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Exploiting Microperimetry as a Functional End Point in Healthy Aging and Different Stages of Age-Related Macular
Johannes Schrittwieser1, Klaudia Birner1,2, Leonard M Coulibaly2
1Laboratory for Ophthalmic Image Analysis, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria.
Objective:
To compare functional parameters between healthy aged eyes and different stages of age-related macular degeneration (AMD) based on functional parameters in microperimetry (MP) in 2 commonly used MP devices.
Design:
A prospective, cross-sectional study.
Subjects:
From 80 eyes from 80 subjects, 14 400 stimuli points were included.
Methods:
Subjects classified as healthy, intermediate AMD, neovascular AMD (nAMD), or geographic atrophy (GA) secondary to AMD were imaged with Spectralis HRA+OCT (Heidelberg Engineering) and underwent 2 consecutive examinations each, using the MP-3 (NIDEK) under photopic conditions and the MAIA (Centervue) under mesopic conditions. Pointwise sensitivity (PWS), mean sensitivity, range between highest and lowest PWS, fixation stability, and examination duration were compared between all 4 groups in both devices. Group comparison was performed using linear mixed-effects models and a discriminant analysis to find the parameters that best discriminated the respective AMD stage.
Main Outcome Measures:
Pointwise sensitivity, range of the PWS, fixation metrics, and durations of the examinations.
Results:
The groups exhibited significant differences in PWS (P < 0.001) and mean sensitivity (P < 0.001), with healthy eyes showing the highest and late stages of AMD showing the lowest sensitivity values. In addition, GA showed significantly greater fixation stability compared with nAMD in the MP-3 at 2° and 4° (P = 0.014 and P = 0.008, respectively). The examination duration in healthy patients was significantly shorter compared with patients with GA (P = 0.041) in MP-3. No significant differences in fixation stability and duration between groups were observed with the MAIA device. The range between the highest and lowest PWS was the most effective parameter for discrimination, with a classification accuracy of 52.5% and 50.6% in the MP-3 and MAIA, respectively.
Conclusions:
Retinal sensitivity declines with disease progression in AMD in both mesopic and photopic background illumination. The lowest retinal sensitivity was observed in patients with GA. Background illumination should be considered when selecting an MP device for a clinical trial.
Financial Disclosures:
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
