Flicker sensitivity and fundus appearance in pre-exudative age-related maculopathy

To evaluate whether foveal flicker sensitivity and fundus appearance are good predictors of exudative age-related maculopathy (ARM) when the effects of aging, retinal illuminance, and criterion differences are controlled.

Fellow eyes of monocular exudative ARM patients were tested at baseline. Seven of these eyes have now developed exudative ARM. Therefore, at baseline they were in pre-exudative stages of ARM. The foveal flicker sensitivity and fundus appearance of the pre-exudative and nonconverted eyes were compared with healthy, age-matched eyes. The flicker stimulus was a uniform, 2.8 deg circular field at 660 nm, modulated sinusoidally at frequencies from 2.5 to 50 Hz. Fundus photographs were evaluated using the Wisconsin ARM grading system.

Flicker modulation sensitivity at two frequencies discriminated pre-exudative from healthy older eyes with 100% accuracy. Using the same criterion, pre-exudative eyes also were discriminated from nonconverted eyes with 100% accuracy. Whereas an overall fundus ARM risk score discriminated pre-exudative from healthy older eyes with 100% accuracy, it did not discriminate pre-exudative from nonconverted eyes at better than chance levels.

There were functional changes in the retina preceding development of exudative ARM. Foveal flicker sensitivity at low- to mid-temporal frequencies seemed highly sensitive to these pre-exudative changes in this relatively small group of subjects. The authors hypothesize that foveal flicker sensitivity is a good predictor of exudative ARM and a sensitive monitor of retinal function in pre-exudative ARM. These predictions are being tested on a larger, independent sample.