Preferential Hyperacuity Perimeter Research Articles

Telemedicine for Glaucoma Patients in COVID-19 Era

In that Era with crowded hospitals and the need for social distance, telemedicine emerges as a solution for many problems. In ophthalmology Telemedicine has been started many years ago with limits. Now we have to widen the scope and applications of telemedicine (1-3)Glaucoma patients needs a special follow-up regimen with intraocular pressure (IOP) measurement, fundus examination, and visual acuity (V/A) assessment. Regular visits to the hospital are required; however, in the telemedicine protocol, we can decrease their visits to the hospitals. (4-6)Excluding emergencies, patients with glaucoma can follow the following protocol:History taking: by phone or video call with health provider (3)Visual acuity assessment: Patients can use Amsler's grid chart or smart applications for visual acuity and color vision. (7) Iop: I CARE tonometer can be a valuable tool; however, it is expensive.Visual field: There are Apps and devices to monitor the central 10, degrees including the commercially available preferential hyperacuity perimeter ForSee® device (Notal Vision) and discrimination apps such as mVT® (Vital Art and Science) application(8,9). Smart phone retinal imaging is available, but not yet designed for patients to use at home. (10-13)Video call: with the health care provider to discuss the condition and guide the patient to either the hospital or drug prescription.Future prospective: We aim at provide an optical coherence tomography (OCT) smart phone like apparatus. Intraocular devices for continuous IOP measurement are required.

Recent Advances of Computerized Graphical Methods for the Detection and Progress Assessment of Visual Distortion Caused by Macular Disorders.

Recent advances of computerized graphical methods have received significant attention for detection and home monitoring of various visual distortions caused by macular disorders such as macular edema, central serous chorioretinopathy, and age-related macular degeneration. After a brief review of macular disorders and their conventional diagnostic methods, this paper reviews such graphical interface methods including computerized Amsler Grid, Preferential Hyperacuity Perimeter, and Three-dimensional Computer-automated Threshold Amsler Grid. Thereafter, the challenges of these computerized methods for accurate and rapid detection of macular disorders are discussed. The early detection and progress assessment of macular disorders can significantly enhance the required clinical procedure for the diagnosis and treatment of macular disorders.

Wearable diagnostic system for age-related macular degeneration.

This paper presents a novel head-mounted point-of-care diagnostic system for detection and continuous monitoring of Age-related Macular Degeneration (AMD). This wearable embedded open-source platform enables accurate monitoring of AMD by taking advantage of multiple standard graphical interface techniques such as Amsler Grid, Threshold Amsler Grid, Macular Computerized Psychophysical Test and Preferential Hyperacuity Perimeter (PHP). Here, we describe the proposed multi-Grid or so-called NGRID software and elaborate on the hardware prototype. This prototype includes a commercially available Oculus HMD incorporated with a single board computer. As the first step towards a fully integrated wearable system, this paper successfully proves the functionality of head-mounted graphical interface device ready for a live demonstration. Participants can experience this device and take a 10-minute AMD eye-exam. Furthermore, NGRID has been approved and permitted for an in-hospital clinical trial.

Assessment of visual distortions in age-related macular degeneration: emergence of new approaches

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.

Functional Characterization and Multimodal Imaging of Treatment-Naïve “Quiescent” Choroidal Neovascularization

To investigate the multimodal morphological and functional characteristics of treatment-naïve "quiescent" choroidal neovascularization (CNV) secondary to AMD. Eleven patients with treatment-naïve "quiescent" CNV that consecutively presented over a 6-month period, underwent multimodal morphological and functional assessment (including indocyanine green angiography [ICGA], spectral-domain optical coherence tomography [SD-OCT], microperimetry, and preferential hyperacuity perimeter [PHP]). For the purpose of this study, asymptomatic previously untreated CNVs showing absence of intraretinal/subretinal exudation in two consecutive visits (at least 6 months apart) were defined as treatment-naïve "quiescent" CNV. Eleven eyes of 11 patients (9 females; mean age 76.5 ± 8.5 years) were included. On fluorescein angiography (FA), "quiescent" CNVs appeared as late speckled hyperfluorescent lesions lacking well-demarcated borders. Mid-late phase ICGA allowed visualizing the hyperfluorescent "quiescent" CNV network and delineating the plaque. Mean lesion area (mid-late phase ICGA) appeared larger compared with earliest previous examination performed 23.8 ± 16.0 months before (3.24 ± 2.51 mm(2) vs. 3.52 ± 2.46 mm(2), respectively; P = 0.01). SD-OCT revealed, at the site of "quiescent" CNV, an irregularly slightly elevated RPE, without hyporeflective intraretinal/subretinal fluid, showing a major axis in the horizontal plane, which was characterized by collections of moderately reflective material in the sub-RPE space and clear visualization of the hyperreflective Bruch's membrane. Hypergeometric distribution revealed a significant correlation between microperimetry and PHP with respect to locations of "affected areas" (P = 0.001). "Quiescent" CNVs are sub-RPE CNVs secondary to AMD, showing absence of intraretinal/subretinal exudation on repeated OCT. "Quiescent" CNVs enlarge over time and may contribute to local reduced retinal sensitivity and metamorphopsia.

Perimetria de hiperacuidade preferencial no estudo do edema macular diabético

Introduction – Preferential hyperacuity perimeter (PHP) is a new psychophysical test, which principle is based on the detection of metamorphopsia in age-related macular degeneration (AMD). It is intended to verify its effectiveness in the study of diabetic macular edema (DME). When there is loss of pericytes in the vascular wall occur a number of microcirculatory changes that lead to the appearance of microaneurysms and other vascular changes that allow the passage of blood components to the surrounding retinal tissue than in normal situation does not occur, this being one of the causes exudative diabetic macular edema. Methodology – It was performed a quantitative study, using descriptive and correlational analysis. A sample of 33 patients was selected, and 60 eyes were analyzed. Results – The sensitivity of PHP on the detection of metamorphopsia associated to EMD was 70.6%, the specificity was 11.5% and the global efficiency of the test was 45%. It was found a weak negative correlation (Phi= -0.215) between thePHP and optical coherence tomography (OCT). Conclusions – This new method of diagnosis was sensitive, but not very specific and effective on the detection of metamorphopsia, due to the DME.

Preferential Hyperacuity Perimeter and Prognostic Factors for Metamorphopsia After Idiopathic Epiretinal Membrane Surgery

To document changes in metamorphopsia via preferential hyperacuity perimeter and to identify prognostic factors related to favorable metamorphopsia outcome after idiopathic epiretinal membrane surgery. Prospective, consecutive, interventional case series. We prospectively included 29 eyes of 27 patients who underwent successful vitrectomy for idiopathic epiretinal membrane. All eyes underwent examinations before surgery and at 2weeks and 1, 3, and 6months after surgery. Metamorphopsia was assessed by using a preferential hyperacuity perimeter. Several clinical factors were analyzed to reveal relationships with final metamorphopsia outcome, including the duration of symptoms, best-corrected visual acuity, and spectral-domain optical coherence tomography findings. Spectral-domain optical coherence tomography findings included assessment of central foveal thickness, and the integrity of the photoreceptor inner segment and outer segment (IS/OS) junction. At baseline, preferential hyperacuity perimeter detected areas of distortion in 15 eyes (51.7%). At 6months after surgery, there was significant reduction in metamorphopsia (P= .001), which was paralleled with significant improvement of best-corrected visual acuity and reduction of central foveal thickness (P < .001). At 6months after surgery, the degree of metamorphopsia was related significantly to the severity of preoperative metamorphopsia and central foveal thickness at baseline (ρ= 0.856; P < .001; ρ= 0.412; P= .027; respectively). Eyes with broadly disrupted IS/OS junction of more than 200μm before surgery revealed significantly poorer postoperative metamorphopsia than those with intact or narrowly disrupted IS/OS junction (P= .001). However, duration of symptoms and baseline best-corrected visual acuity were not correlated with final metamorphopsia (P= .625 and P= .052, respectively). Significant reduction of metamorphopsia paralleled the improvement of best-corrected visual acuity and central foveal thickness until 6months after idiopathic epiretinal membrane surgery. The significant predictors for postoperative metamorphopsia outcome were the degree of preoperative metamorphopsia, central foveal thickness, and the photoreceptor IS/OS junction integrity at baseline.

Multimodal morphological and functional characterization of Malattia Leventinese

To analyze the morphological and functional characteristics of malattia leventinese. This was a chart review of patients with Malattia Leventinese. All patients underwent a complete ophthalmologic examination, including best-corrected visual acuity (BCVA), fundus autofluorescence (FAF), fluorescein angiography (FA), indocyanine green angiography (ICGA), and optical coherence tomography (OCT). Microperimetry and Preferential Hyperacuity Perimeter (PHP) were performed in a subset of patients. Twelve eyes of six patients were included. BCVA ranged from 20/25 to 20/200. The largest drusen were round, not radially distributed, localized in the perimacular area and around the optic disc. The smallest drusen were not round, radially distributed, mostly localized temporally to the macula. FAF revealed an intense autofluorescence of large drusen. On both FA and ICGA, large round drusen turned to hyperfluorescent in the late phase, while small radial drusen progressively decreased their fluorescence. OCT showed the large round drusen as focal or diffuse deposition of hyperreflective material between the RPE and Bruch membrane within the macula, determining focal dome-shaped or diffuse RPE elevation respectively, and the small radial drusen, which ranged from irregular slight thickening of the RPE/Bruch membrane complex to sawtooth RPE elevation. In three patients (six eyes) that underwent microperimetry and PHP, there was a good correspondence between macular sensitivity and PHP score. Functional impairment correlated topographically to sub-RPE deposition of drusenoid material. In this series, large round drusen of Malattia Leventinese appeared similar to drusen in age-related macular degeneration, while small radial drusen of Malattia Leventinese shared similarities with early-onset cuticular drusen.

Preferential Hyperacuity Perimeter as a Functional Tool for Monitoring Exudative Age-Related Macular Degeneration in Patients Treated by Intravitreal Ranibizumab

To analyze the response to anti vascular endothelial growth factor (VEGF) treatment for exudative age-related macular degeneration (AMD), with respect to changes in the Preferential Hyperacuity Perimeter (PHP), best-corrected visual acuity (BCVA), and spectral-domain optical coherence tomography (SD-OCT), and to investigate whether the PHP score predicts the need for reinjection. Consecutive patients with newly diagnosed exudative AMD underwent the PHP metamorphopsia test, BCVA, and SD-OCT at five time points after initiation of ranibizumab therapy (0.05 mL/0.5 mg). At the third and sixth months, reevaluation for additional injections was done. The relationships between PHP, BCVA, and SD-OCT parameters over time as well as their ability to predict the need for reinjection were examined. Analysis included 17 eyes (17 patients, 70% females; mean age, 83.2 years). The mean PHP metamorphopsia test score improved from 25.6 ± 41 (baseline) to 10.7 ± 20.1 (P < 0.05) over 6 months, after a mean of 4.2 (±1.0) injections. Mean reduction in SD-OCT parameters well reflected the functional improvements as evaluated by PHP (Spearman correlation = 0.9, P < 0.05). Mean BCVA did not improve over 6 months (0.6 vs. 0.58 logMAR), and neither correlated with SD-OCT morphologic changes (Spearman correlation = 0.1, P > 0.05) nor with PHP functional changes (Spearman correlation = 0.1, P > 0.05). The PHP predicted the need for reinjection with an accuracy of 75% (sensitivity, 83 ± 12%; specificity, 67 ± 15%), whereas a combination of all the measurements (PHP, BCVA, and SD-OCT) yielded an accuracy of 87% (sensitivity, 83 ± 12%; specificity, 90 ± 10%). Improvement in the metamorphopsia test score after intravitreal injections of ranibizumab, as well as its ability to predict the need for retreatment, suggest that PHP may be used to monitor response to anti-VEGF therapy in patients with exudative AMD.

RETRACTED: Results of Spectral-Domain Optical Coherence Tomography by Preferential Hyperacuity Perimeter in Patients after Idiopathic Epiretinal Membrane Surgery

To evaluate spectral-domain optical coherence tomography (OCT) findings based on preferential hyperacuity perimeter (PHP) in patients after idiopathic epiretinal membrane surgery. Forty eyes of 40 patients undergoing surgery for idiopathic epiretinal membrane were included in the study. The best-corrected visual acuity, PHP, Amsler grid test, and OCT were assessed 3 months after surgery. Patients were classified based on the defect of hyperacuity by PHP, as follows: hyperacuity defect (n = 18 eyes) and hyperacuity intact (n = 22 eyes). There was no difference in age, gender, duration of symptoms, and visual acuity. The average macular thickness and inner nuclear layer thickness in the hyperacuity defect group was thicker than the hyperacuity intact group (P = 0.041 and P = 0.045, respectively). A disrupted photoreceptor layer was more common in the hyperacuity defect group compared with the hyperacuity intact group (P = 0.001). With regard to metamorphopsia, a hyperacuity defect after epiretinal membrane surgery was associated with inner nuclear layer edema and photoreceptor disarrangement.

Comparison between the preferential hyperacuity perimeter and the Amsler grid to detect age-related macular degeneration and Stargardt's disease

Purpose To evaluate the ability of the preferential hyperacuity perimeter (PHP) and the Amsler grid to detect central scotomas in Stargardt's disease and age macular degeneration. Methods Prospective, comparative, cross-section study in which 16 patients affected with AMD and Stargardt's disease were evaluated. All patients had an optometric evaluation including refraction, best corrected visual acuity, evaluation with PHP Foresee and with the Amsler grid. The sensitivity of the macular evaluation tests (The Amsler grid and PHP) for each maculopathy was calculated. Results To detect scotomas in both macular pathologies, the PHP sensitivity is 60–70 %, while the Amsler grid sensitivity is 85–100 %. As screening methods for maculopathies, the PHP sensitivity is 83 %, while the Amsler grid sensitivity is 93 %. Conclusions The Amsler grid and the PHP are both useful to detect scotomas in Stargardt's disease and AMD. As a disease screening method, the Amsler grid is useful in both conditions; however, the PHP is only useful in AMD, not in Stargardt's.

Preferential hyperacuity perimeter in assessing responsiveness to ranibizumab therapy for exudative age-related macular degeneration

AimTo investigate the ability of the preferential hyperacuity perimeter test to assess responsiveness to ranibizumab therapy for exudative age-related macular degeneration (AMD).MethodsFourteen consecutive patients with newly diagnosed choroidal neovascularisation underwent...

TOWARD EARLIER DETECTION OF CHOROIDAL NEOVASCULARIZATION SECONDARY TO AGE-RELATED MACULAR DEGENERATION

The primary purpose of this study was to evaluate the ability of a home device preferential hyperacuity perimeter to discriminate between patients with choroidal neovascularization (CNV) and intermediate age-related macular degeneration (AMD), and the secondary purpose was to investigate the dependence of sensitivity on lesion characteristics. All participants were tested with the home device in an unsupervised mode. The first part of this work was retrospective using tests performed by patients with intermediate AMD and newly diagnosed CNV. In the second part, the classifier was prospectively challenged with tests performed by patients with intermediate AMD and newly diagnosed CNV. The dependence of sensitivity on lesion characteristics was estimated with tests performed by patients with CNV of both parts. In 66 eyes with CNV and 65 eyes with intermediate AMD, both sensitivity and specificity were 0.85. In the retrospective part (34 CNV and 43 intermediate AMD), sensitivity and specificity were 0.85 +/- 0.12 (95% confidence interval) and 0.84 +/- 0.11 (95% confidence interval), respectively. In the prospective part (32 CNV and 22 intermediate AMD), sensitivity and specificity were 0.84 +/- 0.13 (95% confidence interval) and 0.86 +/- 0.14 (95% confidence interval), respectively. Chi-square analysis showed no dependence of sensitivity on type (P = 0.44), location (P = 0.243), or size (P = 0.73) of the CNV lesions. A home device preferential hyperacuity perimeter has good sensitivity and specificity in discriminating between patients with newly diagnosed CNV and intermediate AMD. Sensitivity is not dependent on lesion characteristics.

An Analysis of Metamorphopsia Using Preferential Hyperacuity Perimeter Following Macular-off RRD Surgical Repair

Purpose: To determine the efficacy of using the preferential hyperacuity perimeter (PHP) for the analysis of metamorphopsia following macular-off rhegmatogenous retinal detachment (RRD) surgical repair. Methods: PHP examination was performed in those who complained of metamorphopsia after successful surgical reattachment of RRD. The subjective symptoms were evaluated based on a scale, ranging from 0 to 10, and were compared with the results of PHP examination. Patients age, duration of retinal detachment, pre and post-operative visual acuity, postoperative presence of subretinal fluid (SRF), surgical methods, presence of epiretinal membrane, and time from operation to PHP test were analyzed to find the correlation with the PHP results. Results: Of the 19 eyes included in this study, nine eyes were found to have a hyperacuity defect upon PHP examination. In this group, the subjective level of metamorphopsia was significantly worse (p

Preferential Hyperacuity Perimeter in Exudative AMD With Pigment Epithelial Detachment

Purpose: To analyze the hyperacuity defects by preferential hyperacuity perimeter (PHP) in exudative age-related macular degeneration (AMD) and correlate them with the properties of pigment epithelial detachment (PED) obtained by optical coherence tomography (OCT). Methods: Thirty eyes with exudative AMD with choroidal neovascularization (CNV) diagnosed by fluorescein angiography underwent PHP for hyperacuity defect and OCT for PED length and height. We compared hyperacuity defect with the shape of the PED by OCT. Results: 26 eyes with exudative AMD with CNV tested positive for hyperacuity defects. The size of the hyperacuity defect by PHP and the PED length by OCT showed positive correlation (p=0.010). In the 4 eyes that tested negative for hyperacuity defects, the PED was not high although the size was large. Conclusions: Our results suggest that PHP is a useful method to detect a change of pigment epithelial layer in AMD and the presences of a hyperacuity defect is more sensitive for PED height than size. These results suggest that PHP is useful to detect the state and the activity of CNV lesion.

Comparison of the original Amsler grid with the preferential hyperacuity perimeter for detecting choroidal neovascularization in age-related macular degeneration

To compare the preferential hyperacuity perimeter (Preview PHP; Carl Zeiss Meditec, Dublin, CA) with the original Amsler grid in the detection of choroidal neovascularization (CNV) in patients with age-related macular degeneration (AMD). Patients were classified into groups, based on the severity of the age-related macular degeneration and underwent preferential hyperacuity perimeter and Amsler grid testing. High sensitivity and or high specificity of a method were defined as the observation of at least 80% of each one the parameters. Sixty-five patients (65 eyes) were analyzed statistically. The sensitivity of detection of choroidal neovascularization was 70% by the Amsler grid and 90% by the preferential hyperacuity perimeter and the specificity of the Amsler grid was 85.5% and that of the preferential hyperacuity perimeter 81.8%. The preferential hyperacuity perimeter has greater sensitivity than the Amsler grid in the detection of choroidal neovascularization among patients over 50 years of age and is a promising method for monitoring patients with age-related macular degeneration. Although the original Amsler grid is less sensitive, it is a portable method, not expensive, accessible and presents reasonable sensitivity and high specificity in the diagnosis of choroidal neovascularization. Its use can be recommended for self-monitoring in patients with age-related macular degeneration as an alternative to preferential hyperacuity perimeter and when this method is not available.

THE SIGNIFICANCE OF EARLY DETECTION OF AGE-RELATED MACULAR DEGENERATION

The main cause for visual loss in age-related macular degeneration (AMD) is the development of choroidal neovascularization (CNV), which has been shown to occur in 18% of patients over 5 years. Even though satisfactory treatments for CNV are available, in the majority of cases no improvement in visual acuity occurs and in those it does it is mostly limited. Early detection has the potential of significantly improving the final visual outcome of patients who develop subfoveal CNV. This review is a summary of the importance of early detection in the management of AMD, in view of the current available treatment methods. It is a review of the results of early detection of AMD using the Preferential Hyperacuity Perimeter (PHP). Awareness for symptoms, use of the Amsler grid and monitoring by an ophthalmologist are not satisfactory means for early detection of AMD. The PHP has good sensitivity and specificity in detecting CNV patient early and differentiate them from intermediate AMD. In an era of excellent treatments available for CNV treatment, early detection of CNV by novel technology modalities such as the PHP at a frequency that allows early detection (approximately 4 times a year) is crucial in the armamentarium of AMD patient management.

Monitoring of Photodynamic Therapy Results in Age-Related Macular Degeneration by Means of Preferential Hyperacuity Perimeter

To describe changes revealed by Zeiss Preferential Hyperacuity Perimeter (PreView PHP) in age-related macular degeneration (AMD), before and after photodynamic therapy (PDT), and determine usefulness of such monitoring. Forty patients (40 eyes) with subfoveolar choroidal neovascularization (CNV) and 20 volunteers with cataract (40 eyes) were examined in a prospective study. Control group was screened for false positive results to evaluate reliability of the test. Subfoveolar CNV was confirmed by fluorescein angiography and optical coherence tomography (OCT). Best-corrected visual acuity (BCVA) and macular visual field in the PHP (area and intensity of distortion) were assessed 1 day before and 1 week and 4 weeks after PDT. Four weeks after PDT there was improvement in PHP results in 20 eyes (50%), stabilization in 15 eyes (37.5%) and progression in 5 eyes (12.5%). At this time there was BCVA improvement in 9 eyes (22.5%), stabilization in 28 eyes (70%), and worsening in 3 eyes (7.5%). 1 week after PDT 30 eyes (75%) presented temporary progression in PHP but only 3 patients (7.5%) presented temporary decrease of visual acuity and progression in OCT. Correlation coefficient of BCVA and PHP results was low during whole study. There was no significant change in control group during observation. 17.5% false positive PHP results were obtained at baseline. In the PDT group no false negative results were noted. Visual outcome after PDT cannot be predicted with use of PreView PHP. Temporary progression of changes in PHP 1 week after PDT can be expected in most cases.

Functional Macular Mapping in Patients with Vitreomacular Pathologic Features Before and After Surgery

To evaluate the potential benefit of microperimetry and preferential hyperacuity perimeter (PHP) to document visual performance objectively in patients with macular hole and macular pucker undergoing macular surgery. Observational case series. In 19 patients with macular hole and 18 with macular pucker, best-corrected visual acuity (BCVA; in logarithm of the minimum angle of resolution units), central retinal sensitivity, and presence and extent of metamorphopsia were documented before and four and 12 weeks after surgery. Macular sensitivity (mean sensitivity decibel [dB], stability of fixation) was determined using MP1 microperimetry (Nidek, Padova, Italy). The PreView-PHP (Carl Zeiss Meditec, Dublin, California, USA) was used to quantify metamorphopsia. Before surgery, mean BCVA was 0.68 +/- 0.25 (macular holes) and 0.58 +/- 0.25 (macular pucker). Microperimetry demonstrated a mean retinal sensitivity of 11.3 +/- 2.5 dB (macular holes) and 10.7 +/- 2.8 dB (macular pucker). Twelve weeks after surgery, mean BCVA improved to 0.53 +/- 0.26 (macular holes) and 0.33 +/- 0.26 (macular pucker; P = .042 and P = .004). Accordingly, retinal sensitivity increased significantly with 12.8 +/- 1.9 dB (macular holes) and 12.7 +/- 2.5 dB (macular pucker; P = .04 and P = .02) as well as stability of fixation. At 12 weeks, 47.3% of macular hole eyes and 66.7% of macular pucker eyes improved in BCVA, but a significantly higher number (68.4% [macular holes] and 77.8% [macular pucker]) demonstrated improvement in microperimetry results. PHP results showed no significant change of scotomas, patient reliability, or presence of metamorphopsia at any interval. A higher number of patients improved in microperimetry than in visual acuity testing. Therefore, microperimetry highlights the value of functional macular mapping for these patients and indicates that BCVA may underestimate functional benefit of surgery.

Diagnostik von Metamorphopsien bei Netzhauterkrankungen unterschiedlicher Genese

We investigated the ability of preferential hyperacuity perimeter (PHP) and Amsler grid testing to detect metamorphosia in patients with macular hole (MH), central serous retinopathy (CSR), epiretinal membranes (EM), intermediate AMD (iAMD), classic and occult choroidal neovascularization (CNV) due to AMD, and compared the results. A total of 147 patients (n =153 eyes) with classic (35 eyes) and occult (38 eyes) CNV, iAMD (13 eyes), MF (23 eyes), RCS (11 eyes), EM (13 eyes) and control group (20 eyes) were involved. All of these patients underwent corrected visual acuity and eye examinations inclusive of the Amsler grid. The PHP test was performed after pupil dilation. In all patients, fundus photography and optical coherence tomography (OCT) (Humphrey/Zeiss OCT III) were performed. In patients with CNV and CSR a fluorescein angiography was also performed. Metamorphopsia detection rates by Amsler grid and PHP were compared statistically. The sensitivity of PHP vs Amsler grid in detecting metamorphosia was 69% vs 85% in patients with MH, for CSR 64% vs 73%, EM 77% vs 100%, iAMD 85% vs 100%, classic CNV 83% vs 94% and occult CNV 81% vs 71%. The results for patients with occult CNV were significant (P =0.046), using the chi(2)-test. The PHP-test showed high sensitivity for diagnosing CNV. In occult CNV, PHP was superior to the Amsler grid in detecting metamorphopsia. In the other diseases involving the macular (MH, EM, CSR, iAMD), the detection rate and sensitivity of the Amsler grid was superior to PHP.