Microperimetry Helps Predict Disease Progression in Eyes at High Risk of AMD

Laurent Kodjikian, MD, PhD

The use of microperimetry to predict progression in Age-Related Eye Disease Study Group (AREDS) stages in eyes at high-risk of age-related macular degeneration (AMD) showed promise, according to new findings.

Despite the lack of understood biomarkers of disease progression in AMD, these new findings indicate the significance of mean retinal sensitivity with the prediction of AMD progression.

“Given the lack of biomarkers for predicting disease progression in AMD, this result seems promising and could be used in routine practice in contralateral eyes of AREDS stage 4 eye to evaluate the risk of progression when mean retinal sensitivity is below 24.7 dB,” wrote study author Laurent Kodjikian, MD, PhD, Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon.

Through fundus retinography, the Age-Related Eye Disease Study (AREDS) categorizes AMD into 4 categories: the absence of AMD change (stage 1), specific fundus alterations (stage 2), intermediate (stage 3) or advanced (stage 4) changes.

Previous findings from the team of investigators suggest that microperimetry can be used to differentiate between the 4 AREDS stages in patients with AMD. In the present study, the team determined the performance of microperimetry parameters in detecting the risk of progression at 2 years of an ARED stage 3 eye fellow to a AREDS stage 4 eye.

The prospective, non-comparative, open-label study included patients with AMD from 5 tertiary centers in France between September 2015 and January 2018. Patients were eligible if they were diagnosed with stage 4 AMD in one eye and drusen in the fellow eye (study eye).

Investigators performed a microperimetry examination using the MAIA device at baseline and then every 6 months throughout a 2-year follow-up. Each study eye was either defined as progressive or non-progressive according to the AREDS stage of the study eye at the end of follow-up.

The study analyzed a total of 147 eyes from 147 patients (mean age, 76.4 years) who were predominantly female (n = 95; 64.6%). At the baseline, the mean BCVA was 78.9 ETDRS letters and mean CMT was 264.6 μm.

In the follow-up period, a total of 45 study eyes (30.6%) progressed from AREDS stage 3 to stage 4 and were considered “progressive.” The study reported the microperimetry criterion “mean retinal sensitivity” was significantly different at baseline between non-prorgressive and progressive eyes (P = .022), with lower values for the latter.

A threshold of 24.7 dB was set for mean retinal sensitivity. With this threshold, the diagnostic sensitivity or progression was 80.0% (95% confidence interval [CI], 65.4 - 90.4). Otherwise, the specificity was 30.4% (95% CI, 21.7 - 40.3), positive predictive value was 33.6% (95% CI, 24.8 - 43.4), and negative predictive value was 77.5 (95% CI, 61.5 - 89.2).

The multivariate analysis integrating other ophthalmologic parameters observed the mean retinal sensitivity was the only parameter statistically associated with progression (P = .0004).

A total of 678 were performed over the study period and 38 serious adverse events were reported during the same period, but none were considered related to the procedure.

“Our findings should be taken into consideration knowing that to date, only the presence of retinal pseudodrusen has been described as a risk factor of disease progression in an AREDS stage 3 eye, contralateral to an eye with AREDS stage 4,” Kodjikian added.

The study, “Microperimetry to predict disease progression in eyes at high risk of age-related macular degeneration disease: The PREVISION study,” was published in Acta Ophthalmologica.