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Stephanie Mroczkowska, Antonio Calcagni, Jonathan Gibson, Usha Chakravarthy, Ruth Hogg, ; Investigation into the ability of Preferential Hyperacuity Perimetry (PHP) to detect reactivation of neovascularisation in patients undergoing ranibizumab injections for age-related macular degeneration (AMD). Invest. Ophthalmol. Vis. Sci. 2013;54(15):4153.
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The use of anti-angiogenic therapies for the treatment of neovascular AMD has significantly increased the burden on healthcare providers due to the need for regular and repeated review. Methods that may allow monitoring to be carried out by community optometrists are therefore attractive as they could reduce the burden on secondary care. This study aimed to investigate whether relapse after Lucentis treatment could be reliably detected using PHP and visual acuity (VA) assessment alone without access to optical coherence tomography (OCT) data.
Twenty five patients with neovascular AMD who were within the Lucentis pathway and whose macula was confirmed fluid free were enrolled. PHP was performed at 3 consecutive follow-up appointments. The Optometrist used the PHP and VA data to decide if the patient required retreatment. This was compared with the decision made by an Ophthalmologist who used both OCT and VA.
Of 30 decisions made during the follow-up period 24(80%) were concordant. Sensitivity was 73.3%, specificity 88.9%. Of those screened initially approximately 47% were unable to undertake the test reliably and therefore could not be enrolled in the study. The most common reason for unreliability was a slow reaction time by the patient to the presented stimuli (45%). This ultimately led to a high false positive score. Other contributing factors included arthritic and dexterity problems (17%) and poor VA (4%).
PHP may be useful to detect lesion reactivation in those patients who are able to complete the test reliably.
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