Microperimetry In Patients Research Articles

Long-term longitudinal modifications in mesopic microperimetry in early and intermediate age-related macular degeneration.

To evaluate functional changes (retinal sensitivity and fixation characteristics) determined by microperimetry in patients with early and intermediate AMD over 6years. Prospective, longitudinal follow-up (FU) study of 16 patients (29 eyes) with early and intermediate AMD (AREDS 2 and AREDS 3 classification). All eyes underwent: complete ophthalmic examination with best corrected visual acuity (BCVA) determination, color fundus photo (CFP), optical coherence tomography and microperimetry. All CFP were evaluated by two retinal specialists masked to functional data for changes in severity of clinical features over the course of FU. Of 17 eyes graded as AREDS 2 at baseline, 14 (82.35%) remained stable, and 3 (18.75%) progressed to AREDS 3. Of 12 eyes graded as AREDS 3 at baseline, 10 remained stable (83.33%), and 2 (16.67%) progressed to AREDS 4. Mean BCVA significantly deteriorated in both AREDS 2 (p = 0.006) and AREDS 3 (p = 0.016), with greater decrease in AREDS 3 (p = 0.01)6. Mean retinal sensitivity (RS) significantly decreased over time in both AREDS 2 (p < 0.0001) and AREDS 3 group (p = 0.002), with greater decrease in AREDS 3 (p = 0.006). The mean number of dense scotomas did not change in AREDS 2 (p = 0.3), but significantly increased in the AREDS 3 group (p = 0.035). Points with decreased RS were located in all but the central point (p < 0.0001 for all), without significant differences in number among rings. In the AREDS 2 group, fixation stability remained unchanged. In the AREDS 3 group, four eyes deteriorated from stable to unstable fixation at FU (p = 0.045). A significant deterioration in RS is reported in early and intermediate AMD eyes, whereas fixation stability changed only in intermediate AMD (AREDS 3) over long-term follow-up. Microperimetry examination can become a new functional biomarker in early and intermediate AMD patients.

Chronic Recurrent Vogt–Koyanagi–Harada Disease and Development of ‘Sunset Glow Fundus’ Predict Worse Retinal Sensitivity

ABSTRACTPurpose: To investigate prognostic factors for retinal sensitivity assessed by microperimetry in patients with Vogt–Koyanagi–Harada (VKH) disease.Methods: In total, 34 patients with initial-onset acute disease and 19 patients with chronic recurrent disease were retrospectively evaluated.Results: The mean follow-up period was 40.4 ± 40.5 months. Sensitivity was significantly worse in eyes with more severe anterior segment inflammation at presentation, as indicated by the presence of mutton-fat keratic precipitates, anterior chamber reaction ≥2+, and posterior synechiae. Chronic recurrent presentation, development of complications, and ‘sunset glow fundus’ were significantly associated with worse sensitivity. Using logistic regression analysis, better sensitivity was significantly associated with initial-onset acute presentation (odds ratio, OR = 6.9; 95% confidence interval, CI = 1.53–9.66).Conclusions: Chronic recurrent presentation and development of complications and ‘sunset glow fundus’ are associated with a worse sensitivity outcome.

Microperimetric Assessment after Epiretinal Membrane Surgery: 4-Year Follow-Up.

Purpose. To investigate retinal function using microperimetry in patients affected by idiopathic epiretinal membrane (iERM) and cataract who underwent combined surgery: 4-year follow-up. Design. Prospective, interventional case series. Methods. 30 eyes of 30 consecutive patients with iERM and age-related cataract underwent 25-gauge vitrectomy and cataract surgery. At baseline, 90 and 180 days, and 1 and 4 years, we examined retinal mean sensitivity (MS), retinal mean defect (MD), fixation stability, and frequency of microscotomas using MP1 microperimetry. Best-corrected visual acuity (BCVA) and central retinal thickness (CRT) using a spectral domain optical coherence tomography (SD-OCT) were also performed. Results. All patients completed 1-year follow-up, while 23 patients reached last follow-up. Baseline MS and MD (10.48 ± 4.17 and −9.18 ± 4.40 dB) significantly changed at one year (12.33 ± 3.66 and −7.49 ± 3.31 dB, p < 0.01), at four years (14.18 ± 3.46 and −4.66 ± 2.85, p < 0.01), and between one and four years (p < 0.01) after surgery. Compared to baseline, CRT and BCVA significantly changed at one year and remained stable at four years. No variations were observed in fixation stability and frequency of microscotomas compared to baseline. Conclusions. Long-term follow-up using microperimetry seems useful to evaluate patients after iERM surgery: retinal sensitivity changes even when BCVA and CRT remain stable.

Scotopic and Photopic Microperimetry in Patients With Reticular Drusen and Age-Related Macular Degeneration.

Clinical observations suggest that patients with age-related macular degeneration (AMD) have vision problems, particularly in dim light conditions. Previous studies on structural-functional analysis in patients with AMD with reticular drusen (RDR) have focused on photopic sensitivity testing but have not specifically assessed scotopic function. To evaluate retinal function by scotopic and photopic microperimetry in patients with AMD and a well-demarcated area of RDR. Prospective case series in a referral center of 22 eyes from 18 patients (mean age, 74.7 years; range, 62-87 years). The study was conducted from June 1, 2014, to October 31, 2014. With the use of combined confocal scanning laser ophthalmoscopy and spectral-domain optical coherence tomography imaging, retinal areas with RDR (category 1) and no visible pathologic alterations (category 2) were identified in each eye. Scotopic and photopic microperimetry (MP-1S; Nidek Technologies) was performed using a grid with 56 stimulus points. Comparison of mean threshold sensitivities for each category for scotopic and photopic microperimetry. In all eyes, areas of category 1 showed a relative and sharply demarcated reduction of scotopic threshold values compared with areas of category 2, but only less-pronounced differences were seen for photopic testing. Statistical analysis in the 18 eyes in which the 1.0-log unit neutral density filter was applied revealed a difference of scotopic threshold values in areas of category 1 (mean, 13.5 dB [95% CI, 12.1-15.0]) vs category 2 (mean, 18.3 dB; [95% CI, 17.4-19.3] (P ≤ .001). For photopic testing, the mean threshold values were 16.8 dB (95% CI, 15.5-18.2) in category 1 and 18.4 dB (95% CI, 17.1-19.6) in category 2 (P = .03). The results of this study suggest that rod function is more severely affected than cone function in retinal areas with RDR. This differential structural-functional correlation underscores the functional relevance of RDR in patients with AMD.

Decreased Perifoveal Sensitivity Detected by Microperimetry in Patients Using Hydroxychloroquine and without Visual Field and Fundoscopic Anomalies.

Purpose. To evaluate the usefulness of microperimetry in the early detection of the ocular anomalies associated with the use of hydroxychloroquine. Methods. Prospective comparative case series study comprising 14 healthy eyes of 7 patients (group A) and 14 eyes of 7 patients under treatment with hydroxychloroquine for the treatment of rheumatologic diseases and without fundoscopic or perimetric anomalies (group B). A comprehensive ophthalmological examination including microperimetry (MP) and spectral-domain optical coherence tomography was performed in both groups. Results. No significant differences were found in mean MP foveal sensitivity between groups (P = 0.18). However, mean MP overall sensitivity was significantly higher in group A (29.05 ± 0.57 dB versus group B, 26.05 ± 2.75 dB; P < 0.001). Significantly higher sensitivity values were obtained in group A in comparison to group B for the three eccentric loci evaluated (P < 0.001). Conclusion. Microperimetry seems to be a useful tool for the early detection of retinal damage in patients treated with hydroxychloroquine.

A systematic correlation of morphology and function using spectral domain optical coherence tomography and microperimetry in patients with geographic atrophy

AimsThis study has been designed to describe the functional impact of distinct pathologies within the retinal layers in patients with geographic atrophy (GA) by means of a point-to-point correlation between...

Microperimetric sensitivity in patients on hydroxychloroquine (Plaquenil) therapy

The purpose of this study was to measure macular sensitivity using microperimetry in patients on Plaquenil therapy without evidence of retinopathy as assessed by recommended screening standards. Sixteen patients from a clinical practice treated with 200 or 400 mg/day of Plaquenil for more than 5 years, without visual complaints (visual acuity 20/25 or better), and without a history of diabetes or macular disease were included. Participants underwent a complete ophthalmic examination with spectral-domain optical coherence tomography (SD-OCT), 10-2 Humphrey visual field (HVF), fundus autofluoresecene (FAF), multifocal electroretinography (mfERG), and microperimetry that covered the central 12° of the visual field. Ten age-similar, visually normal subjects served as controls. The average age of the study cohort was of 54.5 years, with an average daily Plaquenil dose of 4.00 mg/kg/day (range, 1.77-6.67 mg/kg/day) and an average cumulative dose of 1485 g (range, 256-3650 g). All patients had normal ocular exams, and no evidence of retinopathy based on 10-2 HVF, FAF, mfERG, and SD-OCT. The mean retinal sensitivity by microperimetry was 15.0 dB (OD) and 14.6 dB (OS). The overall mean microperimetry sensitivity of the patients (14.7±1.9 dB) was significantly lower (P<0.001) than that of the controls (16.5±2.1 dB). Patients on Plaquenil without clinical evidence of retinal toxicity can have reduced retinal sensitivity, as assessed by microperimetry. The mean sensitivity difference between the patients and controls suggests that microperimetry can provide important information regarding visual function in patients on Plaquenil therapy.

Relationship between vision-related quality of life and microperimetry-determined macular sensitivity in patients with retinitis pigmentosa

The aim of our study was to determine the relationship between vision-related quality of life (VRQOL) following the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25) and the macular sensitivity determined by microperimetry in patients with retinitis pigmentosa (RP). The Japanese version of the NEI VFQ-25 was used to assess the VRQOL of 30 patients with typical RP whose decimal visual acuity was ≥0.6. The mean retinal sensitivity within the central 10° was determined by fundus-related microperimetry (MP1). The correlation between the mean of the total composite NEI VFQ-25 score and MP1-determined macular sensitivity was determined. Mean NEI VFQ-25 score was 69.4 ± 14.5 (range 34.6-90.3) in RP patients. There was a significant positive correlation between mean NEI VFQ-25 score and mean retinal sensitivity within 10° (r = 0.673, P = 0.0003). The significant correlation between macular sensitivity and VRQOL measured with the NEI VFQ-25 indicates that sensitivity in the macular area is an important consideration in using VRQOL with RP patients.

The influence of cortical, nuclear, subcortical posterior, and mixed cataract on the results of microperimetry

Microperimetry is a useful instrument for evaluating sensitivity threshold due to retinal pathologies. The aim of the study is to assess the impact of different forms of cataract on microperimetry results. In a prospective design, patients were recruited for cataract surgery at the Department of Ophthalmology, Medical University of Vienna. Exclusion criteria were any other ophthalmic disease except cataract, that is, macular pathology. Using the Lens Opacities Classification System III classification, patients were classified into four groups: nuclear, cortical, subcapsular posterior, and mixed cataract. Then patients underwent microperimetry: results were analyzed for magnitude of retinal sensitivity loss and correlated to the forms and density of the cataract. Mean density of cataract was LOCS 3.2-3.5 in the four groups. Differences were not statistically significant. The best-corrected visual acuity (BCVA) was LogMAR 0.5 ± 0.13 in nuclear, LogMAR 0.49 ± 0.21 in cortical, and LogMAR 0.58 ± 0.12 in mixed cataract patients, and significantly worse in patients with subcapsular posterior cataract (LogMAR 0.64 ± 0.12). Microperimetry shows a mean sensitivity of 11.4-12.6 dB without significant group differences. The BCVA is correlated with microperimetry in patients with nuclear and cortical cataract. Density of cataract is highly correlated with microperimetry results in all groups. The present study shows a good correlation of microperimetry results with the BCVA of patients with nuclear and cortical cataract. In patients with subcapsular posterior cataract, microperimetry results were better than estimated by BCVA. Density of cataract is highly correlated with macular sensitivity. A reduction of 1 dB in microperimetry per 1 posterior capsule opacification score increase can be estimated for these patients.

Intrasession Repeatability of Fixation Stability Assessment with the Nidek MP-1

This study aims to determine the intrasession repeatability and agreement using two methods to analyze fixation stability recorded during microperimetry in patients with macular disease. Fifty patients with macular disease were enrolled prospectively to perform two consecutive microperimetry examinations on the Nidek microperimeter-1 (MP-1) using the same 1° red cross for fixation, Humphrey 10 to 2 grid of 68 test loci, 4 to 2 stair-case strategy, and 200 ms duration stimuli of Goldmann III size. Fixational eye movement was recorded during the two microperimetry examinations, and fixation stability was analyzed in two ways: (1) qualitatively through fixation stability grade (unstable, relatively unstable, and stable) and (2) quantitatively by calculating the logarithm of the bivariate contour ellipse area (logBCEA) that encompassed 68% of fixation points. Agreement and repeatability were assessed by unweighted kappa and the coefficient of repeatability. The mean (SD) visual acuity (VA) was 0.34 (0.32) logarithm of minimum angle of resolution. The mean (SD) duration of microperimetry was 13 (4) and 12 (4) min during the first and second measurements, respectively. During the first test, 10, 19, and 21 patients had unstable, relatively unstable, and stable fixation stability grading, respectively. Seventy percent (kappa: 0.53) of the fixation stability grading remained unchanged during repeat measurement. Of the remaining, 14% had a one-step decline and 16% had a one-step improvement in stability grading. The mean logBCEA were 4.28 and 4.24 in first and second tests, respectively (p = 0.43). The coefficient of repeatability for logBCEA was 0.61. The logBCEA method of analysis for fixation stability assessment is preferable. If logBCEA derived from a microperimetry task is used as part of the core outcome set in a clinical trial, a change of >0.61 may be considered to exceed the limit of test-retest variability.

Macular Function Assessed by Microperimetry in Patients with Enhanced S-Cone Syndrome

Enhanced S-cone syndrome (ESCS), also known as Goldmann-Favre syndrome, is a progressive retinal degeneration that frequently presents with night blindness and nummular pigment clumping around the vascular arcades and is caused by recessive mutations in the photoreceptor-specific NR2E3 transcription factor. A unique feature of this disease is the development of retinoschisis of the macula. This study used fine anatomic and functional assessments within this region to determine whether the loss of retinal function was due to progressive schisis or a primary photoreceptor loss, similar to other rod-cone dystrophies. Cross-sectional, prospective study. Nine probands (n=18 eyes) and 3 controls (n=6 eyes) were studied at Moorfields Eye Hospital in London, United Kingdom. Histories were obtained and visual acuity was measured using Early Treatment Diabetic Retinopathy Study protocol. Autofluorescence (AF), fundus photography, and spectral domain optical coherence tomography (OCT) imaging were co-registered to detailed microperimetry (Nidek MP1; NAVIS software version 1.7.2; Nidek Technologies, Padova, Italy) data for statistical analysis. Retinal sensitivity (decibels) in a customized test grid of the macula; retinal structure assessed with OCT and AF. Patients were divided into 3 cohorts roughly based on life span and documentation of schisis: (1) no schisis, childhood; (2) macular schisis, young adults; (3) resolved schisis, older adults. Retinal sensitivity was significantly attenuated in those with schisis and did not recover in those whose schisis had resolved despite retinal thickness comparable to that of controls. All probands exhibited loss of AF peripherally (and corresponding loss of retinal sensitivity), but there was relative preservation of AF within the macula. Development of macular retinoschisis in ESCS is an important feature of the disease and contributes to attenuated retinal sensitivity that persists after resolution of retinoschisis. The central macula appears to be compromised more by foveoschisis than photoreceptor loss. In contrast, the peripheral retina (ordinarily a rod-rich region) is affected early in the disease process and degenerates rapidly because of photoreceptor loss. Thus, 2 distinct mechanisms of retinal degeneration may exist in ESCS, corresponding to regions of the retina that may experience either normal or abnormal photoreceptor development.

Evaluation of macular abnormalities in Stargardt’s disease using optical coherence tomography and scanning laser ophthalmoscope microperimetry

The purpose of this study is to evaluate the diagnostic value of optical coherence tomography (Stratus OCT) and scanning laser ophthalmoscope (SLO) microperimetry in patients with Stargardt's disease (STGD), and the correlation between macular morphology and visual function in these patients. Twenty-two patients with STGD (mean age 44 years, range 11 to 71 years) and 20 age-matched healthy control subjects were included in the study. OCT imaging was performed using six radial line scans manually centered on the fovea. SLO microperimetry was used to assess central scotoma and fixation behavior in patients with STGD. Mean best corrected Snellen visual acuity (BCVA) was 20/80, range 20/25 to 20/300 (log MAR 0.6, range 0.1 to 1.2) in the STGD group and 20/20 (log MAR 0.0) in the control group. Foveal thickness was significantly reduced in patients with STGD (119.0 +/- 19.6 microm) compared to controls (210.7 +/- 19.6 microm, P < 0.0001). A significant correlation between foveal thickness and BCVA was observed within the STGD group (R(2) = 0.62, P < 0.0001). Photoreceptor loss in the macular area and a corresponding central scotoma were observed in all STGD patients. OCT findings, particularly reduced foveomacular thickness and photoreceptor loss in the macular area may be useful in the diagnosis of STGD. Furthermore, a strong correlation between foveal thickness and visual function was observed in our patients. Assessment of central visual function using SLO microperimetry provides additional useful information, important in the management of STGD.

Morphological and functional analyses of diabetic macular edema in diurnal fluctuation by optical coherence tomography and fundus related microperimetry in patients with type 1 diabetes

Abstract Purpose: To determine the significant correlations between retinal sensitivity measured by fundus‐related microperimetry and the visual acuity and the foveal thickness measured by optical coherence tomography (OCT) in eyes with Diabetic Macular Edema (DME) during diurnal variations of blood glucose levels. Methods: 30 eyes with macular edema of 40 consecutive patients with type1 diabete and 20 eyes of 20 normal subjects were included in our study. Best corrected visual acuity (ETDRS charts), macular thickness, macular sensitivity, and blood glucose concentration were quantified in all patients twice a day (10 am, 5 pm). Optical coherence tomography (Stratus OCT, Zeiss) was used to quantify macular thickness; macular sensitivity and retinal fixation were evaluated with fundus related microperimeter (MP1,Nidek). Results: The mean sensitivities in examinated area were significantly lower in patients with DME than in normal subjects (P&lt;0.0001). The mean retinal sensitivities were inversely correlated with visual acuity and foveal thickness, in according with glucose plasmatic level. ). Conclusions: The mean retinal sensitivities measured with fundus‐related microperimetry were significantly lower in eyes with DME than in normal eyes. A significant correlation between the microperimeter‐determined retinal sensitivity and visual acuity and foveal thickness was observed in the course of the day compared to blood glucose level. MP1 and OCT could be useful techniques in morphological and functional macular analyses of DME.

Scotoma and fixation patterns using scanning laser ophthalmoscope microperimetry in patients with macular dystrophy

PURPOSE: We used scanning laser ophthalmoscope microperimetry to evaluate the retinal scotoma and the fixation points in the patients with macular dystrophy. METHODS: We studied 10 eyes of five patients with macular dystrophy (three patients with cone dystrophy and two patients with Stargardt disease). The mean patient age was 37 years (range, 13 to 64 years). An estimation of scotoma and fixation points on the retina was performed using scanning laser ophthalmoscope microperimetry. RESULTS: All 10 eyes (100%) had one of two types of dense scotoma: type one was a dense ring scotoma (five eyes, 50%), and type two was a dense central scotoma (five eyes, 50%) that included the center of the fovea. In all eyes with a dense ring scotoma, the fixation points were stable and did not shift. In all eyes with a dense central scotoma, the fixation shifted. The logarithm of minimal angle of resolution of the visual acuity in the eyes with the dense central scotoma was significantly worse than that of eyes with the dense ring scotoma type ( P = .005). CONCLUSIONS: Scanning laser ophthalmoscope microperimetry findings demonstrate two types of dense scotoma (dense ring scotoma and dense central scotoma) in the patients with macular dystrophy. The two types of dense scotoma affect the shifting of the fixation points and the stability of fixation and may result in the difference in visual acuity in the patients with macular dystrophy.