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Maximilian Pfau, Philipp Mueller, Leon von der Emde, Moritz Lindner, Ruth Hassenrik, Philipp T Möller, Monika Fleckenstein, Frank Holz, Steffen Schmitz-Valckenberg; Dark-adapted two-color fundus-controlled perimetry in the junctional zone of geographic atrophy. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2421.
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© ARVO (1962-2015); The Authors (2016-present)
To investigate retinal sensitivity in the junctional zone of geographic atrophy (GA) secondary to age-related macular degeneration with high spatial resolution in relation to the specific configuration of atrophic lesions using mesopic and dark-adapted (DA) two-color fundus-controlled perimetry (FCP) and patient-tailored perimetry grids.
Patient-tailored perimetry grids were generated using annotated fundus autofluorescence data (30°x30°, Spectralis OCT2, Heidelberg Engineering, Germany). A custom software positioned test-points along “iso-hulls” surrounding the GA boundary at distances of 128, 256, 384, 640 and 896 μm, respectively. The between test-point distance on each “iso-hull” was 450 µm. The grids were used for duplicate mesopic (background 1.27 cd/m2, achromatic stimuli) and DA two-color (cyan [505 nm] and red [627 nm] stimuli) FCP with a 4-2 staircase strategy (S-MAIA, CenterVue, Italy). Age-adjusted reference data were obtained through regression analysis of normative data followed by spatial interpolation. Mixed-effects models considering the hierarchical data structure (test-point nested in eye) were used for all analyses.
Twenty-five eyes with GA of 25 patients (77.0 ± 6.8 years) from the prospective, natural history study DSGA (Directional Spread in Geographic Atrophy; NCT02051998) and 40 eyes of 40 normal subjects (58.0 ± 17.4 years [range 21.8 – 82.1 years]) were included. The point-wise coefficient of repeatability was ±6.64 dB for mesopic testing and did not differ significantly in dependence of the “iso-hull” (i.e. distance to GA, P>0.05). The mean-deviation from the normative data for mesopic testing decreased significantly with the distance to GA (-10.3 dB [128 µm], -8.2 dB [256 µm], -7.1 dB [384 µm], -6.8 dB [640 µm] and -6.6 dB [896 µm], P<0.01). DA cyan testing exhibited larger mean-deviation values than DA red testing for all “iso-hulls” (-14.8 vs. -11.7 dB, -13.5 vs. -10.1 dB, -12.8 vs. -9.1 dB, -11.6 vs. -8.2 dB, -10.7 vs. -8.0 dB).
Patient-tailored FCP grids allowed for reliable testing of the local retinal function in the junctional zone of GA with high spatial resolution. In accordance with histological studies, a distinct increase in mesopic sensitivity that levels off between 384 µm and 640 µm was observed. Particularly in close proximity to the GA boundary, rod dysfunction exceeds cone dysfunction.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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