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Steffen Schmitz-Valckenberg, Monika Fleckenstein, Leon Alexander von der Emde, Chantal Dysli, Sarah Thiele, Philipp T. Möller, Moritz Lindner, Jennifer Nadal, Matthias Schmid, Frank G Holz, Maximilian Pfau; Light sensitivity within areas of geographic atrophy secondary to age-related macular degeneration. Invest. Ophthalmol. Vis. Sci. 2019;60(9):1167. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To investigate residual sensitivity within areas of geographic atrophy (GA) secondary to age-related macular degeneration (AMD).
Mesopic (achromatic stimuli, Goldmann III) and dark-adapted (DA) cyan and red light sensitivity were investigated using fundus-controlled perimetry (S-MAIA, CenterVue, Italy). Customized software was used to create patient-tailored perimetry grids based on fundus autofluorescence (FAF) imaging. Test-points were placed within GA along an "iso-hull" with a distance of -0.645° to the atrophy boundary. The false-positive response rate was determined with suprathreshold stimuli to the optic disc (Heijl-Krakau method), and used to compute the expected sensitivities for the assumption of absolute scotomata with consideration of the staircase strategy. The outermost visible retinal layer on spectral-domain optical coherence tomography (SD-OCT) at the location of each test-point was determined.
Thirty eyes of 30 patients (76.4 ± 7.1 years; 17 female) with GA from the prospective natural progression study DSGA (Directional Spread in Geographic Atrophy; NCT02051998) were analyzed. A total of 1128 threshold determinations were performed within areas of GA. The measured sensitivities were significantly (p<0.01) higher than the expected values for absolute scotomata (mean difference ± standard error [i.e. measurement – model-based expectation] of +7.29 ± 0.95 dB for mesopic, +2.76 ± 0.63 dB for DA cyan, and +4.88 ± 0.81 dB for DA red testing). For mesopic testing and DA red testing, the presence of the residual outer nuclear layer had a significant effect on this discrepancy (p<0.001). There was no effect of fixation stability or any other reliability index on this discrepancy
Measured sensitivities within the inner junctional zone of GA may not be purely explained by patient-specific false-positive response rates or other reliability indices. The marked influence of the outer retinal configuration on measured sensitivity may be indicative of residual cone function within GA at the inner junctional zone.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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