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Kalas T, Newman A, Whyte J, Sharma A. Clinical utilization of microperimetry in ophthalmic surgery: A narrative review. Surv Ophthalmol 2023:S0039-6257(23)00142-X. [PMID: 37918576 DOI: 10.1016/j.survophthal.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 10/17/2023] [Accepted: 10/23/2023] [Indexed: 11/04/2023]
Abstract
Microperimetry is an emerging technology that provides concurrent analysis of retinal structure and function by combining retinal sensitivity and fixation analysis with fundus imaging. We summarize the substantial evidence validating the evolving role of microperimetry as an adjunctive assessment of visual function in the perioperative setting. We show that microperimetry provides useful complementary information to other established imaging and functional modalities in the perioperative setting for a wide range of vitreoretinal surgical procedures, as well as in cataract and refractive surgeries. This includes preoperative uses such as prognostication of visual and anatomical outcomes, timing of surgical intervention, and assessment of patient suitability for surgery-as well as postoperative uses including quantification of visual recovery, investigation of unexplained postoperative vision loss, and informing expected long term functional outcomes.
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Affiliation(s)
- Timothy Kalas
- Department of Ophthalmology, Queensland Children's Hospital, Queensland, Australia.
| | - Alexander Newman
- Department of Ophthalmology, Royal Brisbane and Women's Hospital, Queensland, Australia; School of Medicine, Griffith University, Southport, Queensland, Australia
| | - Jonathan Whyte
- Department of Ophthalmology, Royal Brisbane and Women's Hospital, Queensland, Australia; School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Abhishek Sharma
- Department of Ophthalmology, Royal Brisbane and Women's Hospital, Queensland, Australia; School of Medicine, University of Queensland, Brisbane, Queensland, Australia; Queensland Eye Institute, South Brisbane, Queensland, Australia
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Kaga T, Kojima T, Yokoyama S, Sato H, Yoshida N, Ichikawa K. SUBRETINAL ENDOSCOPIC SURGERY TO TREAT LARGE SUBRETINAL HEMORRHAGES SECONDARY TO AGE-RELATED MACULAR DEGENERATION. Retina 2019; 39:896-905. [DOI: 10.1097/iae.0000000000002031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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von der Emde L, Pfau M, Thiele S, Möller PT, Hassenrik R, Fleckenstein M, Holz FG, Schmitz-Valckenberg S. Mesopic and Dark-Adapted Two-Color Fundus-Controlled Perimetry in Choroidal Neovascularization Secondary to Age-Related Macular Degeneration. Transl Vis Sci Technol 2018; 8:7. [PMID: 30637177 PMCID: PMC6327348 DOI: 10.1167/tvst.8.1.7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 10/17/2018] [Indexed: 01/14/2023] Open
Abstract
Purpose To determine the retest variability of mesopic and two-color dark-adapted (DA) fundus-controlled perimetry (FCP), to evaluate the predictive value of patient reliability indices, and to analyze the extent of impairment of rod- and cone function in neovascular age-related macular degeneration (nAMD). Methods A total of 50 eyes of 50 patients with nAMD (mean age, 76.1 years) and 70 eyes of 70 age-similar normal subjects underwent multimodal imaging as well as mesopic and DA two-color perimetry using the S-MAIA device. A subset of patients (n = 28) underwent duplicate testing for retest reliability assessment. Mixed models were used for analysis of the hierarchical data. Results In eyes with nAMD, the coefficient of repeatability was (mean ± standard deviation [SD]) 5.99 ± 1.55 dB for mesopic, 6.14 ± 2.19 dB for DA cyan, and 6.06 ± 1.09 dB for DA red testing. “Patient reliability indices” explained 55%, 54.2%, and 64.2% of the variance in retest variability. The mean sensitivity loss was greater for DA cyan compared to DA red testing (cyan-red differences [mean ± SD] −2.63 ± 3.87 dB, P < 0.001). Conclusions The relatively greater degree of DA cyan versus DA red sensitivity loss indicates preferential rod vulnerability in nAMD, and qualifies rod function-based outcomes measures as potential sensitive and early markers of treatment response in nAMD. Translational Relevance The S-MAIA allows reliable testing of mesopic, DA cyan, and DA red sensitivity in patients with nAMD. Patient reliability indices may serve as eligibility criteria for clinical trials to identify patients with adequate retest reliability.
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Affiliation(s)
- Leon von der Emde
- Department of Ophthalmology, University of Bonn, Ernst-Abbe-Str. 2, Bonn, Germany
| | - Maximilian Pfau
- Department of Ophthalmology, University of Bonn, Ernst-Abbe-Str. 2, Bonn, Germany.,GRADE Reading Center, University of Bonn, Ernst-Abbe-Str. 2, Bonn, Germany
| | - Sarah Thiele
- Department of Ophthalmology, University of Bonn, Ernst-Abbe-Str. 2, Bonn, Germany.,GRADE Reading Center, University of Bonn, Ernst-Abbe-Str. 2, Bonn, Germany
| | - Philipp T Möller
- Department of Ophthalmology, University of Bonn, Ernst-Abbe-Str. 2, Bonn, Germany.,GRADE Reading Center, University of Bonn, Ernst-Abbe-Str. 2, Bonn, Germany
| | - Ruth Hassenrik
- Department of Ophthalmology, University of Bonn, Ernst-Abbe-Str. 2, Bonn, Germany
| | - Monika Fleckenstein
- Department of Ophthalmology, University of Bonn, Ernst-Abbe-Str. 2, Bonn, Germany.,GRADE Reading Center, University of Bonn, Ernst-Abbe-Str. 2, Bonn, Germany
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Ernst-Abbe-Str. 2, Bonn, Germany.,GRADE Reading Center, University of Bonn, Ernst-Abbe-Str. 2, Bonn, Germany
| | - Steffen Schmitz-Valckenberg
- Department of Ophthalmology, University of Bonn, Ernst-Abbe-Str. 2, Bonn, Germany.,GRADE Reading Center, University of Bonn, Ernst-Abbe-Str. 2, Bonn, Germany
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The use of microperimetry in assessing visual function in age-related macular degeneration. Surv Ophthalmol 2017; 63:40-55. [PMID: 28579549 DOI: 10.1016/j.survophthal.2017.05.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 05/22/2017] [Accepted: 05/25/2017] [Indexed: 11/23/2022]
Abstract
Microperimetry is a novel technique for assessing visual function that appears particularly suitable for age-related macular degeneration (AMD). Compared with standard automated perimetry, microperimetry offers several unique features. It simultaneously images the fundus, incorporates an eye-tracking system to correct the stimulus location for fixation loss, and identifies any preferred retinal loci. We identified 52 articles that met the inclusion criteria for a systematic review of microperimetry in the assessment of visual function in AMD. We discuss microperimetry and AMD in relation to disease severity, structural imaging outcomes, other measures of visual function, and evaluation of the efficacy of surgical and/or medical therapies in clinical trials. The evidence for the use of microperimetry in the functional assessment of AMD is encouraging. Disruptions of the ellipsoid zone band and retinal pigment epithelium are clearly associated with reduced differential light sensitivity despite the maintenance of good visual acuity. Reduced differential light sensitivity is also associated with outer segment thinning and retinal pigment epithelium thickening in early AMD and with both a thickening and a thinning of the whole retina in choroidal neovascularization. Microperimetry, however, lacks the robust diffuse and focal loss age-corrected probability analyses associated with standard automated perimetry, and the technique is currently limited by this omission.
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Midena E, Pilotto E. Microperimetry in age: related macular degeneration. Eye (Lond) 2017; 31:985-994. [PMID: 28257134 DOI: 10.1038/eye.2017.34] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 01/18/2017] [Indexed: 11/09/2022] Open
Abstract
Age-related macular degeneration (AMD) is one of the major causes of visual loss and legal blindness in people over 55. Visual function tests are the cornerstone of visual function investigation and any therapeutic approach to AMD implies, as primary endpoint, the maintenance or improvement of visual function. The progression of visual impairment and the quantification of final residual visual function are currently determined by means of visual acuity quantification. The quantification of high-contrast visual acuity though has many drawbacks and cannot be considered a complete functional examination. Microperimetry is a non-invasive method used to analyse fixation and central visual field defects in a topographic related manner. The introduction of mesopic and more recently scotopic microperimetry, in research and clinical practice of macular disorders, now allows us to better investigate macular function as it strictly relates to macular morphology. We therefore can monitor the functional natural history and quantify the beneficial or detrimental effects of different therapies. The application of microperimetry in clinical studies has provided interesting diagnostic and prognostic information on functional macular changes in AMD patients. The present review brings new updates on the correlation between macular changes, mainly described with optical coherence tomography, and microperimetry changes in patients with AMD.
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Affiliation(s)
- E Midena
- Department of Ophthalmology, University of Padova, Padova, Italy.,GB Bietti Foundation, IRCCS, Rome, Italy
| | - E Pilotto
- Department of Ophthalmology, University of Padova, Padova, Italy
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Ramos de Carvalho JE, Willig A, Chung R, Peiretti E, Mura M. Current surgical treatment of age-related macular degeneration. EXPERT REVIEW OF OPHTHALMOLOGY 2014. [DOI: 10.1586/17469899.2014.920692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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