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Daniela Claessens, Ronald V. Krüger; AMD - A Metamorphopsia Detector. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4109.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: We developed the computer based App AMD -A Metamorphopsia Detector- to provide a self-control monitoring tool to detect and control the degree and size of metamorphopsias and scotomas. This study was performed to examine sensitivity and specificity of AMD and its correlation with anatomical course, functional development and quality of life.
Methods: AMD is based on the Amsler grid. The software uses the concept of a negative image: a distorted image can be straightened by moving the mouse. Degree and dimension of distorted lines or scotoma are transformed into indices.<br /> I) In a pretest sensitivity and specificity of the AMD App were examined in 17 healthy and 5 eyes with metamorphopsias due to macular degeneration (age 61-83).<br /> II) In a second step 19 eyes (age 24-91) with maculopathies performed the metamorphopsia module alone or in combination with the scotoma module.<br /> III) In a prospective observational clinical pilot study we examined monocular best corrected visual acuity (BCVA), Amsler grid, vision related quality of life (National Eye Institute Visual Function Questionnaire NEI VFQ 25), OCT (optical coherence tomography) and AMD in 13 eyes (age 37-91) with macular edema before and after intravitreal injections of anti vascular endothelial growth factor. Prior to the study all patients signed informed consent.
Results: I) Pretests confirmed construct validity and reliability. Sensitivity of AMD was 80%, specificity was 100%. Chi2-Test lead to rejection of the zero hypothesis (c2 > 3.84; freedom degree = 1, α = 0.05).<br /> II) Including a wider range of pathologies, addition of the scotoma module increased sensitivity from 0.84 to 0.94. OR to detect macular pathologies without metamorphopsias was 3.37; 95% CI: 0.94 - 5.67 when combining both app modules.<br /> III) a-VEGF improved OCT and AMD in all 13 eyes: average decrease of macular thickness was 77.54 µm (median 55 µm; SD 49.99; CI 104.75; 50.33) and 6.0 (median 4.76; SD 3.5; CI 7.9; 4.1) for metamorphopsia index. Mean gain in NEI VFQ 25 was 8.77 (median 19; SD 12.39; CI 15.51; 2.03).BCVA improved in 10 and was stable in 3 patients. Geometric mean BCVA was 0.38 logMAR (SD 0.28) before and 0.25 logMAR (SD 0,21) after treatment.
Conclusions: As a quantitative test AMD can support conventional diagnosis, lower the threshold for diagnosis,enhance compliance and adherence in the treatment of age related macular degeneration and other diseases leading to macular edema.
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