Microperimetry in age-related macular degeneration: association with macular morphology assessed by optical coherence tomography

Roh, Miin; Shin, Hyun Joon; Park, Dong Ho; Mach, Steven; Vavvas, Demetrios G.; Kim, Ivana K.; Miller, Joan W.; Husain, Deeba

doi:10.1136/bjophthalmol-2018-313316

Cited by 23 publications

(36 citation statements)

References 32 publications

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“…Other studies have also reported MAIA values from healthy eyes as control groups in their studies. 4,8,19,25,33 The mean MS reported ranges from 24.9 to 29.5 dB. It is important to note that direct comparing of MS values reported by different groups to our data is not appropriate as the test grids differ.…”

Section: Discussionmentioning

confidence: 71%

“…However, three studies used the same test grid across different age groups. 4,8,19 One study reported a mean (SD) MS of 29.2 (1.5) dB in 32 normal eyes with a mean (SD) age of 24.1 (3.1) years. Two other investigations conducted using the same test grid reported mean (SD) MS of 28.7 (1.7) and 27.1 (3.6) dB in participants aged 65.4 (6.6) and 71.7 (7.4) years, respectively, which supports our assumption of age-related decline in MAIA sensitivity.…”

Section: Discussionmentioning

confidence: 99%

“…2 Hence, MAIA microperimetry has been used for investigating and monitoring paracentral scotoma in retinal clinical trials [3][4][5] and in routine clinical care. [6][7][8] Currently, clinical interpretation of MAIA results relies on the manufacturer's analysis printout. The printout shows the measured retinal sensitivity at each test loci (pointwise sensitivity [PS]) as well as the mean sensitivity (MS) across all test loci.…”

Section: Introductionmentioning

confidence: 99%

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Interpreting MAIA Microperimetry Using Age- and Retinal Loci-Specific Reference Thresholds

Charng

Sanfilippo

Attia

et al. 2020

Trans. Vis. Sci. Tech.

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Macular Integrity Assessment (MAIA) microperimetry is used widely in clinical trials and routine practice to assess paracentral scotoma. Current interpretation of MAIA is based on an assumed uniform 25 decibel (dB) cutoff for normal function irrespective of subject age and retinal location. We examined this convention by establishing an ageand loci-specific reference in healthy eyes and comparing this to the <25 dB cutoff. Methods: Retrospective MAIA results from healthy eyes were analyzed for prevalence of loci with <25 dB. At each locus, a new reference cutoff was derived from quantile regression of sensitivity against age at the 2.5th percentile. Two clinical cases of serial MAIA testing were analyzed using the new approach and compared to the <25 dB cutoff. Results: Fifty-four and 56 age-matched (range: 16-75 years) healthy eyes underwent small (37 loci) and large (68 loci) grid testing, respectively. Retinal sensitivity <25 dB was found in 5% of the small grid (1998 data points) and 10% of the large grid (3808 data points). These were found predominantly in older subjects and at the central point or in the perifoveal region. Quantile regression at each individual locus showed age-related decline with a median gradient of 0.6 dB/decade. Conclusions: We caution against using <25 dB cutoff in MAIA interpretation and advocate an age-and loci-specific cutoff criterion. Translational Relevance: Our study suggests that MAIA interpretation is influenced by the criterion used for defining abnormal pointwise measurement.

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Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Interpreting MAIA Microperimetry Using Age- and Retinal Loci-Specific Reference Thresholds

Charng

Sanfilippo

Attia

et al. 2020

Trans. Vis. Sci. Tech.

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“…In this respect, SRF might be interpreted more as a biomarker of efficient disease management preventing IRF and bleeding, and less as a by itself protective factor. On the contrary, the sole appreciation of visual acuity might represent an only partial view on visual function; several studies have recently shown that sub-retinal fluid significantly reduces retinal sensitivity, which might impair visual performance especially under low-luminance 34,35 .…”

Section: Discussionmentioning

confidence: 99%

Impact of Sub-Retinal Fluid on the Long-Term Incidence of Macular Atrophy in Neovascular Age-related Macular Degeneration under Treat & Extend Anti-Vascular Endothelial Growth Factor Inhibitors

Fischer

Schworm

Kreutzer

et al. 2020

Sci Rep

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Sub-retinal fluid (SRF) has been discussed as a protective factor against macular atrophy in eyes with neovascular age-related macular degeneration (nAMD).To gauge the impact of SRF on macular atrophy, a database of 310 nAMD eyes was screened for eyes manifesting an SRF-only phenotype under treat & extend anti-VEGF treatment, defined as nAMD expressing CNV exudation beyond the three monthly anti-VEGF loading doses by SRF only without any signs of exudative intra-retinal fluid (IRF) for ≥3 years. incidence of macular atrophy and treatment responses were evaluated on multimodal imaging, including optical coherence tomography (OCT), blue autofluorescence (BAF) and near-infrared (NIR) confocal scanning laser ophthalmoscopy and fluorescence and indocyanine green angiography (FAG/ ICGA). In total, 27 eyes (8.7%) of 26 patients with a mean follow-up of 4.2 ± 0.9 (3-5) years met the inclusion criteria. Mean age was 72 ± 6 (range: 61-86) years. The SRF only phenotype was seen from baseline in 14 eyes (52%), and in 13 eyes (48%) after a mean 1.0 ± 1.3 (1-3) injections. In years 1 to 5, mean 7.5, 5.9, 6.1, 6.1 and 7.0 anti-VEGF injections were given (p = 0.33). Cumulative macular atrophy incidence was 11.5% at year 1, 15.4% throughout years 2 to 4, and 22.4% at year 5. In conclusion, eyes manifesting activity by SRf only in treat & extend anti-VeGf regimen for nAMD seem to exhibit rather low rates of macular atrophy during long-term follow-up. SRf might be an indicator of a more benign form of nAMD. The introduction of anti-vascular endothelial growth factor (VEGF) therapy in neovascular age-related macular degeneration (nAMD) has improved visual acuity and quality of life for millions of patients worldwide 1. In the era of anti-VEGF, the long-term maintenance of visual acuity is now challenged less by fibrovascular, and more by atrophic scars 2. Incidence and growth of macular atrophy are strongly dependent on CNV activity and resulting anti-VEGF therapy 2. CNV activity and the need for retreatment are mostly defined by the presence of macular fluid, i.e. intra-retinal fluid (IRF), sub-retinal fluid (SRF), and, less prominently, sub-pigment epithelium fluid 3. While many studies have shown a robust association of IRF with worsening visual acuity and increasing rates of macular atrophy 4-6 , subretinal fluid presence has paradoxically been shown to correlate with better visual acuity as compared to a completely dry macula, especially if located sub-foveally 7,8. The reasons for the documented beneficial effects of sub-retinal fluid on visual acuity are largely unclear. The most common hypothesis concludes that SRF presence reduces the risk of vision-threatening macular atrophy 9. Therefore, new modified treat & extend regimen tolerating SRF are currently being investigated 10. However,

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“…The MAIA ( Ma cular I ntegrity A ssessment; CenterVue, Padova, Italy) device is a commercially available confocal scanning laser ophthalmoscope-based microperimeter that has demonstrated robust reliability, 9 intersession agreement, 9 and coefficient of repeatability. 10 The MAIA has been widely used in routine clinical care 11 – 13 as well as in monitoring retinal function in clinical trials. 14 – 16 More recently, the MAIA device has been used to demonstrate spatial correlation between decreased retinal sensitivity and the doughnut region bound by the double hyperautofluorescent rings 17 and the perifoveal region of reduced deep capillary plexus vessel density on optical coherence tomography angiography 18 in USH2A retinopathy.…”

Section: Introductionmentioning

confidence: 99%

Edge of Scotoma Sensitivity as a Microperimetry Clinical Trial End Point in USH2A Retinopathy

Charng

Lamey

Thompson

et al. 2020

Trans. Vis. Sci. Tech.

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Purpose Microperimetry is commonly used to assess retinal function. We perform cross-sectional and longitudinal analysis on microperimetry parameters in USH2A retinopathy and explore end points suitable for future clinical trials. Methods Microperimetry was performed using two grids, Grid 1 (18° diameter) and Grid 2 (6° diameter). In Grid 1, four parameters (number of nonscotomatous loci, mean sensitivity [MS], responding point sensitivity [RPS], and edge of scotoma sensitivity [ESS]) were analyzed. In Grid 2, number of nonscotomatous loci and MS were examined. Interocular symmetry was also examined. Longitudinal analysis was conducted in a subset of eyes. Results Microperimetry could be performed in 16 of 21 patients. In Grid 1 ( n = 15; average age, 35.6 years), average number of nonscotomatous loci, MS, RPS, and ESS were 46.6 loci, 10.0 dB, 14.7 and 9.6 dB, respectively. In Grid 2 ( n = 13; average age, 37.4 years), 12 eyes had measurable sensitivity across the entire grid. Average MS was 23.8 dB. Interocular analysis revealed large 95% confidence intervals for all parameters. Longitudinally, Grid 1 ( n = 12, average follow-up 2.6 years) ESS showed the fastest rate of decline (–1.84 dB/y) compared with MS (–0.34 dB/y) and RPS (–0.90 dB/y). Conclusions Our data suggest that ESS may be more useful than MS and RPS in test grids that cover a large extent of the macula. We caution the use of contralateral eye as an internal control. Translational Relevance ESS may decrease the duration or sample size of treatment trials in USH2A retinopathy.

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Microperimetry in age-related macular degeneration: association with macular morphology assessed by optical coherence tomography

Cited by 23 publications

References 32 publications

Interpreting MAIA Microperimetry Using Age- and Retinal Loci-Specific Reference Thresholds

Interpreting MAIA Microperimetry Using Age- and Retinal Loci-Specific Reference Thresholds

Impact of Sub-Retinal Fluid on the Long-Term Incidence of Macular Atrophy in Neovascular Age-related Macular Degeneration under Treat & Extend Anti-Vascular Endothelial Growth Factor Inhibitors

Edge of Scotoma Sensitivity as a Microperimetry Clinical Trial End Point in USH2A Retinopathy

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