Individualized mesopic and dark-adapted fundus-controlled perimetry: Longitudinal changes in retinal sensitivity at the border of geographic atrophy.

Abstract

Purpose : To analyze mesopic and dark-adapted (DA) retinal sensitivity changes based on fundus-controlled perimetry (FCP) test patterns designed to the shape of geographic atrophy (GA).

Methods : A total of 40 patients (75.8 ± 8.5 years old; 21 females) were prospectively examined by mesopic, DA cyan, and DA red FCP with the S-MAIA device (CenterVue, Padua, Italy). Test points were placed along iso-hulls (i.e., contour lines) at even distances surrounding the GA boundary at −0.645°, 0.43°, 0.86°, 1.29°, 2.15°, and 3.01° with customized software. Retinal sensitivity was assessed in 40 eyes, with longitudinal data for 29 eyes with a median [IQR] of one follow-up visit [0;2] spanning 2.1 [1.9;2.3] years. Linear mixed model analysis was applied to estimate the change in sensitivity over time with “test point nested in eye” as a random effects term.

Results : At baseline, mesopic, DA cyan, and red testing showed a curvilinear relationship between sensitivity and distance to GA with more severely reduced light sensitivity in the proximity to GA (Figure 1). In the longitudinal analysis (Table 1), for mesopic testing, the estimated marginal mean [95% CI] for sensitivity change was -2.29 [-3.27;-1.31] dB/y at 0.43° and gradually less for more distant test points. For DA cyan testing, the most severe decline in sensitivity was observed for more peripheral loci at 2.15° with -1.38 [-2.09;-0.67] and at 3.01° with -1.38 [-2.09;-0.68] dB/y, due to a floor effect for DA cyan testing at 0.43°. The pattern of decline in DA red sensitivity paralleled the changes in mesopic sensitivity.

Conclusions : Individualized, lesion-tailored mesopic and DA cyan and red FCP testing in eyes with dry AMD detect advancing functional loss prior to GA development. Differential patterns of decline in sensitivity over time - depending on the distance from the GA border and on the mode of FCP testing - reveal a dynamic functional “fingerprint”: Early, pronounced rod-related sensitivity loss in a certain distance to the actual atrophic lesion along with late, pronounced mesopic sensitivity decline colocalizing with the atrophic lesion border. This data demonstrates in vivo the dynamic functional consequences of localized pathobiological processes in advancing GA progression.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.

 

Baseline sensitivity as a function of distance to GA.

 

Estimated marginal means for the change in sensitivity over time.