal sensitivity assessments.

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Area of Science:

  • Ophthalmology
  • Visual Neuroscience

Background:

  • Microperimetry assesses central retinal sensitivity using fundus tracking.
  • Current reliability indicators like fixation loss have limitations in distinguishing true tracking failures from other response sources.

Purpose of the Study:

  • To investigate the relationship between blind spot scotoma responses and fixation performance in microperimetry.
  • To determine if fixation performance metrics can serve as reliable indicators of microperimetry accuracy.

Main Methods:

  • Part 1: Mapped physiological blind spots using a custom grid and analyzed scotoma responses against bivariate contour ellipse areas (BCEA63 and BCEA95) in controls.
  • Part 2: Collected fixation data from controls and patients with retinal diseases (234 eyes).

Main Results:

  • A significant correlation was found between scotoma responses and BCEA95 in controls (P < 0.001).
  • Upper 95% confidence intervals for BCEA95 varied significantly across conditions: controls (3.7 deg2), choroideremia (27.6 deg2), rod-cone dystrophies (23.1 deg2), Stargardt disease (21.4 deg2), and AMD (111.3 deg2).
  • An overall upper limit BCEA95 was determined to be 29.6 deg2 across all pathology groups.

Conclusions:

  • Microperimetry reliability is strongly correlated with fixation performance, with BCEA95 serving as a surrogate marker for test accuracy.
  • Recommended reliability thresholds: BCEA95 > 4 deg2 for healthy individuals and BCEA95 > 30 deg2 for patients with retinal disease.
  • Fixation performance, summarized by BCEA95, is a more appropriate measure for assessing microperimetry reliability than fixation loss levels.