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Daniela Claessens; Dynamics of metamorphopsia characteristics during progression from intermediate to advanced age-related macular degeneration. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2375.
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This prospective, longitudinal study was performed to observe metamorphopsia measurement in eyes with intermediate age-related macular degeneration in order to examine if specific metamorphopsia patterns reflect conversion to advanced age-related macular degeneration.
A cohort of 35 patients with intermediate age-related macular degeneration (i-AMD) was followed from 2015-2017. Eyes were classified as non-progressors (np) or progressors (p) respectively when advanced AMD (a-AMD) developed. In bilateral disease the first eye converting to a-AMD was included. Written informed consent was obtained prior to the study. The zero (alternative) hypothesis was: progression to a-AMD does not (does) change metamorphopsia value and pattern.Metamorphopsia measurement was performed with AMD – A Metamorphopsia Detector® (app4eyes) documenting magnitude (d), localization (ε), area (a), local frequency (d/a) of metamorphopsia and global metamorphopsia index (MI). Best-corrected visual acuity, ophthalmoscopy, spectral domain optical coherence tomography (Cirrus, Carl Zeiss Meditec) with measurement of central foveal thickness (CFT) and fluorescein angiography were documented at study inclusion and follow up.
7 patients were lost to follow-up. In this cohort (28 eyes: 8 men, 20 women) mean age was 75 (SD 5.1) years in the np- and 74 (4.2) in the p-group. Mean study period was 10.7 months (SD 6.1) in the np- and 10.0 (SD 4.0) in the p-group. 19 eyes (68 %) remained stable (i-AMD), 8 eyes (28.5%) progressed to neovascular AMD (n-AMD), 1 eye (3.5%) to geographic atrophy (GA). Mean change in CFT was -3 µm (SD 63) in the np-group, +40 µm (SD 60) in the p-group. Mean change for d, ε, a and d/a was 1.10 (SD 1.14) / 0.62 (SD 1.10) / 0.47 (SD 0.71) / 0.87 (SD 0.73) in the np-group and 3.34 (SD 1.45) / 1.44 (SD 1.22) / 0.26 (SD 1.25) / 1.59 (SD 0.76) in the p-group. Mean change of MI was +2.18 (SD 2.02, confidence interval (CI) [1.27; 3.08]) in the np-group, +5.80 (SD 2.71, CI [3.93; 7.68]) in the p-group and decreased by 5.16 in the eye with GA. A t-value of 7.73 lead to rejection of the zero hypothesis.
This pilot study supports the hypothesis that progression from intermediate to neovascular age-related macular degeneration is accompanied by an increase of Metamorphopsia Index and may clear the way to a (home) monitoring test.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
Metamorphopsia measurement and OCT
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