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Influence of OCT biomarkers on microperimetry intra- and interdevice repeatability in diabetic macular edema
Heiko Stino1, Klaudia Birner1,2, Laetitia Hinterhuber1
1Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.
Abstract:
To evaluate the intra- and interdevice repeatability of microperimetry (MP) assessments in patients with diabetic macular edema (DME) two consecutive MP testings (45 fovea-centered stimuli, 4-2 staircase strategy) were performed using MP3 (NIDEK, Aichi, Japan) and MAIA (CenterVue, Padova, Italy), respectively. Intraretinal fluid (IRF) and ellipsoid zone (EZ) thickness were automatically segmented by published deep learning algorithms. Hard exudates (HEs) were annotated semi-automatically and disorganization of retinal inner layers (DRIL) was segmented manually. Point-to-point registration of MP stimuli to corresponding spectral-domain OCT (Spectralis, Heidelberg Engineering, Germany) locations was performed for both devices. Repeatability was assessed overall and in areas of disease-specific OCT biomarkers using Bland-Altmann coefficients of repeatability (CoR). A total of 3600 microperimetry stimuli were tested in 20 eyes with DME. Global CoR was high using both devices (MP3: ± 6.55 dB, MAIA: ± 7.69 dB). Higher retest variances were observed in stimuli with IRF (MP3: CoR ± 7.4 dB vs. ± 6.0 dB, p = 0.001, MAIA: CoR ± 9.2dB vs. ± 6.8 dB, p = 0.002) and DRIL on MP3 (CoR ± 6.9 dB vs. ± 3.2 dB, p < 0.001) compared to stimuli without. Repeatabilities were reduced in areas with thinner EZ layers (both p < 0.05). Fixation (Fuji classification) was relatively unstable independent of device and run. These findings emphasize taking higher caution using MP in patients with DME.
Insights
Microperimetry (MP) assessments in diabetic macular edema (DME) show high repeatability overall but reduced accuracy in diseased retinal areas. Caution is advised when using MP for DME patients due to variability linked to intraretinal fluid and retinal layer disruption.
Area of Science:
- Ophthalmology
- Medical Imaging
- Retinal Diseases
Background:
- Diabetic macular edema (DME) is a leading cause of vision loss.
- Microperimetry (MP) is crucial for assessing visual function in DME.
- Evaluating the repeatability of MP devices is essential for reliable clinical use.
Purpose of the Study:
- To assess the intra- and interdevice repeatability of MP assessments in patients with DME.
- To compare the performance of MP3 and MAIA devices in DME.
- To investigate the impact of retinal biomarkers on MP repeatability.
Main Methods:
- Two consecutive MP tests were performed using MP3 and MAIA devices.
- Retinal biomarkers (IRF, EZ, HEs, DRIL) were segmented using deep learning and manual methods.
- Point-to-point registration of MP stimuli to OCT locations was performed.
- Repeatability was evaluated using Bland-Altmann coefficients of repeatability (CoR).
Main Results:
- High global CoR was observed for both MP3 (± 6.55 dB) and MAIA (± 7.69 dB).
- Repeatability was significantly reduced in areas with intraretinal fluid (IRF) and disorganization of retinal inner layers (DRIL).
- Thinner ellipsoid zone (EZ) layers also correlated with reduced repeatability.
- Fixation stability was generally poor, irrespective of the device.
Conclusions:
- Microperimetry demonstrates high overall repeatability but is less reliable in areas of DME-related retinal changes.
- The presence of IRF, DRIL, and thinner EZ layers significantly impacts MP test-retest variability.
- Clinicians should exercise caution when interpreting MP results in DME patients, considering fixation stability and localized retinal pathology.
