Microperimetry : understanding what went wrong or predicting therapeutic routes

Abstract

Abstract Purpose: To investigate macular sensitivity and fixation patterns with automatic fundus perimetry (microperimetry) in patients with early and late age‐related macular degeneration (ARMD). Methods: A hundred and twenty eyes of 101 consecutive patients with early ARMD or with subfoveal choroidal neovascularization (CNV) secondary to ARMD were evaluated. Best corrected visual acuity (ETDRS charts), fundus photography, and fluorescein angiography were performed. Microperimetry (MP1, Nidek Technologies, Padova, Italy) was used to quantify macular sensitivity and fixation patterns (location and stability). Results: Macular sensitivity was significantly decreased over large drusen and over pigment abnormalities (p<0.0001) and in patients with CNV when compared to normal age‐related values (p<0.0001). Fixation moved from central to eccentric and from stable to unstable in patients with active CNV, (p<0.001 and p<0.05) respectively. Angiographic classification of subfoveal CNV (occult versus classic) was not significantly related to fixation pattern (p>0.05). In cases that responded to treatment retinal sensitivity and fixation characteristics improved significantly, (p<0.05). Conclusions: Microperimetric quantification of macular sensitivity and fixation patterns in eyes with early and late ARMD offers new data about the impact of visual impairment in these eyes. In retinal areas affected by early ARMD retinal sensitivity deteriorates, despite good visual acuity. Microperimetry may allow early detection of functional impairment due to these lesions. Moreover, microperimetry may be of value in predicting the outcome of CNV when different treatments (laser, PDT, anti‐VEGF drugs, macular translocation and RPE transplants) are planned in current or future studies