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E. Pilotto, S. Vujosevic, E. Convento, R. Melis, P. Sportiello, S. Segalina, E. Midena; Multimodal Integrated Approach to Atrophic Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2009;50(13):4915.
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To investigate functional and retinal morphologic changes in patients with atrophic age-related macular degeneration (AMD).
Fourteen consecutive patients (20 eyes), with non exudative AMD with an area of geographic atrophy of at least 1.3 mm2 (0.5 MPS disc area) were studied by means of Spectral domain OCT, fundus color photo, fundus autofluorescence (FA), digital ophthalmoscope using blue, green, red and IR laser and a retromode system. All patients underwent static (fixation and sensitivity) and kinetic microperimetry, preferential hyperacuity perimetry (PHP). All examinations were performed during the same day and examined in a masked fashion.
Fundus autofluorescence showed at least one hypo-autofluorescent (hypo-AF) area in all cases. In all cases PHP was positive. Kinetic microperimetry detected a dense scotoma exactly corresponding to the hypo-AF areas in 13 eyes (65%) whereas in seven cases (35%) the hypofluorescent area was not characterized by a uniformly dense scotoma. Fixation was predominantly central in 11 eyes (55%), poorly central or eccentric in 9 eyes (45%). In eight cases (40%) fixation was next to or surrounded by a hypo-AF area. In 16 eyes (80%) atrophic areas were present in the peripheral retina.
Residual retinal function may be present in hypo-AF areas and these may be the site of fixation. PHP is positive in atrophic AMD but cannot distinguish among different morphologic changes causing metamorphopsia. In atrophic AMD morphologic changes may be detectable in the peripheral retina.
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