Patient-tailored fundus-controlled perimetry testing in intermediate and early atrophic age-related macular degeneration

Abstract

Purpose : The functional implications arising from structural imaging findings in intermediate and early atrophic age-related macular degeneration (AMD), as well as the feasibility of quantifying such impact, are not yet fully elucidated. We report initial preliminary results of patient-tailored fundus-controlled perimetry (FCP, also called microperimetry) to assess topographic retinal sensitivity as part of the prospective, multicenter, observational HONU study.

Methods : The analysis included 33 subjects (median age 70.8 years, 26 females) that had undergone mesopic FCP with a fixed macular pattern (37 stimuli, each 2° apart) and duplicate FCP with a targeted macular pattern (dense 37 stimuli), the latter being individually located by the reading center (GRADE) based on prior imaging data of high-risk lesions, nascent geographic atrophy (nGA) and lesions with incomplete and complete retinal pigment epithelium and outer retinal atrophy (iRORA and cRORA). Study and fellow eyes were tested at baseline (D1) and week 12 (W12), respectively. Test-retest reliability of targeted patterns and the precision of detecting localized retinal dysfunction compared to interpolated hill-of-vision models (thin plate splines) based on the fixed macular patterns were analyzed.

Results : The coefficient of the 95% repeatability for mean sensitivity targeted pattern testing was ±1.52 dB. Smooth hill-of-vision models (based on the fixed macular pattern) overestimated the localized mean sensitivity in the area corresponding to the localized grid by (mixed model estimate [95% CI]) by +1.08 dB [0.03,2.13] for cRORA/nGA lesions (P=0.045). There was no overestimation at iRORA lesions (-0.49dB[-1.33,0.35]) or high-risk lesions (-0.44 dB[-1.10,0.23]). Regarding the minimum sensitivity within the area of the localized grid, the overestimation was even more severe (cRORA/nGA: +10.47 [7.78, 3.16], iRORA: +5.03 [3.40,6.67], high-risk lesions: +3.76 [1.65,5.87]).

Conclusions : The results demonstrate the feasibility of measuring localized dysfunction in multicenter trials among individuals with intermediate AMD by implementing test patterns tailored to each subject. The results have implications as relative scotomata are highly localized. Our analysis also highlights the limitation of using standard test patterns, which may overestimate retinal sensitivity in areas with functionally relevant AMD-specific lesions.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.