June 2020
Volume 61, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2020
Dense scotomas in patients with CNV may not correlate with the observable lesion on infrared imaging
Author Affiliations & Notes
  • Janet S Sunness
    Hoover Low Vision Rehabilitation Services, Greater Baltimore Medical Center, Baltimore, Maryland, United States
    Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland, United States
  • Carol A Applegate
    Hoover Low Vision Rehabilitation Services, Greater Baltimore Medical Center, Baltimore, Maryland, United States
  • Michael J Elman
    Elman Retina, Maryland, United States
  • John T Thompson
    Retina Specialists, Maryland, United States
  • Ray Sjaarda
    Retina Specialists, Maryland, United States
  • David Baranano
    Retina Specialists, Maryland, United States
  • Lisa Schocket
    Ophthalmology and Vision Science, University of Maryland School of Medicine, Maryland, United States
  • Edward Goldman
    Retina Center, Maryland, United States
  • Footnotes
    Commercial Relationships   Janet Sunness, None; Carol Applegate, None; Michael Elman, None; John Thompson, None; Ray Sjaarda, None; David Baranano, None; Lisa Schocket, None; Edward Goldman, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2020, Vol.61, 3376. doi:
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    • Get Citation

      Janet S Sunness, Carol A Applegate, Michael J Elman, John T Thompson, Ray Sjaarda, David Baranano, Lisa Schocket, Edward Goldman; Dense scotomas in patients with CNV may not correlate with the observable lesion on infrared imaging. Invest. Ophthalmol. Vis. Sci. 2020;61(7):3376.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To determine how well the infrared appearance of CNV/scar correlates with the presence of a dense scotoma.

Methods : All patients with CNV from AMD, who were referred for low vision evaluation and underwent (Goldmann size III) microperimetry testing using the Optos OCT/SLO/Microperimeter from 9/2014 to 9/2019 were included. Eyes with other causes of vision loss such as stroke, diabetic retinopathy, and glaucoma were excluded. The presence and location of the dense scotoma was correlated with the presence of CNV change on infrared imaging, including atrophy, scar, and fibrosis (called the IR lesion). We categorized the dense scotoma as being smaller than, equal to, or larger than the IR lesion.

Results : 186 eyes with CNV of 139 patients were included. Of these, 29 eyes (16%) did not have adequate testing because of low reliability, inadequate testing, or poor visualization of the retina. Of the remaining 157 eyes, 16 (10%) had no dense scotoma, 2 (1%) had a dense scotoma without an IR lesion, 84 (54%) had the dense scotoma corresponding to the IR lesion, 30 (19%) had the dense scotoma larger than the IR lesion, and 25 (16%) had the dense scotoma smaller than the IR lesion. Of the 32 patients with adequate testing in both eyes, 19 (59%) had the same dense scotoma-IR lesion relationship in both eyes, and 13 (41%) had different relationships in the two eyes. Among the 28 eyes with VA 20/40 or better and adequate testing, 18 (64%) had dense scotomas equal to IR lesion, 3 (11%) had dense scotoma smaller, 2 (7%) had dense scotoma larger, and 5 (18%) had no dense scotoma.

Conclusions : For 54% of eyes, the IR lesion defined the area of dense scotoma, while 36% had dense scotomas different from the size of the IR lesion, and 10% had no dense scotoma. Dense scotomas were present in 82% of eyes with visual acuity 20/40 or better. The IR appearance is often inadequate for estimating the dense scotoma present. Further correlation with OCT will help to clarify these relationships. Patients may have significant low vision needs that are not obvious on clinical examination alone.

This is a 2020 ARVO Annual Meeting abstract.

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