Macular Function Surveillance Revisited

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Information about Macular Function Surveillance Revisited

Published on October 11, 2007

Author: rhodopsin

Source: slideshare.net

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Presentation on the use of newer technologies to assist patients with macular degeneration with monitoring their vision at home

Macular Function Surveillance Revisited Rick Trevino, OD VA Outpatient Clinic Evansville, IN

Macular Function Surveillance Earlier intervention improves outcome Argon Laser Photodynamic Therapy Anti-VEGF Home surveillance of macular function can result in earlier detection of the symptoms of CNV More effective in younger patients

Earlier intervention improves outcome

Argon Laser

Photodynamic Therapy

Anti-VEGF

Home surveillance of macular function can result in earlier detection of the symptoms of CNV

More effective in younger patients

Macular Function Surveillance Richard Förster (1862) Marc Amsler (1953) Ted Schlaegel (1968) MPS (1983) Entoptic Perimetry (2000) Hyperacuity Perimetry (2003) Computerized Amsler Grid (2004)

Richard Förster (1862)

Marc Amsler (1953)

Ted Schlaegel (1968)

MPS (1983)

Entoptic Perimetry (2000)

Hyperacuity Perimetry (2003)

Computerized Amsler Grid (2004)

Disadvantages of Amsler Grid Low Sensitivity 50% of scotomas missed Only 30% of pts on Amsler surveillance that develop CNV detected their lesion using the grid (Zaidi, et al. Eye. 2004;18:503.) Completion Phenomena Perceptual filling-in of defects Eccentric Fixation Poor Compliance (50%)

Low Sensitivity

50% of scotomas missed

Only 30% of pts on Amsler surveillance that develop CNV detected their lesion using the grid (Zaidi, et al. Eye. 2004;18:503.)

Completion Phenomena

Perceptual filling-in of defects

Eccentric Fixation

Poor Compliance (50%)

Improving the Amsler Grid Red Grid Threshold Grid Cross-Polarizing Lenses Low Contrast Cards Computerized Amsler grid

Red Grid

Threshold Grid

Cross-Polarizing Lenses

Low Contrast Cards

Computerized Amsler grid

Non-Grid Surveillance Techniques Environmental Amsler Entoptic Perimetry Hyperacuity Perimetry Internet-based Programs

Environmental Amsler

Entoptic Perimetry

Hyperacuity Perimetry

Internet-based Programs

Environmental Amsler Monocular inspection of straight lines in your surroundings for signs of distortion Door frames Telephone poles Ceiling or floor tiles Crossword puzzles Lines of text Encourage pts to develop the habit of monocularly assessing their vision

Monocular inspection of straight lines in your surroundings for signs of distortion

Door frames

Telephone poles

Ceiling or floor tiles

Crossword puzzles

Lines of text

Encourage pts to develop the habit of monocularly assessing their vision

Entoptic Perimetry Random flickering of black and white dots on video display (TV “snow”) Makes scotomas visible to the patient so they can be monitored for change 89% more sensitive than Amsler grid in detecting diabetic macular edema Home surveillance with TV or computer

Random flickering of black and white dots on video display (TV “snow”)

Makes scotomas visible to the patient so they can be monitored for change

89% more sensitive than Amsler grid in detecting diabetic macular edema

Home surveillance with TV or computer

Entoptic Perimetry Advantages Simultaneous examination of the whole visual field Subjective experience of visual field defects Can be performed at home using a conventional TV Disadvantages Low sensitivity for congenital or suprageniculate lesions (blind spot, most hemianopic defects) Qualitative examination

Advantages

Simultaneous examination of the whole visual field

Subjective experience of visual field defects

Can be performed at home using a conventional TV

Disadvantages

Low sensitivity for congenital or suprageniculate lesions (blind spot, most hemianopic defects)

Qualitative examination

Hyperacuity Perimetry Utilizes Vernier acuity More sensitive than Amsler grid in detecting late-stage vision defects in AMD Early AMD (PHP: 30%, AG: 30%) Interm AMD (PHP: 46%, AG: 52%) GA (PHP: 87%, AG: 67 %) Wet AMD (PHP: 84%, AG: 80 %) Potentially able to differentiate pts with CNV Home surveillance?

Utilizes Vernier acuity

More sensitive than Amsler grid in detecting late-stage vision defects in AMD

Early AMD (PHP: 30%, AG: 30%)

Interm AMD (PHP: 46%, AG: 52%)

GA (PHP: 87%, AG: 67 %)

Wet AMD (PHP: 84%, AG: 80 %)

Potentially able to differentiate pts with CNV

Home surveillance?

Hyperacuity Perimetry PreView preferential hyperacuity perimeter Macular perimetry using a dot deviation signal Tests central 14 ˚ with 500 data points in 5 min Preferential looking analysis: Quantitatively maps field defects using artificial distortions of the deviation signal Algorithm analysis of the data is designed to detect the presence of CNV

PreView preferential hyperacuity perimeter

Macular perimetry using a dot deviation signal

Tests central 14 ˚ with 500 data points in 5 min

Preferential looking analysis: Quantitatively maps field defects using artificial distortions of the deviation signal

Algorithm analysis of the data is designed to detect the presence of CNV

Hyperacuity Perimetry Advantages Quantitative Positive predictive value Disadvantages Requires expensive specialized equipment Not suitable for home monitoring

Advantages

Quantitative

Positive predictive value

Disadvantages

Requires expensive specialized equipment

Not suitable for home monitoring

Internet-Based Programs Currently available: Downloadable Amsler Great potential for newer generation tests Entoptic perimetry Hyperacuity perimetry Threshold Amsler

Currently available: Downloadable Amsler

Great potential for newer generation tests

Entoptic perimetry

Hyperacuity perimetry

Threshold Amsler

Internet-Based Program Free web-based entoptic perimetry computer program Record scotomas and alert patient to significant changes Research study to compare defects on Amsler grid and entoptic perimetry in pts with AMD

Free web-based entoptic perimetry computer program

Record scotomas and alert patient to significant changes

Research study to compare defects on Amsler grid and entoptic perimetry in pts with AMD

Home Surveillance Amsler Grid Reinforce compliance Environmental Amsler Make it a habit to check monocular vision Television Entoptic Perimetry More sensitive than Amsler

Amsler Grid

Reinforce compliance

Environmental Amsler

Make it a habit to check monocular vision

Television Entoptic Perimetry

More sensitive than Amsler

Thank You!

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