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W. Eisenbarth, N. Feucht, C. Enders, M. MacKeben, M. Maier, C. P. Lohmann; Vision Assessment and Monitoring of Anti-VEGF Therapy in Patients With AMD. Invest. Ophthalmol. Vis. Sci. 2010;51(13):511.
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The macular mapping test (MMT) allows topographic vision testing with inclusion of the near periphery, different contrast levels and a recognition task. We used the MMT to obtain additional information about overall visual function in comparison with standard clinical measurements. We evaluated MMT "general field scores" for monitoring patients with neovascular AMD under anti-VEGF therapy (Lucentis).
We tested the central visual field (10° radius) in 43 patients using letter recognition in 33 parafoveal target locations at two contrast levels (10 % and 100 %). Testing at baseline was performed before the first of three monthly intravitreal injections and 4 weeks after the 3rd injection (month 4). Additionally, near and far BCVA as well as Pelli-Robson contrast sensitivity was measured at both visits.
MMT field scores showed improved values in 27 and worse values in 16 patients (pre-operative MMT score at 100 % C: median = 55.50; post-operative MMT score at 100 % C: median = 60.50).The MMT field scores for 100 % and 10 % contrast (post-operative) showed weak to moderate correlation (coefficient of determination r2) with near vision (100 %: r2 = 0.38; 10 %: r2 = 0.42) and Pelli-Robson scores (100 %: r2 = 0.69; 10 %: r2 = 0.39). The Pelli-Robson scores were unchanged in 17 patients (pre- vs. post-operative), in whom the corresponding MMT scores were improved in 12 cases at 100 % contrast and in 10 cases at 10 % contrast. Comparing pre- and post-operative values, median BCVA at 5 meters increased from 0.31 to 0.35 (decimal). Near vision was changed from 0.10 to 0.16 decimal (median). The changes in BCVA were not statistically significant. Near vision improved in 13 patients, became worse in 12, and remained equal in 18. In these 18 cases, however, the corresponding MMT scores were enhanced in 10 cases at 100 % contrast and in 9 cases at 10 % contrast.
Intravitreal injection of Lucentis benefits some patients, but not others. Benefits are likely to be caused by drug effects on foveal as well as non-foveal areas of the retina. The macular mapping test provides an effective method to gain additional information about visual function in the near periphery that is not reflected in testing central visual acuity and contrast sensitivity alone or in combination.
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