Use Of Microperimetry Research Articles

Correlation between macular sensitivity and kidney function in patients with diabetes.

The aim of this study is to investigate the correlation between kidney function in patients with diabetes and macular sensitivity at central 10° using microperimetry. A cross-sectional study was carried out on 30 diabetic patients (58 eyes). A full-threshold microperimetry of the central 10° of retina (the macula) was performed on all subjects, consisting of 37 measurement points, using a 4-2 representation strategy. Macular sensitivity was expressed as the average threshold value in decibels for the entire field tested. The correlation between macular sensitivity and GFR, as well as microalbuminuria, blood glucose and HbA1c, was calculated using Pearson correlation rank. A significant positive correlation was observed between GFR and macular sensitivity among both male and female study subjects. For male participants, the correlation was measured to r([16]) = [.615], p = [<.007] and r([15]) = [.844], p = [<.001] for the left and right eyes, respectively. As for female participants, the correlation was r ([9]) = [.903], p = [<.001] and r([10]) = [.941], p = [<.001] for the left and right eyes, respectively. The correlation between macular sensitivity and the following variables was statistically insignificant: microalbuminuria, blood glucose, and HbA1c. Despite intact visual acuity measured on standard ophthalmic examination, patients with impaired kidney function had decreased macular sensitivity. This emphasizes the importance of microperimetry in preventative care and detection of early signs of diabetic retinopathy. Furthermore, we should consider the use of microperimetry as an auxiliary tool for monitoring kidney function in diabetics.

Microperimetry to predict disease progression in eyes at high risk of age-related macular degeneration disease: The PREVISION study.

The aim of the present study was to determine whether microperimetric parameters could predict the progression of an eye at high risk of age-related macular degeneration (AMD) at 24 months. We conducted a multicentric prospective non-comparative open-label study including patients with one eye in stage 4 of the Age-Related Eye Disease Study Group (AREDS) classification, and the other eye in AREDS stage 3 (study eye). A microperimetry examination (MAIA™, CenterVue, Padova, Italy) was performed at baseline and every 6months during the 2-year follow-up. At the end of the follow-up, each study eye was classified as 'progressive' (i.e. AREDS stage 4) or 'non-progressive' (i.e. AREDS stage 3). A total of 147 patients were analysed, of which 30.6% progressed from AREDS stage 3 to stage 4. The microperimetry criterion 'mean retinal sensitivity' was significantly different at baseline between non-progressive and progressive eyes (p=0.022), with lower values for the latter. With a threshold for mean retinal sensitivity set at 24.7dB, diagnostic sensitivity was 80% [95%CI (65.4-90.4)], specificity was 30.4% [95%CI (21.7-40.3)], positive predictive value was 33.6% [95%CI (24.8-43.4)], and negative predictive value was 77.5% [95%CI (61.5-89.2)]. In the multivariate analysis including microperimetric parameters and other routine ophthalmologic examinations, mean retinal sensitivity was the only predictive parameter statistically associated with progression (p=0.0004). Our findings are encouraging as regards the use of microperimetry, and mean retinal sensitivity value in particular, to predict the 2-year risk of progression to AREDS stage 4 eye.

Association between peripheral visual field defects and focal lamina cribrosa defects in highly myopic eyes.

We aimed to identify peripheral visual field (VF) defect pathogenesis in high myopia using optical coherence tomography (OCT) and microperimetry and to investigate the association between focal lamina cribrosa defects (fLCDs) and high myopia-specific peripheral visual field defects (HM-pVFDs). Retrospective case-control study. Thirty-five highly myopic patients (refractive error ≥ 8.0 D or axial length > 26.5mm) with an HM-pVFD, diagnosed using the V-4 isopter in Goldmann perimetry, and 35 age- and 35 sex-matched controls were studied. The optic nerve head (ONH) morphology was analyzed by use of OCT; retinal light sensitivities around the ONH were evaluated by use of microperimetry. The main outcome measures were best-corrected visual acuity (BCVA), axial length (AL), refractive error, intraocular pressure (IOP), the OCT findings, and the microperimetry findings. The BCVA, AL, IOP, and refractive error did not differ significantly between the patient and the control groups. Of the 35 eyes with an HM-pVFD, twenty-four had fLCDs detected by use of OCT, one showed no evidence of fLCDs, and ten had inadequate images due to excessive ONH tilting. Of the 35 control eyes, two had fLCDs, twenty-eight showed no evidence of fLCDs, and five had inadequate images. The peripapillary retinal light sensitivity was decreased in 29 of the 35 eyes with an HM-pVFD; no such decrease was noted in 30 of the 35 control eyes. Peripheral VF abnormality detection by use of microperimetry had 82.9% sensitivity and 85.7% specificity. Our findings indicate an important relationship between HM-pVFDs and fLCDs, suggesting fLCD involvement in peripheral VF abnormality pathogenesis in highly myopic patients. Furthermore, microperimetry is reproducible for evaluating HM-pVFDs.

Understanding the role of microperimetry in glaucoma.

The present narrative review attempts to provide an overview on the use of microperimetry or fundus-driven perimetry in glaucoma, considering the clinical use, the different strategies and limits compared to standard automated perimetry. An electronic database (PubMed and Medline) search was performed of articles of any type published in the English language between 1998 and 2020 with a combination of the following terms: microperimetry, glaucoma, primary open-angle chronic glaucoma, visual field, Humphrey visual field, fundus automated perimetry. All the original articles, case reports, and short series analyzed were included in the present review, offering an excursus on the strengths and limitations characterizing the use of microperimetry in glaucomatous patients. The characteristics of a recently introduced fundus-driven perimetry Compass (CMP; Centervue, Padua, Italy) were also included. Although there remain several contradictions regarding routine use of microperimetry and the restricted research on this topic limits our ability to draw firm conclusions, microperimetry may be preferable in cases of localized retinal nerve fiber layer defects in patients with primary open-angle glaucoma and normal visual field. However, standard automated perimetry remains the gold standard for monitoring glaucoma, especially in patients with diffuse retinal nerve fiber layer impairment and visual field defects. The newly introduced Compass device can potentially provide a more accurate structural-functional evaluation than standard automated perimetry and can therefore produce superior testing reliability.

Microperimetry in Children’s Practice

Child health is a global health priority. The program “Elimination of Eliminable Blindness in the World of Vision-2020” gives the fourth place to the problems of pediatric ophthalmopathology and creates targeted programs for their elimination. The introduction of modern equipment in the clinical practice of pediatric ophthalmologists has expanded the boundaries of traditional diagnostics. Microperimetry is an innovative, quantitative, non-invasive diagnostic study aimed at assessing the functional ability of the retina in strict correlation with morphology. Along with the assessment of light sensitivity, the device allows you to measure fixation parameters, which serves as a reliable criterion for its stability and indirectly reflects the functional organization of central vision. In this regard, the literature review presents the results of domestic and foreign researchers who used microperimetric testing as the main or additional research method for diseases of various etiologies, such as hereditary retinal diseases, amblyopia, and nystagmus. Most authors have demonstrated the high diagnostic significance of this method, the ability to assess photosensitivity of the retina, the detection of fixation disorders, such as eccentricity and instability, even in pediatric patients. The use of microperimetry as a new method of treatment for these diseases has also been shown. Visual rehabilitation based on biofeedback provided by this device has shown high efficiency in diseases of the central region. More research remains to be done to determine future potential applications of this technology, in particular in pediatric practice, and to develop the potential of microperimetry as a tool for the visual rehabilitation of patients.

Microperimetry for geographic atrophy secondary to age-related macular degeneration

Geographic atrophy (GA) is a progressive, advanced form of age-related macular degeneration leading to visual function impairment and irreversible vision loss. Standard clinical tests to evaluate visual function in patients with GA provide poor anatomic-functional correlation, whereas fundus imaging does not assess the visual function deficit. Microperimetry is a psychophysical visual function test that spatially maps retinal sensitivity and allows for identification of correlation of anatomic features with visual function. In this review, we present an overview of mesopic microperimetry for GA, including commercially available microperimetry devices, strategies to capture a mesopic microperimetry test, and strategies to assess and interpret microperimetry data in patients with GA. We demonstrate the importance of microperimetry data for assessing GA progression and for evaluating visual function loss through anatomic-functional correlations. Although valuable, current microperimetry tests require an extensive time commitment from the patient and examiner, and the development of faster, more reproducible and accessible methods is important to enable broader use of microperimetry in both clinical and research settings.

Cross-Sectional and Longitudinal Assessment of Retinal Sensitivity in Patients With Childhood-Onset Stargardt Disease.

PurposeWe assess cross-sectional and longitudinal microperimetry and full-field static perimetry-derived retinal sensitivity with conventional and volumetric indices of retinal function in childhood-onset Stargardt disease (STGD1).MethodsSubjects with molecularly confirmed childhood-onset STGD1 underwent full-field static perimetry and/or microperimetry using custom designed grids. Mean sensitivity (MS) and total volume (VTOT) were computed for each microperimetry test. MS, VTOT, and central field volume (V30) were computed for each full-field static perimetry test. Subjects under 18 years old at baseline were classified as children and subjects 18 years or older as adults.ResultsA total of 43 children (mean age at baseline, 13.0 years; range, 8–17) and 13 adults (mean age at baseline, 23.1 years; range, 18–32) were included in the analysis. For full-field static perimetry and microperimetry for both subgroups, intraclass correlation coefficient results for MS and volumetric indices were good to excellent, indicating strong test–retest reliability. Interocular symmetry in terms of baseline measurements and the annual rate of progression was observed. A greater rate of progression was observed in childhood.ConclusionsTo our knowledge, this is the first prospective study of retinal sensitivity in a large cohort of molecularly confirmed subjects with childhood-onset STGD1 demonstrating that children with STGD1 can reliably undertake detailed functional testing. Moreover, using custom designed grids and subsequent topographic analysis, volumetric indices of retinal function provide a reliable measure of retinal sensitivity.Translational RelevanceThis study highlights the use of microperimetry and full-field static perimetry, as well as volumetric indices of retinal function, in monitoring disease progression.

Retinal sensitivity after displacement of submacular hemorrhage due to polypoidal choroidal vasculopathy: effectiveness and safety of subretinal tissue plasminogen activator.

To investigate the effectiveness of displacement of submacular hemorrhage (SMH) caused by polypoidal choroidal vasculopathy (PCV) by assessing retinal sensitivity using microperimetry. We retrospectively reviewed the medical records of 11 consecutive PCV patients with SMH. All patients underwent vitrectomy, subretinal injection of tissue plasminogen activator, and fluid-air exchange, followed by antivascular endothelial growth factor therapy using a pro re nata regimen. The retinal sensitivity was measured by use of microperimetry before and after surgery. The mean (SD) age of the patients was 74.1±9.4years. The mean SMH diameter was 6.8±5.2 disc diameters. The best-corrected visual acuity (BCVA), mean retinal sensitivity, and mean number of measure points with a sensitivity ≥10dB before the surgery were 0.94±0.49, 4.2±4.5dB, and 15.6±15.1 points, respectively. These had significantly improved 6months after surgery (0.39±0.37, 15.6±7.3dB, and 50.9±22.2 points, respectively; P<0.05 for all outcome measures). The mean number of measure points with an absolute scotoma before surgery had decreased significantly 6months after surgery (from 40.5±15.0 to 9.4±16.0 points; P<0.001). Displacement of SMH effectively improves retinal sensitivity as well as BCVA.

The Use of Microperimetry to Detect Functional Progression in Non-Neovascular Age-Related Macular Degeneration: A Systematic Review.

We reviewed the current literature on the ability of microperimetry to detect non-neovascular age-related macular degeneration (AMD) disease progression. The index test was retinal sensitivity measurement assessed by microperimetry and comparators were other functional measures (best-corrected and low-luminance visual acuities, and fixation stability) and structural parameters [retinal thickness, choroidal thickness, and area of geographic atrophy (GA) determined by color fundus photographs, short-wave or near-infrared fundus autofluorescence]. The reference standard was area of GA. The literature search was conducted in January 2016 and included MEDLINE, EMBASE, the Cochrane Library, Biosis, Science Citation Index, ProQuest Health and Medicine, CINAHL, and Highwire Press. We included 6 studies that enrolled 41 eyes with intermediate AMD (from a single study) and 80 eyes with GA secondary to AMD. Retinal sensitivity measured by microperimetry was the only functional measure that consistently detected progression in each cohort. Insufficient reported data precluded meta-analysis. Various microperimetry parameters were used to assess cohort-level change in retinal sensitivity, but the methods of analysis have yet to mature in complexity in comparison with established glaucoma field progression analysis. Microperimetry-assessed retinal sensitivity measurement may be more sensitive in detecting progression than other functional measures in non-neovascular AMD. However, the lack of standardized testing protocol and methods of progression analysis hindered comparison. Harmonization of testing protocol and development of more robust methods of analyzing raw microperimetric data will facilitate clinical implementation of this valuable retinal assessment tool.

Spatial Interpolation Enables Normative Data Comparison in Gaze-Contingent Microperimetry.

To demonstrate methods that enable visual field sensitivities to be compared with normative data without restriction to a fixed test pattern. Healthy participants (n = 60, age 19-50) undertook microperimetry (MAIA-2) using 237 spatially dense locations up to 13° eccentricity. Surfaces were fit to the mean, variance, and 5th percentile sensitivities. Goodness-of-fit was assessed by refitting the surfaces 1000 times to the dataset and comparing estimated and measured sensitivities at 50 randomly excluded locations. A leave-one-out method was used to compare individual data with the 5th percentile surface. We also considered cases with unknown fovea location by adding error sampled from the distribution of relative fovea-optic disc positions to the test locations and comparing shifted data to the fixed surface. Root mean square (RMS) difference between estimated and measured sensitivities were less than 0.5 dB and less than 1.0 dB for the mean and 5th percentile surfaces, respectively. Root mean square differences were greater for the variance surface, median 1.4 dB, range 0.8 to 2.7 dB. Across all participants 3.9% (interquartile range, 1.8-8.9%) of sensitivities fell beneath the 5th percentile surface, close to the expected 5%. Positional error added to the test grid altered the number of locations falling beneath the 5th percentile surface by less than 1.3% in 95% of participants. Spatial interpolation of normative data enables comparison of sensitivity measurements from varied visual field locations. Conventional indices and probability maps familiar from standard automated perimetry can be produced. These methods may enhance the clinical use of microperimetry, especially in cases of nonfoveal fixation.

Fascicular Visual Field Defects in Open-Angle Glaucoma: Evaluation with Microperimetry.

Purpose. Use of microperimetry (Mp-1), correlating with Humphrey perimetry (30-2 program), in patients affected by primary open-angle glaucoma (POAG) with perimetric defects, in order to obtain an evaluation of the accuracy of the results obtained by Mp-1. Materials and Methods. In this study 40 eyes of 25 patients affected by POAG with perimetric defects were included. All patients underwent microperimetry test by Nidek Mp-1 (NAVIS software version 1.7.2, Nidek Technologies). Mean sensitivity values expressed in decibel (dB) of all tested dots and mean values for each quadrant obtained by microperimetric test were correlated with corresponding quadrants obtained by static perimetry analysis. Data were analyzed by Pearson's correlation and Bland-Altman analysis. Results. Interpolated data showed that mean sensitivity values in all spots tested by Mp-1 (11.98 dB, SD 4.31) may be significantly correlated with mean total values obtained by Humphrey 30-2 perimetry (17.95, SD 4.32), with correlation coefficient of 0.556. Conclusions. Topographic visualization of the perimetric alteration by microperimetry allows retesting areas with reduced sensitivity which are topographically visualized and displayable on the ocular fundus examination, avoiding worsening of the functional defect by better modulation of the antiglaucoma therapy and therefore it allows better monitoring of the pathologic functional damage.

Screening Patients With Cataract for Premium IOL Candidacy Using Microperimetry.

To explore the use of microperimetry in the evaluation of macular dysfunction in patients with cataract, to aid in proper intraocular lens selection (multifocal vs monofocal), and to set expectations for postoperative visual function. One randomly chosen eye of 10 patients diagnosed as having mild (1+) to moderate (3+) cataract was evaluated before and 1 week after cataract surgery with the MAIA microperimeter (Centervue S.p.A, Padova, Italy). Corrected distance visual acuity, dilated and undilated biomicroscopy and indirect fundus examinations, intraocular pressure measurement, and a MAIA microperimeter test to measure macular sensitivity and fixation pattern were also performed. Two patients showed macular abnormalities before and after surgery that were noted on MAIA testing: one patient showed reduced average threshold sensitivity and abnormal percent reduced threshold, whereas the other patient showed fixation drift demonstrating eccentric fixation. Both eyes had reduced postoperative visual performance after uneventful cataract surgeries. Because not every macular lesion noted on fundus examination or optical coherence tomography may be clinically significant, microperimetry can be useful to detect clinically significant retinal dysfunction prior to cataract surgery. The outcome may aid in the selection of intraocular lens type and may yield a better documented surgical prognosis. Further studies are necessary to confirm these findings.

Use of microperimetry to evaluate hydroxychloroquine and chloroquine retinal toxicity

ObjectiveTo check the ability of microperimetry to detect early retinal damage in patients with rheumatism taking hydroxychloroquine (HCQ), chloroquine (CQ), or both, and to describe the microperimetric alterations attributable to these drugs and their correlation with some clinical variables. DesignControlled cross-sectional study. ParticipantsPatient group was 209 patients taking HCQ or CQ. Control group was 204 individuals not taking antimalarials. Exclusion criterion was other diseases that could alter microperimetry. MethodsAn ophthalmic examination and a microperimetry were performed on all individuals. Outcomes measured were average threshold, fixation stability, and macular integrity. Information about patient weight, height, main diagnosis, daily and cumulative dose, and creatinine, bilirubin, and transaminases levels were collected. Analysis of variance, t tests, and a regression analysis were carried out to detect differences between groups. ResultsSignificant differences in microperimetry indexes were detected between cases and control subjects, between patients of different age groups, and between patients taking CQ and HCQ. Significant differences were also detected in retinal sensitivity between patients overdosed for CQ, but not for those overdosed for HCQ. Daily overdosing per ideal weight alone cannot explain retinal toxicity, although the effect of cumulative dose in macular sensibility is significant to explain both average threshold and macular integrity. ConclusionsMicroperimetry is an accurate tool for detecting early macular hyposensibility caused by CQ and HCQ. Microperimetry indexes of retinal sensibility are worse in elderly patients taking these drugs and in short-stature patients taking CQ. A high cumulative dose is an important factor in explaining retinal hyposensibility on microperimetry.

A Simplified Method of Identifying the Trained Retinal Locus for Training in Eccentric Viewing

In the typical human visual system, the macula allows for high visual resolution. Damage to this area from diseases, such as age-related macular degeneration (AMD), causes the loss of central vision in the form of a central scotoma (Kanski, 2008). Since no treatment is available to reverse AMD, providing low vision rehabilitation to compensate for the loss of central vision is invaluable for individuals with this condition. Teaching persons with a central scotoma the technique of eccentric viewing to use their remaining peripheral retina to read and perform tasks of daily living has been shown to be effective (Nilsson, Frennesson, & Nilsson, 2003; Petre, Hazel, Fine, & Rubin, 2000; Vukicevic & Fitzmaurice, 2002). It has been reported that persons with AMD can unconsciously adopt an eccentric area of the uncompromised retina, allowing them to achieve better vision. This eccentric area acts as a pseudo-fovea and is termed the preferred retinal locus (PRL) (Schuchard, 1995; Timberlake et al., 1986). Although useful, this spontaneous choice of location may not provide optimal vision for individuals to perform various visual tasks, such as reading, recognizing faces, or performing activities of daily living. Optimizing the location of the retinal area used can be addressed with formal training in eccentric viewing to teach individuals to use a more suitable part of their retina to see by introducing a trained retinal locus (TRL) (Culham, Silver, & Bird, 1990; Fletcher, Schuchard, & Watson, 1999; Nilsson et al., 2003; Vukicevic & Fitzmaurice, 2005, 2009). Although there are many methods for training eccentric viewing, the fundamental principles are equivocal and involve two stages: 1. Identification of the residual areas of the healthy retina by mapping the individual's visual field and 2. Location of the most suitable area to be used as the TRL on the basis of the proximity to the fovea. A number of methods and apparatuses are available to chart the visual field, but the preferred method is by microperimetry with such devices as the Macular Integrity Assessment Microperimeter (CenterVue SpA, Padova, Italy) or the Nidek MP-1 Micro Perimeter (Nidek Technologies Srl, Padova, Italy). Alternately, the visual field can be mapped by tangent screen perimetry, such as the Bjerrum tangent screen. Microperimetry allows clinicians to precisely delineate the borders of the scotoma and the corresponding visible pathology on the retina. The technique is also capable of displaying direct, real-time observation of the retina, and stimuli can be placed on the retina for the purposes of training in eccentric viewing. For this reason, microperimetry is useful (Sunness, Bressler, & Maguire, 1995; Timberlake et al., 1986). Nevertheless, microperimetry is not widely used clinically because it is considered to be the least popular method of identifying the retinal locus for eccentric viewing training (Weisser-Pike, 2008). Low vision practitioners have reported that microperimeters are difficult to use and difficult for clients to understand how to perform the required task. The preference is for simpler methods, such as the Amsler grid or the Bjerrum tangent screen. Clinicians' preference is not the only issue that restricts the clinical use of microperimetry in a low vision setting: it is expensive equipment and hence is generally reserved for research purposes (Manivannan et al., 2001). Low vision practitioners commonly use the Bjerrum tangent screen as a method of mapping the central visual field or the central scotoma or both. The Bjerrum tangent screen is a black felt screen that evaluates the central 30 degrees of the retina at a one- or two-meter (about 3 feet or 6.5 feet) testing distance. The Bjerrum has statico-kinetic properties that allow the borders of the scotoma to be accurately charted (kinetically) and individual test points to be grossly quantified (statically). …

Use of microperimetry to compare macular light sensitivity in eyes with open-angle and angle-closure glaucoma

Use of microperimetry to compare macular light sensitivity in early and moderate primary open-angle glaucoma (POAG), chronic angle-closure glaucoma (CACG), and normal controls. A cross-sectional, case-control, comparative study. A total of 126 eyes from 126 subjects, 53 normal eyes, 50 POAG eyes, and 23 CACG eyes were studied. A macular 10° program was performed with MP-1 microperimetry. The mean sensitivities (MS) of the central 2°, 6°, and 10° visual fields were compared among the POAG, CACG, and normal controls. The mean light sensitivities of the four quadrants in the central 6° were also analyzed in each group. The MS of the central 2°, 6°, 10°, and total macular areas in the POAG patients were significantly reduced compared with those for the normal controls (all P < 0.05). The MS of the central 6°, 10°, and total areas, except those at the central 2°, in the CACG patients were significantly reduced. In the central 6°, more severe loss of MS was observed in the inferotemporal quadrant in the POAG group. In the CACG group, the reduction in the MS among the four quadrants was not significantly different (P = 0.623). Different patterns of macular function damage were identified in both early and moderate stage POAG and in CACG patients.