Scanning Laser Ophthalmoscope Imaging Stabilized Microperimetry in Dry Age-Related Macular Degeneration

PURPOSE. To quantify and compare the structural and functional changes in subjects with early age-related macular degeneration (AMD), using spectral-domain optical coherence tomography (SD-OCT) and microperimetry.METHODS. Twenty-one eyes of 21 subjects with early AMD were examined. MP-1 10-2 visual fields (VFs) and SD-OCT line and detail volume scans were acquired. The thicknesses of the outer segment (OS; distance between inner segment ellipsoid band and upper retinal pigment epithelium [RPE] border) and RPE layers and elevation of the RPE from Bruch's membrane were measured using a computer-aided manual segmentation technique. Thickness values were compared with those for 15 controls, and values at locations with VF total deviation defects were compared with values at nondefect locations at equivalent eccentricities. RESULTS.Sixteen of 21 eyes with AMD had VF defects. Compared with controls, line scans showed significant thinning of the OS layer (P ¼ 0.006) and thickening and elevation of the RPE (P ¼ 0.037, P ¼ 0.002). The OS layer was significantly thinner in locations with VF defects compared with locations without defects (P ¼ 0.003). There was a negligible difference between the retinal layer thickness values of the 5 eyes without VF defects and the values of normal controls.CONCLUSIONS. In early AMD, when VF defects were present, there was significant thinning of the OS layer and thickening and elevation of the RPE. OS layer thinning was significantly associated with decreased visual sensitivity, consistent with known photoreceptor loss in early AMD. For AMD subjects without VF defects, thickness values were normal. The results highlight the clinical utility of both SD-OCT retinal layer quantification and VF testing in early AMD. (Invest Ophthalmol Vis Sci. 2012;53:7618-7624) DOI:10.1167/iovs.12-10361 A ge-related macular degeneration (AMD) is the third leading cause of blindness worldwide, accounting for 8.7% of blindness in the global population.1 Due to the increase in the average lifespan of the elderly population, it is expected that 17.8 million individuals in the United States will be affected by 2050.2 In view of the relevance of AMD as a public health issue, it is important to understand the changes that occur in the early stages of disease, which may lead to improved future intervention strategies.There has been recent interest in the use of fundus perimetry, also known as microperimetry, as an outcome measure in clinical trials of macular disease.3-7 Functional loss due to AMD was previously demonstrated by findings of reduced visual field sensitivity in retinal locations with drusen compared with nondrusen locations, using scanning laser ophthalmoscope (SLO) perimetry and microperimetry. [8][9][10][11] In contrast, other studies reported no difference in sensitivity between drusen and nondrusen areas. 12Optical coherence tomography (OCT) is a noninvasive imaging technique that provides cross-sectional images of retinal layer structure, useful for visualization of pathology. Spectral-domain O...

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“…[8][9][10][11] In contrast, other studies reported no difference in sensitivity between drusen and nondrusen areas.…”

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confidence: 41%

Relationship between Retinal Layer Thickness and the Visual Field in Early Age-Related Macular Degeneration

Acton

Rjh

Hood

et al. 2012

Invest. Ophthalmol. Vis. Sci.

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“…Previous studies of microperimetry in AMD have included patients with dry AMD, 13,14 and patients with nvAMD that have been treated with verteporfin photodynamic therapy, 9 autologous RPE-choroid graft, 15 360 degree macular translocation, 16 systemic bevacizumab, 17 intravitreal bevacizumab, 8 and intravitreal ranibuzumab. [18][19][20] Bolz et al 18 conducted a prospective study to evaluate the functional and morphological effects of three loading doses of intravitreal ranibizumab in 29 patients (29 eyes) with previously untreated nvAMD.…”

Section: Discussionmentioning

confidence: 99%

Microperimetric changes in neovascular age-related macular degeneration treated with ranibizumab

Alexander

Mushtaq

Osmond

et al. 2012

Eye

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Purpose To assess the value of microperimetry in eyes with neovascular age-related macular degeneration previously treated with ranibizumab and now in the maintenance phase of therapy. Methods A total of 21 eyes (14 patients) were included. Microperimetry was performed using the Macular Integrity Assessment Device on at least three occasions for each eye. Intravitreal ranibizumab was administered if visual acuity (VA) or optical coherence tomography (OCT) showed signs of active disease. Results Five eyes showed no change in VA or OCT findings, and required no intravitreal injections. In these eyes, mean threshold sensitivity (TS) decreased by 13% (paired t-test, P ¼ 0.05) during the study period, but fixation stability (FS) was unchanged. In all, 16 eyes showed signs of disease activity, and therefore required ranibizumab injections during the study. In these eyes, VA, central retinal thickness (CRT), FS, and TS remained unchanged during follow-up. Peak TS was noted when CRT was 210 lm; above or below 210 lm, there was a gradual reduction in TS. Conclusion This study has provided novel information on the relationship between macular sensitivity, CRT, and VA in the maintenance phase of ranibizumab therapy. Patients with stable VA and CRT may still have deteriorating retinal sensitivity. This is usually a late manifestation and may indicate subclinical CNV activity.

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“…First, the inner 3,4 , outer 5 and total 6 retinal thicknesses change. Second, drusen (extracellular deposits) occur between the retinal pigment epithelium (RPE) and Bruch's membrane 7,8 . As such, both drusen volumes and thicknesses of various retinal layers are of interest as potential biomarkers for disease monitoring and diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Loosely coupled level sets for retinal layers and drusen segmentation in subjects with dry age-related macular degeneration

et al. 2016

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Important noteTo cite this publication, please use the final published version (if applicable). Please check the document version above. CopyrightOther than for strictly personal use, it is not permitted to download, forward or distribute the text or part of it, without the consent of the author(s) and/or copyright holder(s), unless the work is under an open content license such as Creative Commons. Takedown policyPlease contact us and provide details if you believe this document breaches copyrights. We will remove access to the work immediately and investigate your claim. ABSTRACTOptical coherence tomography (OCT) is used to produce high-resolution three-dimensional images of the retina, which permit the investigation of retinal irregularities. In dry age-related macular degeneration (AMD), a chronic eye disease that causes central vision loss, disruptions such as drusen and changes in retinal layer thicknesses occur which could be used as biomarkers for disease monitoring and diagnosis. Due to the topology disrupting pathology, existing segmentation methods often fail. Here, we present a solution for the segmentation of retinal layers in dry AMD subjects by extending our previously presented loosely coupled level sets framework which operates on attenuation coefficients. In eyes affected by AMD, Bruch's membrane becomes visible only below the drusen and our segmentation framework is adapted to delineate such a partially discernible interface. Furthermore, the initialization stage, which tentatively segments five interfaces, is modified to accommodate the appearance of drusen. This stage is based on Dijkstra's algorithm and combines prior knowledge on the shape of the interface, gradient and attenuation coefficient in the newly proposed cost function. This prior knowledge is incorporated by varying the weights for horizontal, diagonal and vertical edges. Finally, quantitative evaluation of the accuracy shows a good agreement between manual and automated segmentation.

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Scanning Laser Ophthalmoscope Imaging Stabilized Microperimetry in Dry Age-Related Macular Degeneration

Abstract: Scanning laser ophthalmoscope microperimetry is able to detect changes in retinal sensitivity in AMD patients overlying drusen and at the margin of GA. It is a useful device to grade focal retinal sensitivity in patients with dry age-related macular degeneration.

Cited by 77 publications

References 30 publications

Relationship between Retinal Layer Thickness and the Visual Field in Early Age-Related Macular Degeneration

Relationship between Retinal Layer Thickness and the Visual Field in Early Age-Related Macular Degeneration

Microperimetric changes in neovascular age-related macular degeneration treated with ranibizumab

Loosely coupled level sets for retinal layers and drusen segmentation in subjects with dry age-related macular degeneration

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