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R. Gulati, M. Roser, S. Torr-Brown, A. Jeong, G. Dagnelie; A Comparison Study of the Visual & Memory Stimulating (VMS) Grid® and the Amsler grid as Self-monitoring tools for Age-related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2009;50(13):950.
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To compare and examine self-monitoring results and survey reports with the Visual & Memory Stimulating (VMS) and Amsler Grids in patients with Age-related Macular Degeneration (AMD). Long-term Amsler grid testing has been shown to lead to habituation and loss of sensitivity in the detection of AMD-related metamorphopsias and scotoma changes. The VMS grid has been designed for interactive use and easy evaluation of such perceived changes against more salient landmarks than those provided by the Amsler grid.
Subjects aged 60 and over with documented AREDS grade 3 or 4 severity of AMD were given a survey where they drew their visual distortions on both the VMS and the Amsler grids, and answered a series of questions about the two tests. They rated the ease/difficulty in delineating their distortions on both grids as well as their confidence in the accuracy of such drawings. They also indicated preferences for one vs. the other grid. The survey was repeated up to 3 times, at 1-week intervals. Subjects were recruited at 3 sites: retina clinic, Wilmer Eye Institute (WEI): 16; retina clinic, Hartford, CT (RCT): 15; retirement community, Baltimore (RCB): 7. Within-session test order (1. Amsler; 2. VMS) was switched on the final administration in the RCT and RCB cohorts.
To date, fully completed sets of surveys have been received from 9, 11, and 5 subjects at the respective sites, with 5, 3, and 1 subjects continuing submissions, and up to 30 additional subjects to be recruited. Twenty-one subjects did not express a consistent preference for either grid, while 15 did (VMS, 11; Amsler, 4). Preference for a particular grid did not correlate with subjects’ history of regular (weekly/monthly/occasional/never) Amsler grid self-testing. When analyzed on the basis of test order within sessions, there was a clear tendency for the second grid to be preferred in ease and confidence level over the first one. Preliminary examination of drawings submitted suggests that VMS may show more detail in visual distortions than Amsler. Comparison of these drawings to fundus photos and fluorescein angiograms collected by subjects’ retina specialists is under way.
Based on this preliminary analysis the VMS grid appears to be a viable alternative to the Amsler grid in patients with established AMD pathology. Continued studies will be needed to compare these two grids for sensitivity, specificity, and consistency of detection, and validate these measures against retinal imaging results.
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