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Merina Thomas, Yulia Wolfson, Voraporn Chaikitmongkol, Neil Bressler; Preferential Hyperacuity Perimetry Monitoring in Patients During Treatment of Neovascular Age-related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4173. doi: https://doi.org/.
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To determine how often the home device preferential hyperacuity perimeter (PHP) detects changes in participants being treated with anti-angiogenic therapy for neovascular age-related macular degeneration (AMD), and how often those changes correspond to images of neovascular AMD obtained as part of standard care.
Patients with neovascular AMD requiring anti-VEGF treatment at a current visit were enrolled into a prospective longitudinal study to investigate the correlation between PHP test scores, quantitative measurements including the rate of normal and abnormal responses, the average size of the presented distortion, and maps of spatial representation of hyperacuity visual field defects to clinical findings including visual acuity and OCT data. Follow-up was at 4 weeks; if treated at 4 weeks, follow-up at 8 weeks also was obtained. An additional PHP test also was administered 1 week following each clinical examination.
90% (n = 19) of the study candidates had a reliable qualification test score and were followed. 76% (n = 16) of participants were women. The mean age of participants was 77 years, (range 61 to 89 years). Mean visual acuity of the qualification eye was logMAR 0.25 (20/32-20/40). 57% (n = 12) of patients used bifocal eyeglasses during testing. The mean PHP test score improved (decrease in raw score) from baseline to week 1 (-0.10, P = 0.03) and deteriorated (increase in raw score) from baseline to week 4 (+0.09, P = 0.09). For patients who received injections in two subsequent months, the PHP test score improved (decrease in raw score) from week 4 to week 5 (-0.14, P = 0.13) and deteriorated (increase in raw score) to near baseline at week 8 (-0.12, P = 0.12). The mean visual acuity increased slightly (mean difference logMAR +0.06 or 3 letters, P = 0.27) over the 2 month follow-up period. The OCT CST decreased (-1.78 µ, P = 0.46) and the OCT volume increased (0.93 mm3, P = 0.02) over 2 months.
These data suggest that the PHP home device can detect changes during antiangiogenic therapy consistent with the course of the disease as determined by clinical and imaging findings. Further studies would be needed to determine if this device has a role in monitoring patients receiving anti-VEGF therapy in an as needed regimen.
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