Regional Variation of Retinal Sensitivity in Intermediate AMD in the PINNACLE study

Abstract

Purpose : Topographic variations in the risk of age-related macular degeneration (AMD)-associated lesions were reported. In this study we performed microperimetry (MP) subfield analyses in intermediate age-related macular degeneration (iAMD) to investigate regional differences in photoreceptor function

Methods : This is a cross-sectional analysis of baseline data from 247 patient eyes of the longitudinal, prospective, multicenter and non-interventional PINNACLE study. Mesopic MP was conducted with the MAIA (Centervue, Italy) device, which predominantly measures cone function. The Visual Field Modeling and Analysis software was applied to calculate MP-derived hill-of-vison surface plots and the volume beneath the plots. MP regional subfields were defined as quadrants and cubes (see Figure 1). We calculated paired non-parametric statistics to account for comparisons of subfields within same eyes. Where appropriate, Friedman and multiple-comparison tests were used.

Results : Based on the mean sensitivity (MS) (p = 0.005) and volumetric (V) (p = 0.015) analysis, the retinal sensitivity in the superior half of the PINNACLE standard grid was significantly higher than in the inferior half. Similarly, retinal sensitivity in the nasal half was higher than in the temporal half (MS: p = 0.007; V: p = 0.003). A Friedman test revealed that retinal sensitivity varied between the quadrants significantly in MS-based (p = 0.0003) and in V-based analysis (p = 0.007). Specifically, the superior nasal quadrant (SNQ) exhibited significantly higher retinal sensitivities than all other quadrants in MS. In V analysis, the SNQ showed significantly higher retinal sensitivities than the superior temporal quadrant (STQ) and the inferior temporal quadrant (ITQ). The Friedman test of PINNACLE cubes yielded significant differences (p < 0.0001) both for MS and V. More specifically, multiple-comparison testing revealed significantly lower retinal sensitivities in the inferior cube (IC) compared to all other tested cubes both in MS and V.

Conclusions : Using mesopic MP, our study further elucidates topographic variations in AMD-development, adding functional data from a large cohort of patients with iAMD. We detected significant differences in cone-mediated retinal sensitivity throughout the tested macular regions. Generally, retinal sensitivity was higher in the nasal macula and lower in the inferior macula.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.