Comparison of Macular Integrity Assessment (MAIA ™), MP-3, and the Humphrey Field Analyzer in the Evaluation of the Relationship between the Structure and Function of the Macula

Macular integrity assessment microperimeter, Humphrey field analyzer and OCT in glaucoma practice: a correlation study

OBJECTIVE

To compare and correlate retinal sensitivities measured with macular integrity assessment microperimetry (MAIA-MP) and Humphrey field analyzer (HFA) 10-2 tests with structural parameters obtained from optical coherence tomography (OCT) in primary open-angle glaucoma (POAG) and ocular hypertension.

METHODS

This study included 63 participants (22 with POAG, 20 with ocular hypertension, and 21 control individuals). All participants underwent HFA 10-2 and MAIA-MP (macular retinal sensitivity tests) and measurements for optic nerve head (ONH), peripapillary retinal nerve fibre layer thickness (PRNFLT), and ganglion cell inner plexiform layer thickness (GCIPLT) using OCT. The relationship between macular retinal sensitivity and OCT parameters was evaluated by Pearson correlation analysis and linear regression modelling.

RESULTS

POAG cases had a strong association between the MAIA-MP and ONH parameters (optic disc area [ODA], p = 0.037; cup volume, p = 0.043), PRNFLT (average, p = 0.009; inferior PRNFLT, p = 0.004), and GCIPLT in all macula sectors (p ≤ 0.005 for all). HFA 10-2 had a moderate correlation with the ONH parameters (cup-to-disc ratio [CDR], p = 0.042; vertical CDR, p = 0.037; cup volume, p = 0.037; ODA, p = 0.014), PRNFLT (average, inferior, and nasal, p < 0.05 for all), and GCIPLT in all macula sectors (p < 0.005 for all). OHT cases had a weak correlation between HFA 10-2 and nasal and superior PRNFLTs (p = 0.035 and p = 0.047, respectively).

CONCLUSION

MAIA-MP and HFA 10-2 functional parameters have strong correlations with the structural parameters obtained by OCT in POAG cases. Both devices are useful in assessing the central visual field in glaucoma, with MAIA-MP potentially beneficial in patients with limited cooperation or poor vision.

Trends in research related to ophthalmic microperimetry from 1992 to 2022: A bibliometric analysis and knowledge graph study

Background

Microperimetry is a novel technology to assess macular function. The aim of the study was to explore the global research status and trends in microperimetry.

Methods

Documents related to microperimetry in ophthalmology from 1992 to 2022 were extracted from the Science Citation Index Expanded (SCI-E) database of the Web of Science Core Collection (WOSCC). Raw data were analyzed using the VOSviewer and CiteSpace software. Bibliometric parameters included annual publication quantity, countries, authors, journals, international cooperation, and keywords.

Results

A total of 1,217 peer-reviewed documents were retrieved. Annual research output has increased significantly since 2005, especially since 2013. Holz F, Rubin G, and Guymer R contributed most to the number of articles published about microperimetry. Rubin G, Fitzke F, and Holz F, respectively, received the most citations for their study. The countries publishing most were the USA, Italy, and the UK, while the USA, the UK, and Germany received the most citation frequency. Univ Bonn, UCL, and Moorfields Eye Hosp were the top three productive institutions for microperimetry research in the world. The top three journals that publish articles about microperimetry were Retina-The Journal of Retinal and Vitreous Diseases, Investigative Ophthalmology and Visual Science, and the American Journal of Ophthalmology. The top 10 common keywords included microperimetry, optical coherence tomography, eye, retinal sensitivity, macular degeneration, fundus autofluorescence, scanning laser ophthalmoscope, visual acuity, sensitivity, and degeneration. Keywords "optical coherence tomography angiography," "retinitis pigmentosa," and "internal limiting membrane" burst in the last 3 years.

Conclusion

The bibliometric and knowledge graph analysis of research status and trends in microperimetry provided global researchers with valuable information to propose future cooperation and track cutting-edge progress.

Focal electroretinogram and microperimetry testing of photoreceptor-retinal pigment epithelium function in intermediate age-related macular degeneration

Purpose

To compare the performance of focal electroretinogram (FERG) and fast mesopic microperimetry in evaluating macular function of intermediate age‐related macular degeneration (iAMD) subjects with preserved visual acuity.

Methods

Cross‐sectional, observational study. Participants with drusen >125 µm and VA ≥80 ETDRS letters and age‐ and sex‐comparable healthy subjects were consecutively enrolled in the study. Three photopic FERG recordings of the central 9° of the macula with luminance modulated stimuli flickering at 42.5 Hz and a fast mesopic microperimetry with a custom pattern of 3 central (CS) and 3 paracentral (pCS) stimuli at 1.2° and 6° from fixation were acquired.

Results

Overall, 112 eyes of 77 participants (age 73.0 ± 7.1 years, 47 iAMD eyes) were analysed. Mean FERG amplitude, CS and pCS (all p < 0.05) were lower in the iAMD group. A significant association was observed between FERG amplitude and iAMD (OR 9.58, p < 0.001) in multiple logistic regression analysis. Z‐scores of FERG were lower than microperimetry in iAMD (p = 0.002) but not for healthy participants. AUC of the ROC curve was greater for FERG than microperimetry (0.895 versus 0.644 and 0.675, both p < 0.05).

Conclusion

Focal ERG objectively measures a cumulative response originating from the photoreceptor‐RPE complex of the central 9° of the macula and demonstrated high accuracy in identifying decreased central macular function in iAMD patients with preserved visual acuity, performing better than fast mesopic microperimetry. Focal ERG should be considered a reliable technique for measuring retinal sensitivity of iAMD patients.

Comparison of the structure-function relationship between compass microperimetry and Humphrey field analyser in myopic open-angle glaucoma eyes

BACKGROUND/AIMS

To compare the structure-function relationship between compass microperimetry (CMP; CenterVue, Padova, Italy) and Humphrey field analyser (HFA; Carl Zeiss Meditec, Dublin, California, USA) in open-angle glaucoma (OAG) eyes with myopia.

METHODS

Circumpapillary retinal nerve fibre layer thickness (cpRNFLT) and visual field (VF) mean sensitivity (MS) were obtained in 90 OAG subjects using the optical coherence tomography, CMP and HFA in a random order. The global and sectoral structure-function relationships between the cpRNFLT and VFMS were assessed with different VF devices (CMP vs HHA) in OAG eyes with and without myopia.

RESULTS

Overall, the global and regional structure-function relationships between the two devices did not show significant differences except for the superotemporal sector. In the myopic subgroup, the global association between the average cpRNFLT and VFMS_CMP was significantly stronger than that between the average cpRNFLT and VFMS_HFA (r=0.806 vs. 0.720, p=0.035). The presence of myopia and higher global cpRNFLT were significantly associated with the greater global VFMS differences between the two devices (p<0.05).

CONCLUSION

In general, structure-function relationship is similar between CMP and HFA in OAG eyes. However, the global structure-function relationship is significantly stronger with CMP than with HFA in OAG eyes with myopia.

A Comparison Among Microperimetry, Standard Automated Perimetry and Spectral Domain Optical Coherence Tomography in the Evaluation of the Macula in Glaucoma Eyes with Hemifield Defects

Introduction

To evaluate the correlation between macular integrity assessment (MAIA) and standard automated perimetry (SAP) in detecting macular function damage in glaucoma and to explore the relationship between macular structure and functional damage by using spectral domain optical coherence tomography (SD-OCT).

Methods

This was a cross-sectional study. Seventy patients with glaucoma, with hemifield defects verified by Humphrey 24-2 examination, and 60 normal subjects underwent Humphrey 10-2 and MAIA expert 10-2 examinations. Patients with glaucoma with normal hemifields, as detected by SAP, were divided into a normal hemifield group and a visual field (VF) defect group. The difference in the retina and ganglion cell complex (GCC) thicknesses was analyzed between the abnormal and normal hemifields.

Results

Among the 70 glaucoma eyes, the results of MAIA and SAP were consistent for 66 (66/70, 94.3%). The others showed SAP hemifield defects, while MAIA was normal (4/70, 5.7%). There was a good correlation of the mean sensitivity between MAIA and SAP (P < 0.001). There also was a good correlation between the mean threshold of MAIA and the mean deviation (MD) of SAP (P = 0.008, r = 0.507). Among the patients with glaucoma with a normal hemifield, MAIA showed abnormal results in 50 eyes (50/66, 75.8%), which was consistent with the changes in the inner retina and GCC thicknesses. Meanwhile, MAIA showed normal results; there were no significant differences between patients with glaucoma and the normal group in the thicknesses of the inner retina and GCC.

Conclusion

MAIA and SAP have good consistency in detecting macular dysfunction. MAIA can also identify abnormal VFs in the macular regions that may not be detected by SAP, which is consistent with the changes in the GCC thicknesses, suggesting that there may be central VF damage in patients with glaucoma that has not been previously identified.

Retinal Differential Light Sensitivity Variation Across the Macula in Healthy Subjects: Importance of Cone Separation and Loci Eccentricity

Purpose

Microperimetry measures differential light sensitivity (DLS) at specific retinal locations. The aim of this study is to examine the variation in DLS across the macula and the contribution to this variation of cone distribution metrics and retinal eccentricity.

Methods

Forty healthy eyes of 40 subjects were examined by microperimetry (MAIA) and adaptive optics imaging (rtx1). Retinal DLS was measured using the grid patterns: foveal (2°–3°), macular (3°–7°), and meridional (2°–8° on horizontal and vertical meridians). Cone density (CD), distribution regularity, and intercone distance (ICD) were calculated at the respective test loci coordinates. Linear mixed-effects regression was used to examine the association between cone distribution metrics and loci eccentricity, and retinal DLS.

Results

An eccentricity-dependent reduction in DLS was observed on all MAIA grids, which was greatest at the foveal-parafoveal junction (2°–3°) (−0.58 dB per degree, 95% confidence interval [CI]; −0.91 to −0.24 dB, P < 0.01). Retinal DLS across the meridional grid changed significantly with each 1000 cells/deg² change in CD (0.85 dB, 95% CI; 0.10 to 1.61 dB, P = 0.03), but not with each arcmin change in ICD (1.36 dB, 95% CI; −2.93 to 0.20 dB, P = 0.09).

Conclusions

We demonstrate significant variation in DLS across the macula. Topographical change in cone separation is an important determinant of the variation in DLS at the foveal-parafoveal junction. We caution the extrapolation of changes in DLS measurements to cone distribution because the relationship between these variables is complex.

Translational Relevance

Cone density is an independent determinant of DLS in the foveal-parafoveal junction in healthy eyes.

Microperimetry-Assessed Functional Alterations and OCT-Changes in Patients after Retinal Detachment Surgery Using Pars Plana Vitrectomy and SF6 Tamponade

Background: We study the retinal function measured by macular integrity assessment microperimetry (MAIA) and structural changes assessed by scanning swept source optical coherence tomography (SS-OCT) between healthy individuals and patients undergoing pars plana vitrectomy (PPV) after rhegmatogenous retinal detachment (RRD). Methods: Cross-sectional study. Early Treatment Diabetic Retinopathy Study (ETDRS) grids were measured by SS-OCT and compared with the MAIA parameters. Results: Thirty-eight eyes with RRD (19 macula-on and 19 macula-off) were compared with 113 healthy eyes. The retinal sensitivity and average total threshold were reduced in all sectors in the RRD group; macular integrity index was increased. Macular thicknesses in total retina and ganglion cell layer (GCL)++ protocols were higher in the RRD group in nasal outer (NO) and central (C) sectors and only in C sector for GCL+ protocol. Thicknesses were lower in total retina, GCL++ protocols in the temporal outer (TO) sector and in the GCL+ protocol in NO sector. Best-corrected visual acuity (BCVA) correlated moderately with retinal sensitivity in all sectors and in just several sectors with time between the date of surgery and the test. The central nasal (CN) sector thickness and the average total threshold were higher in the macula-on subgroup. Conclusions: RRD and subsequent surgery results in functional and structural changes, especially in individuals with macular detachment.

Relationship between retinal sensitivities and optical coherence tomographic findings in eyes with myopic chorioretinal atrophy

PURPOSE

To determine whether there is a significant correlation between the retinal sensitivity and the integrity of the ellipsoid zone (EZ) of the photoreceptors in eyes with myopic chorioretinal atrophy (CRA). We also determined the significance of the correlation between the retinal sensitivity and the retinal and choroidal thicknesses.

METHODS

The medical records of 10 eyes of six subjects with myopic CRA were reviewed. The integrity of the EZ was determined in the spectral-domain optical coherence tomographic (OCT) images at 37 points of six scans corresponding to the locations where the retinal sensitivities were measured by MP-3 microperimetry. The mesopic retinal sensitivities were determined within the central 16°. The significance of the correlations between the integrity of the EZ and the mesopic retinal sensitivities was determined. The relationships between the retinal and choroidal thickness and the retinal sensitivity were also determined.

RESULTS

The average age of the patients was 70.0 ± 6.7 years, and the average axial length of the eye was 29.2 mm. The mesopic sensitivities at the points where the EZ was present were significantly higher than those where the EZ was absent (p < 0.01). The mesopic sensitivity was significantly correlated with the retinal thickness (p < 0.01, r = 0.30) and the choroidal thickness (p < 0.01, r = 0.23).

CONCLUSIONS

The significant correlation between the mesopic retinal sensitivity and the integrity of the EZ indicates that the mesopic sensitivities can be used to assess the integrity of the photoreceptors in eyes with myopic CRA.

Comparison of the Humphrey Field Analyzer and Photopic Negative Response of Focal Macular Electroretinograms in the Evaluation of the Relationship Between Macula Structure and Function

Purpose: To investigate the association between macular inner retinal layer thickness and macula visual field (VF) mean deviation as measured by the Humphrey Field Analyzer (HFA) or macular function as measured by focal macular electroretinograms (ERGs) in patients with glaucoma.

Methods: The participants in this cross-sectional study were 71 patients with glaucoma and 10 healthy controls. Macular inner retinal layer thickness and function were measured in all participants using optical coherence tomography (OCT) and HFA or focal macular ERGs, respectively. Macular OCT images were segmented into the macular retinal nerve fiber layer (mRNFL), macular ganglion cell layer/inner plexiform layer (GCL/IPL), and ganglion cell complex (GCC). Spearman correlation analysis was used to assess the relationship between macular inner retinal layer thickness and function.

Results: Focal macular ERGs were composed of a negative wave (N1), a positive wave (P1), and a slow negative wave (N2). The N2 response density was significantly reduced in eyes with glaucoma, and was significantly associated with the thickness of the mRNFL (R = 0.317), GCL/IPL (R = 0.372), or GCC (R = 0.367). The observed structure–function relationship was also significantly correlated with the HFA VF mean deviation for each thickness [mRNFL (R = 0.728), GCL/IPL (R = 0.603), or GCC (R = 0.754)].

Conclusions: Although a significant correlation was found between the N2 response density and the thickness of the macular inner layer, the observed structure–function relationship with the mean deviation of the HFA VF was higher than that of the N2 response density.

Fundus-controlled perimetry (microperimetry): Application as outcome measure in clinical trials

Fundus-controlled perimetry (FCP, also called 'microperimetry') allows for spatially-resolved mapping of visual sensitivity and measurement of fixation stability, both in clinical practice as well as research. The accurate spatial characterization of visual function enabled by FCP can provide insightful information about disease severity and progression not reflected by best-corrected visual acuity in a large range of disorders. This is especially important for monitoring of retinal diseases that initially spare the central retina in earlier disease stages. Improved intra- and inter-session retest-variability through fundus-tracking and precise point-wise follow-up examinations even in patients with unstable fixation represent key advantages of these technique. The design of disease-specific test patterns and protocols reduces the burden of extensive and time-consuming FCP testing, permitting a more meaningful and focused application. Recent developments also allow for photoreceptor-specific testing through implementation of dark-adapted chromatic and photopic testing. A detailed understanding of the variety of available devices and test settings is a key prerequisite for the design and optimization of FCP protocols in future natural history studies and clinical trials. Accordingly, this review describes the theoretical and technical background of FCP, its prior application in clinical and research settings, data that qualify the application of FCP as an outcome measure in clinical trials as well as ongoing and future developments.

Comparison and Correlation of Retinal Sensitivity Between Microperimetry and Standard Automated Perimetry in Low-tension Glaucoma

PRéCIS:: Our study demonstrated that in low-tension glaucoma (LTG) patients, Microperimeter-3 (MP-3)-derived and Humphrey Field Analyzer (HFA)-derived retinal sensitivities were similar and strongly correlated, allowing the respective data to be interrelated.

PURPOSE

To compare and correlate retinal sensitivities obtained by Nidek MP-3 with those obtained from the HFA in eyes with LTG.

MATERIALS AND METHODS

In this prospective comparative study, 45 eyes of 24 LTG patients underwent retinal sensitivity assessments using the MP-3 (Nidek Technologies) and the HFA (Carl Zeiss Meditec) at the UCLA-Doheny Eye Center. Global and pointwise retinal sensitivity measurements were compared and correlated between the 2 devices.

RESULTS

No statistically significant differences (P=0.85) were noted between the mean retinal sensitivities determined by each device (MP-3: 26.33±4.31 dB; range, 13.05 to 31.60 vs. HFA: 26.42±3.98 dB; range, 17.17 to 30.96), and a strong correlation (r=0.66, P<0.001) was noted for retinal sensitivity measurements. In addition, moderate to strong correlations were observed between the mean retinal sensitivity derived by MP-3 versus HFA-derived mean deviation (r=0.57, P<0.001), as well as, the pattern standard deviation (r=0.67, P<0.001). The intraclass correlation coefficient was excellent (ICC=0.80, 95% confidence interval, 0.63-0.89), while the Bland-Altman analysis showed good agreement between the 2 devices with respect to retinal sensitivity.

CONCLUSION

Retinal sensitivity measurements obtained by the MP-3 microperimetry instrument and the standard automated HFA perimeter were similar and highly correlated in patients with LTG. Given the potential benefits of microperimetry technology such as auto-eye-tracking and potentially more precise structure-function correlations, the use of microperimetry to monitor visual function in glaucoma management warrants further consideration.

Correlation of retinal sensitivity in microperimetry with vascular density in optical coherence tomography angiography in primary open-angle glaucoma

Purpose

To evaluate the correlation between retinal sensitivity in microperimetry (MP) with vessel density (VD) using optical coherence tomography angiography (OCTA) in primary open-angle glaucoma (POAG).

Methods

We enrolled 30 participants (52 eyes) with POAG and 15 participants (23 eyes) in the healthy control group. All participants were examined for retinal structure using OCTA to assess VD and Spectral domain OCT (SD-OCT) to assess ganglion cell complex (GCC) and peripapillary retinal nerve fiber layer (pRNFL) thickness. Retinal sensitivity was tested with MP and standard automatic perimetry (SAP).

Results

The VD in moderate/severe POAG was lower than that in mild POAG and healthy control in the macular superficial vascular plexus (SVP) (38.7±6.3% vs. 42.9±5.2%, 49.7±2.6% respectively, P<0.001) and peripapillary radial peripapillary capillaries (pRPC) (36.4±5.7% vs. 43.6±6.6%, 49.1±2.4% respectively, P<0.001). The Pearson’s correlations between function-structure parameters were strongest with MP average sensitivity threshold and SVP VD in the area of whole macula (r = 0.68); followed by SAP mean deviation (MD) and pRNFL thickness (r = 0.63); SAP MD and pRPC VD (r = 0.59) and MP average threshold and GCC thickness (r = 0.54). We found the AUROCs for discriminating between glaucomatous and healthy eyes were highest for structural parameters as follows: pRNFL (0.94), macular SVP whole (0.92), pRPC (0.92) and GCC (0.91). Pairwise comparison of the above parameters showed no difference (P>0.05).

Conclusion

The relationship between microvascular damage in the macular SVP whole and the decrease of MP average sensitivity threshold is stronger than the pRNFL thickness measurements and SAP parameters. OCTA and MP techniques are valuable methods that allow clinically monitor structural and functional changes in glaucomatous eyes.

Direct comparison of retinal structure and function in retinitis pigmentosa by co-registering microperimetry and optical coherence tomography

PURPOSE

To evaluate the retinal structure-function relationships in the macula of retinitis pigmentosa (RP) patients by comparing microperimetry-3 (MP-3) images with co-registered optical coherence tomography (OCT) images.

METHODS

Thirty patients with typical RP were recruited from our hospital. The maculae of patients were examined with MP-3 and OCT. The retinal sensitivity was measured by MP-3 at 40 testing points arranged concentrically in a 16° diameter of the central retina, and we divided the 40 points into four zones according to degree from the fovea (2°, 4°, 6°, and 8°). We analyzed the correlation coefficients between the retinal sensitivity and the total retinal thickness (TRT), the length from the inner limiting membrane to the retinal pigment epithelium (RPE), and between the retinal sensitivity and the outer retinal thickness (ORT), the length from the outer plexiform layer to the RPE at each stimulus point.

RESULTS

TRT showed moderate correlations with the retinal sensitivity at 2° (median ρ = 0.59 interquartile range (IQR) [0.38-0.72]), 4° (ρ = 0.59 [0.55-0.68]) and 6° (ρ = 0.60 [0.54-0.63]), and TRT was weakly-to-moderately related to the retinal sensitivity at 8° (ρ = 0.27 [0.19-0.48]). ORT exhibited strong correlations at 2° (ρ = 0.72 [0.60-0.81]), 4° (ρ = 0.71 [0.75-0.67]) and 6° (ρ = 0.70 [0.54-0.74]), and a weak-to-moderate correlations at 8° (ρ = 0.34 [0.29-0.53]). ORT was more strongly correlated with the retinal sensitivity compared to TRT (p = 0.018).

CONCLUSION

ORT, rather than TRT, within 6° eccentricity was strongly correlated with the retinal sensitivity, suggesting that measuring ORT in those areas will help evaluate the macular status and progression in RP.

Reproducibility of Microperimeter 3 (MP-3) Microperimetry in Open-Angle Glaucoma Patients

PURPOSE

Primary open-angle glaucoma (POAG) is a chronic progressive optic neuropathy, leading to degeneration of retinal ganglion cells and characteristic morphological changes at the optic disc. In advanced stages of the disease, functional tests, such as standard automated perimetry (SAP), are the main diagnostic tools to detect progression. Compared to SAP, microperimetry offers fundus imaging with motion tracking to ensure precise stimulation of certain locations of the retina. Aim of the study was to assess reproducibility of microperimetry compared to SAP in patients with POAG.

METHODS

This prospective monocenter study included patients suffering from POAG with visual field defects in the central 20° zone. After inclusion into the study, 3 consecutive study visits were scheduled within 1 month, assessing microperimetry and SAP at each visit.

RESULTS

From 19 patients recruited, data from 18 patients could be analyzed. No significant difference between study visits could be detected in mean retinal sensitivity in microperimetry and SAP (microperimetry p = 0.401; SAP p = 0.644; Friedman's 2-way analysis of variance). The intraclass-correlation coefficient was 0.981 (95% CI 0.978-0.984) for microperimetry and 0.948 (95% CI 0.941-0.955) for SAP. Absolute agreement between deep scotoma points was found in 81 test locations (79%) in microperimetry and in 35 test locations (20%) in SAP (p = 0.003, chi-square test).

CONCLUSIONS

Microperimetry and conventional perimetry showed high reproducibility, with slightly better performance of microperimetry. However, the reduced angle of visual field in microperimetry limits its application to central glaucomatous field damage.

Discordance of Disc-Fovea Raphe Angles Determined by Optical Coherence Tomography and MP-3 Microperimetry in Eyes With a Glaucomatous Hemifield Defect

Purpose

The purpose of this study was to evaluate the concordance of a temporal raphe architecture estimated using optical coherence tomography (OCT) and MP-3 microperimetry.

Methods

We enrolled 25 eyes with either an upper or lower glaucomatous hemifield defect, as detected on the Humphrey visual field 30-2 test. A structural temporal raphe was extrapolated from visible end points of retinal nerve fiber bundles present in a perimetrically normal hemiretina on an en face Spectralis OCT image. A functional temporal raphe was drawn as a line from the fovea to the border of at least a 10-dB difference in sensitivity, at vertically adjacent test points, with at least three consecutive pairs among 25 test points placed at 8° to 18° from the fovea (2° intervals) on the MP-3. An angle determined by the optic disc center, the fovea, and the temporal raphe line (the DFR angle) was calculated. Correlations and agreement of the OCT- and MP-3-derived DFR angles and factors affecting discordance of the two estimates were evaluated.

Results

Despite no significant demographic differences, the functional DFR angle (mean ± SD, 171.8° ± 3.5°) was significantly larger than that of the structural DFR angle (166.5° ± 3.2°) in 14 eyes with upper hemifield defects and vice versa in 11 eyes with lower hemifield defects (163.4° ± 3.0° vs. 170.5° ± 3.2°). The mean deviation was significantly associated with the functional and structural DFR angle difference in eyes with only upper hemifield defects.

Conclusions

The structural temporal raphe was more deviated to the perimetrically normal hemiretina side than to the functional temporal raphe, thereby suggesting that a structural change may precede a functional loss.

Comparisons of Two Microperimeters: The Clinical Value of an Extended Stimulus Range

SIGNIFICANCE

Fundus-guided perimetry is a common clinical tool used to measure visual field sensitivities. Comparisons between perimeters are often made despite relative differences in hardware parameters. We directly compared two perimeters using Weber contrast, which allowed us to assess the clinical gain associated with the extended stimulus range of the macular integrity assessment (MAIA).

PURPOSE

The purpose of this study was to directly compare sensitivity thresholds for two microperimeters, the MAIA and Optos optical coherence tomography/scanning laser ophthalmoscope, using Weber contrast values. We also examined the clinical utility of the extended stimulus range of the MAIA.

METHODS

Six normally sighted adults with no visual field loss and 16 adults with low vision were recruited. Thresholds were measured on the MAIA and Optos using the same threshold algorithm and test points. To compare equivalent units, decibel thresholds were converted to light increments in apostilbs and then to delta increment intensities relative to each instrument's background luminance. Repeatability was assessed for normally sighted adults by testing both instruments on 3 separate days.

RESULTS

For normally sighted observers, mean thresholds were similar on both instruments, and repeatability within microperimeters was high. The MAIA has a 0.3-log lower contrast range and 1.37 higher contrast range. The lower contrast values did not result in lower thresholds for the normally sighted observers on the MAIA. There was a 25% increase in the number of measurable thresholds owing to the higher contrast values in low-vision observers.

CONCLUSIONS

The higher contrast range in the MAIA yielded only a small increase in detectable thresholds for participants with visual field loss.

Predicting the Integrated Visual Field with Wide-Scan Optical Coherence Tomography in Glaucoma Patients

PURPOSE

This study aimed to calculate a predicted integrated visual field (IVF) based on predicted monocular visual fields (MVFs) derived, with a new method, from wide-scan optical coherence tomography (OCT) data.

MATERIALS AND METHODS

Visual field testing used the central (6 × 4) 24 points of the Humphrey Field Analyzer 24-2 program. OCT scans of a corresponding retinal area, centered on the fovea, were divided into a 6 × 4 grid. The thickness of the macular retinal nerve fiber layer (mRNFL), ganglion cell layer + inner plexiform layer (GCIPL), and mRNFL + GCIPL (GCC) was measured in each grid area. Next, a support vector machine was used to create a MVF prediction model, with training data from 101 eyes of 60 glaucoma patients. Then, the prediction model was validated with data from 108 eyes of 54 glaucoma patients, for MVF and IVF. A simulated IVF was created by merging bilateral simulated MVFs.

RESULTS

The overall average of the median 95% prediction interval length for the MVF prediction model (measured in dB) was 10.0, 18.3, and 11.3 for the mRNFL, GCIPL, and GCC, respectively. In the validation data, the overall average root mean squared error (dB) between actual and predicted sensitivity for the IVF was 9.6, 10.5, and 9.5 for the mRNFL, GCIPL, and GCC, respectively, in the 24 grid areas. The intraclass correlation coefficient between average actual and predicted IVF was 0.61, 0.44, and 0.59 in the mRNFL, GCIPL, and GCC, respectively, in the 24 grid areas.

CONCLUSIONS

We calculated a predicted IVF based on predicted MVFs that were derived, with a new method, from OCT data and validated the accuracy of the calculated IVF. This technique should improve glaucoma management in cases when standard visual field testing is difficult.

Characterizing the Natural History of Visual Function in Choroideremia Using Microperimetry and Multimodal Retinal Imaging

Purpose

Centripetal retinal degeneration in choroideremia (CHM) leads to early visual field restriction and late central vision loss. The latter marks an acute decline in quality of life but visual prognostication remains challenging. We investigated visual function in CHM by correlating best-corrected visual acuity (BCVA), microperimetry and multimodal imaging.

Methods

Fifty-six consecutive CHM patients attending Oxford Eye Hospital were examined with BCVA, 10–2 microperimetry, optical coherence tomography, and fundus autofluorescence (AF). Microperimetry was repeated in 21 eyes and analyzed with Bland-Altman. Kaplan-Meier survival plots of eyes retaining 20/20 BCVA were created. Intereye symmetry was assessed.

Results

Microperimetry coefficient of repeatability was 1.45 dB. Survival analysis showed an indistinguishable pattern between eyes (median survival 39 years). Macular sensitivity showed a similar decline in right and left eyes, with half-lives of 13.6 years. Zonal analysis showed faster decline nasal to the fovea. Intereye symmetry was more consistent for microperimetry sensitivity (r = 0.95, P < 0.001) than BCVA (r = 0.42, P = 0.0006). Near normal foveal sensitivity was maintained when the fovea was at least 2500 μm from the advancing edge of AF.

Conclusions

BCVA is a marker of central degeneration and can provide valuable information about the position of the remaining retina as well as a measure of the impact on daily living. Microperimetry represents the global macular region. Both visual functions showed a high degree of intereye symmetry, particularly in early stages, indicating the fellow eye can provide a suitable control for assessing interventions to one eye. The findings may help to tailor visual prognosis and interpret outcomes of trials.

Evaluation of Two Systems for Fundus-Controlled Scotopic and Mesopic Perimetry in Eye with Age-Related Macular Degeneration

Purpose

The purpose of this study was to evaluate and compare the MP-1S (Nidek Technologies, Padova, Italy) and the S-MAIA (CenterVue, Padova, Italy) for mesopic and scotopic fundus-controlled perimetry (FCP) in age-related macular degeneration (AMD).

Methods

Eleven eyes from 11 patients underwent mesopic and, after 30 minutes of dark adaptation, scotopic (MP-1S: Goldmann V, 200 ms, background luminance 0.0032 cd/m²; S-MAIA: Goldman III, 200 ms, background luminance <0.0001 cd/m²) FCP. For the S-MAIA device, cyan (505 nm) and red (627 nm) scotopic FCP were performed. For both devices, a grid of 56 stimulus points covering 16° of the central macula was used. Examination time, fixation stability, and threshold values were analyzed.

Results

The upper end of the dynamic range (≤4 dB of lowest threshold) was frequently reached by the MP-1S for mesopic testing (median 34 of 56 stimuli), while threshold values within the lower 4 dB of the dynamic range were occasionally found with the S-MAIA for scotopic testing (median 3 for cyan, median 2 for red). After correction of the stimulus intensity for the S-MAIA results, the median difference for all stimuli between both devices for mesopic testing was −2.0 dB (interquartile range [−4;0], range –14 to 6).

Conclusions

The results indicate that robust testing of mesopic and scotopic function is feasible with both devices in patients with AMD, although both devices are susceptible to floor and ceiling effects.

Translational Relevance

The interpretation and particularly the comparison of both scotopic and mesopic FCP results between the MP-1S and the S-MAIA in AMD eyes need to consider variable susceptibility of floor and ceiling effects. Further software updates are desirable as FCP captures visual functional loss that is not noted with best-corrected central visual acuity and is important for clinical trials in AMD.

Interdevice comparison of retinal sensitivity assessments in a healthy population: the CenterVue MAIA and the Nidek MP-3 microperimeters

Background

To compare and correlate the retinal sensitivity measurements obtained with Nidek Microperimetry-3 (MP-3) and the CenterVue Macular Integrity Assessment (MAIA) microperimeters among healthy subjects.

Methods

In this prospective comparative study, 31 eyes of 23 subjects underwent complete ophthalmological examination including retinal sensitivity assessments using two microperimeters, the MP-3 (Nidek Technologies) and the MAIA (CenterVue). The mean retinal sensitivity (dB) and its corresponding luminance (asb) and contrast (log units) were analysed between the two instruments. The interdevice reproducibility and level of agreement between the sensitivity values of the devices were assessed.

Results

The mean retinal sensitivity (dB) measured by the MP-3 (25.02±1.06 dB, range: 20.90–26.70) was significantly (p<0.0001) lower compared with the MAIA (30.68±0.74 dB, range: 28–31.84). The luminosity levels were significantly (p<0.0001) higher with the MP3 (7.75±1.31 asb, range: 6.44–9.06) compared with the MAIA (0.92±0.14 asb, range: 0.78–1.06). The contrast sensitivity was significantly higher for the MP-3 (0.94±0.33 log units, range: 0.61–1.27) compared with the MAIA (0.23±0.03 log units, range: 0.20–0.26). Despite these absolute differences, the intraclass coefficient was 0.85 (95% CI 0.70 to 0.92) between the two devices after applying a standard correction factor to each data point (MAIA sensitivity=MP-3 sensitivity+5.65) with a mean difference between MAIA and MP-3 of 0.01.

Conclusion

Retinal sensitivity measures higher, but luminance and contrast sensitivity measure lower for MAIA-generated values compared with the MP-3. The relationships, however, appeared fairly consistent, and application of a standard correction factor allowed the data to be inter-related, at least for normal eyes.

Assessing Visual Fields in Patients with Retinitis Pigmentosa Using a Novel Microperimeter with Eye Tracking: The MP-3

PURPOSE

The purpose of the current study is to investigate the test-retest reproducibility of visual fields (VFs) measured with the MP-3 microperimeter, in patients with retinitis pigmentosa (RP).

METHOD

VFs were twice measured with the MP-3 and also the Humphrey Field Analyzer, using the 10-2 test grid pattern in both perimeters, in 30 eyes (15 right and 15 left eyes) of 18 RP patients (11 males and 7 females). Test-retest reproducibility was assessed using the mean absolute deviation (MAD) measure at all 68 points in the test grid. Reproducibility was also evaluated using the intraclass correlation coefficient (ICC) of VF sensitivities.

RESULT

The mean sensitivity measured in the HFA 10-2 was significantly higher than that measured in the MP-3 in both the first and second VF tests (p <0.0001, linear mixed model). The MAD was 2.4±0.6 [1.1 to 3.6] dB for MP-3 and 2.4±0.9 [1.1 to 5.1] dB for HFA 10-2, which was not significantly different (p = 0.76, linear mixed model). The ICC value associated with the MP-3 VFs was 0.81±0.13 [0.49 to 0.98], which was significantly larger than that observed for the HFA 10-2 VFs: 0.77±0.19 [0.20 to 0.94] (p = 0.043, linear mixed model).

CONCLUSION

The MP-3 microperimeter appears to be useful to evaluate central visual function in RP eyes, exhibiting test-retest reproducibility that is equal to, or better than, that observed in HFA 10-2 VFs.