Abstract
With the arrival of effective treatments for neovascular age-related macular degeneration (nvAMD) there is a need to find improved tests that would allow early detection. Ideally, these tests would allow monitoring of vision by patients themselves from home. The aim of this review is to discuss the available evidence for two recently developed vision tests designed for this purpose: the Preferential Hyperacuity Perimeter (PHP) test and the Radial Shape Discrimination (RSD) test. Articles that investigated detection of nvAMD were reviewed. The methodology of the clinical evidence, where available, was judged for bias and applicability of the results to the general population using the QUADAS-2 quality assessment tool. The PHP test has proved to be good at detecting nvAMD but many studies assessed in this review were biased in the selection of patients, restricting the results to only those patients who can use the test and produce reliable results. On the other hand the RSD test is a simple test, well accepted by elderly patients with AMD. However, clinical studies to determine its value in the detection of early signs of nvAMD are still required. To date, more studies have investigated the utility of the PHP test compared with the RSD test for detection of nvAMD. Both tests show promise but further evidence is needed to determine the real generalisability of the PHP test and the sensitivity of the RSD test.
Highlights
Neovascular age-related macular degeneration and geographic atrophy (GA) are responsible for the majority of cases of blindness and visual impairment in developed countries.[1,2] Currently, the number of peopleLandmark clinical trials have demonstrated that ranibizumab (Lucentis),[4,5] bevacizumab (Avastin)[6,7] and aflibercept (Eylea)[8] are effective treatments for nvAMD
Over the last 70 years visual distortions caused by nvAMD have mainly been assessed using the Amsler grid (AG);[12] there is a concern about the real utility of this test.[13]
The group that was monitored with the Preferential Hyperacuity Perimeter (PHP) under clinical supervision had better visual acuity (VA; 9.7 letters, 95% CI 0.41–19.0, p = 0.04), better contrast sensitivity (CS; 7.2 letters, 95% CI 1.6–12.8, p = 0.15) and a smaller lesion area ( p = 0.023) at conversion to nvAMD32 (Table 1)
Summary
Neovascular age-related macular degeneration (nvAMD) and geographic atrophy (GA) are responsible for the majority of cases of blindness and visual impairment in developed countries.[1,2] Currently, the number of people. Over the last 70 years visual distortions caused by nvAMD have mainly been assessed using the Amsler grid (AG);[12] there is a concern about the real utility of this test.[13] Alternative tests for the detection of distortion and scotomas have been summarised in recent reviews,[13,14] and include M-charts, the Macular Mapping Test, the Scanning Laser Entoptic Perimeter, the Preferential Hyperacuity Perimeter and the Radial Shape Discrimination test. The aim of this review is to discuss the latter two tests: the Preferential Hyperacuity Perimeter (PHP) and the Radial Shape Discrimination test (RSD) For this purpose, an initial literature search was performed in Web of Science with the following key words: radial shape discrimination, shape discrimination hyperacuity, preferential hyperacuity perimeter, and age-related macular degeneration. The methodology was assessed using the QUADAS-2 quality assessment tool[15] and conference abstracts were only included if of high relevance and the full articles could not be obtained
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