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Justin Nguyen, Kenneth M.P. Yee, Giancarlo A Garcia, Alfredo A Sadun, J Sebag; Quantifying Vision Beyond Visual Acuity in Macular Holes. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1085. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Full thickness macular holes (MH) reduce visual acuity (VA), however, there is no methodology to evaluate vision that fully takes into account MH severity beyond visual acuity. It is hypothesized that by quantifying central scotomata and distortions, 3-D Threshold Amsler Grid (3D-TAG) testing can assess decreased vision as related to the diameter of MH and extent of pericentral macular cyst formation, while VA cannot.
Prospective evaluations were performed in 16 eyes of 8 patients (5 women, 3 men; mean age = 70 ± 4.7 years) with unilateral full thickness MH using Snellen VA, and 3D-TAG (% Volume Lost: %VL; Graefes Arch 247:165-70, 2009; BJO 95:1419-23, 2011]. Optical Coherence Tomography (OCT) determined the diameter of MH (μm) and the volume (μL) of the pericentral macula as an index of intraretinal cyst severity.Spearman's R was calculated to evaluate correlations between 3D-TAG and OCT measurements. Sutureless 25 G vitrectomy with chromodissection and gas tamponade was performed without complications by one surgeon (JS).
Preoperatively, VA = 0.087 ± 0.06, MH diameter was 439 ± 103 μm, and pericentral macular volume was 67% increased in MH eyes (0.75 ± 0.12 μL) as compared to control fellow eyes (0.45 ± 0.02 μL; p < 0.01). 3D-TAG = 1.81 ± 1.12 %VL in MH vs. 0 %VL in control eyes (p < 0.01). There was no correlation between VA and either MH diameter or pericentral macular volume. 3D-TAG, however, was correlated with MH diameter (Spearman's R = 0.638, p < 0.05) and preoperative pericentral macular volume (Spearman's R = 0.768, p < 0.05).Post-operatively, all MHs were closed. At 3 months VA improved to 0.21 (58% better, p < 0.01) and 3D-TAG testing in MH eyes found 0.36% VL (80% improved; p < 0.03) while pericentral macular volume = 0.41 μL (45 % improved; p < 0.01). At 6 months, 3D-TAG = 0.12% VL (p < 0.05) and pericentral volume remained 0.41 μL, comparable to the control fellow eye at 0.45 μL, representing an 84% improvement in visual function and 45% improvement in structure (p < 0.01).
3D-TAG quantifies the visual impact of MH beyond visual acuity, displaying positive correlation with increasing MH diameter and the degree of pericentral cyst formation. As 3D-TAG also quantifies the degree of improvement post-operatively, this may be useful as a quantitative outcome measure of vision that evaluates surgery and new treatment modalities (such as pharmacologic vitreolysis) for MH and other maculopathies.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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