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H.P. Scholl, F. Roth, H.–M. Helb, S. Schmitz–Valckenberg, A. Bindewald, N. Eter, F.G. Holz; Microperimetric Assessment of Pigment Epithelium Detachments in Patients With Age–related Macular Degeneration (AMD) . Invest. Ophthalmol. Vis. Sci. 2005;46(13):1582.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: Detachment of the retinal pigment epithelium (PED), a common feature of late age–related macular degeneration (AMD), is known to cause visual acuity loss. However, detailed data on the retinal light increment sensitivity (LIS) of both the area of PED and the adjacent areas at the posterior pole are not available. To address this we performed fundus controlled static threshold microperimetry of the macula in AMD patients. Methods: Nineteen eyes of 17 AMD patients (median age: 67 years; range 59–81 years) were included. Patients were investigated by means of funduscopy, visual acuity charts, digital cSLO fluorescein angiography, and optical coherence tomography (OCT3). Fundus controlled static threshold perimetry was performed with the MP1 (Nidek, Inc., Italy), Goldmann III stimuli and a white background illumination, using a 4–2–1–test strategy in 10 eyes and a 4–2–test strategy in 9 eyes, respectively. The range of luminance was 0–20 dB. Results: Visual acuity was reduced in all patients (median visual acuity 0.3; range: 0.2–0.6). LIS was reduced over PED lesions in all patients. However, there was considerable heterogeneity in LIS of up to 14 db. In 10 eyes there was no LIS detectable at least at some test locations. In all eyes the average LIS over the PED lesions was considerably lower than the retinal sensitivity of adjacent areas at the posterior pole. However, these areas also exhibited marked heterogeneity of LIS (up to 13 dB). In none of the patients included in this study, adjacent retinal areas of the PED were completely normal. In 9 eyes, normal LIS was measured in at least a subgroup of test locations outside the PED lesion, whereas in 8 eyes not a single retinal locus exhibited normal LIS. Conclusions: These findings indicate that PEDs are associated with different degrees of functional impairment that is not homogeneously distributed over the entire PED lesion. Retinal areas adjacent to PEDs in AMD also are not normal and can show measurable degrees of sensitivity loss. It is believed that in AMD structural and compositional ECM changes at the level of Bruch membrane along with accumulation of focal and diffuse drusen contribute to the development of PEDs and compromise metabolic exchange between the choroid and retina with subsequent photoreceptor dysfunction. Our findings are in agreement with this concept.
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