Macular Dysfunction and Structure in Macular Pucker with Good Visual Acuity

Abstract

Purpose: : To characterize the functional and structural status of Macular Pucker (MP) patients who have good objective visual acuity, despite subjective distortions.

Methods: : 10 eyes in 10 patients with MP and visual acuity of 20/32 or better underwent quantification of central field abnormalities with 3D Computer-automated Threshold Amsler Grid (3D-CTAG) testing (Fink & Sadun, J Biomed Opt, 2004). Quantitative analysis of the 3D visual field abnormalities were: Lost Area Grade (LAG = scotoma area ratio as a function of contrast sensitivity), Preserved Area Grade (PAG = intact visual field area ratio as a function of contrast sensitivity), Difference Area Grade (DAG = PAG minus LAG), and Hill-of-Vision Volume Loss (%). Results were compared to macular thickness [µ] and macular volume [µL] as measured by combined Optical Coherence Tomography/Scanning Laser Ophthalmoscopy (OCT/SLO, OPKO/OTI, Miami). Fellow eyes were normal in 5 subjects and served as controls.

Results: : The average macular thickness was 304.8 µ and macular volume was 2.83 µL in the MP eyes, compared to 272.6 µ and 2.54 µL in controls (p= 0.015 and p=0.04, respectively). Average LAG, PAG, and DAG differed from controls by 42.95%, 25.75%, and 68.7% (p=0.0009, p=0.071, and p=0.00005, respectively). Positive correlation existed between macular thickness and both LAG (Spearman’s Coefficient r=0.74, p=0.01) and PAG (r=0.77, p=0.008). The mean Hill-of-Vision Volume Loss was 1.66% in the MP eyes, which significantly differed from controls (p=0.005).

Conclusions: : 3D-CTAG and OCT/SLO determined that there are significant functional and structural abnormalities in eyes with MP and good visual acuity. That there was nearly 50% loss of LAG and over 50% in DAG were striking. Since 3D-CTAG quantification of central vision correlates well with macular structure, it may be better in assessing the effects of MP on vision in patients with normal visual acuity. Furthermore, these quantitative indices of central vision might provide useful outcome measures of therapy with either surgery or pharmacologic vitreolysis (Sebag, RETINA 29:871-4, 2009).

Keywords: macula/fovea • visual fields • imaging/image analysis: clinical