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J. M. Mones, L. Amselem; Agreement of Preferential Hyperacuity Perimetry (PHP) With the Clinical Decision to Treat CNV Patients. Invest. Ophthalmol. Vis. Sci. 2009;50(13):954.
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Currently, clinical decision to extend, stop or resume treatment of CNV is based on anatomical measures such as fluorescein angiography, biomicroscopy and OCT imaging. Changes in physiological function, however, may precede anatomical changes. The Preferential Hyperacuity Perimeter (PHP) quantifies the severity of metamorphopsia across the macular visual field. In this study we examined the degree of agreement between PHP results and clinical decisions taken during the active period and the stabilized (post-treatment) periods. the objective of this study is: to estimate the degree of agreement between the PHP test and the clinical decision to treat CNV patients
Retrospective study of CNV patients. Each visit included biomicroscopy, fluorescein angiography, BVCA, common OCT parameters and various PHP measurements. For the purpose of this study, we defined that the CNV was stabilized if at least two successive clinical decisions were to follow-up without treatment. Using this criterion we divided the clinical decisions to those taken during the active period and those taken in the stabilized period.
61 clinical decisions were evaluated for 31 CNV eyes (30 patients) monitored over the course of 150±91 (µ±σ) days (range: 47-364). During the active period, 14 of 43 decisions were to extend treatment: PHP results agreed (deteriorated or remained unchanged) with this decision in 11 cases (Sensitivity: 79%); of 29 decisions to follow up, PHP agreed (improved) in 21 cases (Specificity: 72%); For comparison, agreement of clinical decision with change in OCT parameters alone yielded a sensitivity of 71% and a specificity of 89%. During the stable period, 8 of 17 decisions were to resume treatment (because of reactivation): PHP agreed in 7 cases (Sensitivity: 88%). 11 of 17 decisions were to follow up: PHP agreed in 9 cases (Specificity: 82%). Agreement of clinical decision with change in OCT parameters alone yielded a sensitivity of 73% and a specificity of 75%.
The PHP test supplies functional information that can support clinical decisions to extend, stop or resume treatment of CNV eyes.
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