Marco U Morales

Mp1 And Maia Fundus Perimetry In Healthy Subjects And Patients Affected By Retinal Dystrophies

Purpose: To compare retinal sensitivity obtained with MP1 and MAIA microperimeters in patients affected by retinal dystrophies (RD) and in healthy subjects. Methods: Thirty-six patients affected by RD and 25 healthy subjects were considered for the study. All patients and controls underwent a complete ophthalmic examination including fundus-related perimetry, performed by means of two microperimeters, the MP1 (Nidek Technologies) and the MAIA (CenterVue). Main outcome of the study was the comparison of retinal sensitivity. Such comparison was performed converting the MP1 decibel (dB) values to their MAIA equivalent dB values. Results: Mean retinal sensitivity in patients affected by RD was 5.68 ± 6.08 dB (mean ± SD) on MP1 (9.66 ± 10.06 dB converted to their equivalent MAIA values) and 14.66 ± 9.37 dB on MAIA (P < 0.0001). Mean retinal sensitivity in healthy subjects was 18.46 ± 3.10 dB on MP1 (22.44 ± 7.08 dB on their converted equivalent MAIA values) and 28.52 ± 1.12 dB on MAIA (P < 0.0001). Thirty eyes affected by RD (41%) showed retinal areas characterized by sensitivity under 1 dB on MP1, whereas the MAIA examination of the same areas revealed a mean retinal sensitivity of 4.7 dB. Moreover, 28 of these eyes disclosed also areas of absolute scotoma on MP1, but examining the same areas on MAIA, just 13 of these eyes (46%) disclosed an absolute scotoma. In addition, in a subgroup of 6 eyes affected by RD (8%) showing a retinal sensitivity of 20 dB on MP1, the corresponding value on MAIA varied from 26.3 dB to 30.0 dB, with a mean value of 27.8 ± 1.3 dB. Conclusion: The MAIA microperimeter provides a more accurate characterization of functional impairment in RD with respect to the MP1 system, especially in cases with low and high retinal sensitivity. MAIA microperimeter could reveal particularly useful in precisely identifying and monitoring subtle changes in retinal sensitivity, especially in view of the availability of therapies aiming at a functional rescue in patients with RD.

Bilateral eccentric vision training on pseudovitelliform dystrophy with microperimetry biofeedback

Low vision patients with eccentric viewing (EV) use extrafoveal retinal areas to compensate for the loss of central vision. Such retinal loci are known as the preferred retinal locus (PRL). It is known that EV is accompanied by unstable fixation. Microperimetry systems with biofeedback training have been used as a rehabilitation aid to improve fixation stability in EV patients. Normally, only the best or dominant eye is selected for such rehabilitation. This case report describes the rehabilitation on both eyes by means of PRL relocation with MAIA microperimetry (Centervue, Padova, Italy) with biofeedback training technology of a 74-year-old woman diagnosed with adult pseudovitelliform dystrophy. The patient presented binocularly similar anatomical and functional characteristics with the PRL located over the dystrophic area. At the end of the 3 months rehabilitation period, the PRL was successfully relocated inferiorly from the fovea showing relevant visual acuity improvement.

Reference Clinical Database for Fixation Stability Metrics in Normal Subjects Measured with the MAIA Microperimeter

Purpose The purpose of this study was to establish a normal reference database for fixation stability measured with the bivariate contour ellipse area (BCEA) in the Macular Integrity Assessment (MAIA) microperimeter. Methods Subjects were 358 healthy volunteers who had the MAIA examination. Fixation stability was assessed using two BCEA fixation indices (63% and 95% proportional values) and the percentage of fixation points within 1° and 2° from the fovea (P1 and P2). Statistical analysis was performed with linear regression and Pearsons product moment correlation coefficient. Results Average areas of 0.80 deg2 (min = 0.03, max = 3.90, SD = 0.68) for the index BCEA@63% and 2.40 deg2 (min = 0.20, max = 11.70, SD = 2.04) for the index BCEA@95% were found. The average values of P1 and P2 were 95% (min = 76, max = 100, SD = 5.31) and 99% (min = 91, max = 100, SD = 1.42), respectively. The Pearsons product moment test showed an almost perfect correlation index, r = 0.999, between BCEA@63% and BCEA@95%. Index P1 showed a very strong correlation with BCEA@63%, r = −0.924, as well as with BCEA@95%, r = −0.925. Index P2 demonstrated a slightly lower correlation with both BCEA@63% and BCEA@95%, r = −0.874 and −0.875, respectively. Conclusions The single parameter of the BCEA@95% may be taken as accurately reporting fixation stability and serves as a reference database of normal subjects with a cutoff area of 2.40 ± 2.04 deg2 in MAIA microperimeter. Translational Relevance Fixation stability can be measured with different indices. This study originates reference fixation values for the MAIA using a single fixation index.

Prevalence of reticular pseudodrusen in an elderly UK Caucasian population—The Bridlington Eye Assessment Project (BEAP): a cross-sectional study (2002–2006)

Aims:To determine prevalence, associations, and risk factors for reticular pseudodrusen (RPD) in a UK population.Methods:Cross-sectional study of Bridlington residents aged ≥65 years. Masked grading of colour fundus photographs from 3549 participants. RPD presence, phenotype, and topography were recorded, demographic details were analysed, and prevalence was calculated.Results:RPD was detected in 281 eyes (176 individuals) of 3476 participants (5.06%) with gradable images, and bilateral in 76.6%. Digital enhancement increased detection by 15.7%. Prevalence increased significantly with age from 1.18% (65–69 years) to 27.27% (≥90 years) (mean age 81.1, SD 6.01; OR 1.18, 95% CI 1.15–1.21, p value <0.001), was higher in females (5.9% vs 4.0%; OR 1.52, 95% CI 1.09–2.13, p = 0.014), and associated with diabetes (OR 1.97, CI 1.20–3.17, p = 0.005). History of antihypertension treatment appeared protective (OR 0.64, 95% CI 0.46–0.90, p = 0.009). RPD subtypes were dot in 18.5%, ribbon in 36.7%, and mixed in 36.3%. RPD were located outside the ETDRS grid in 88%, and most commonly in the outer superior subfield. Central grid involvement occurred in 12.1% of right and 14.3% of left eyes. RPD occurred in 25.9% of participants with grade 4 AMD in at least one eye. RPD was associated with visual dissatisfaction after controlling for age (OR 0.63, 95% CI 0.45–0.88, p = 0.007).Conclusion:RPD occur more commonly than previously reported, most frequently in the upper–outer macular subfield, but also within the central subfield, albeit with reduced frequency and altered morphology. RPD may be associated with visual dissatisfaction and diabetes, but are less frequent in persons receiving antihypertension therapy.

Prevalence of reticular pseudodrusen in newly presenting adult onset foveomacular vitelliform dystrophy

PurposeTo report the association and prevalence of reticular pseudodrusen (RPD) in eyes with newly presenting adult onset foveomacular vitelliform dystrophy (AFVD). To compare the strength of association with other pathologies resulting from dysfunction of the choroid-Bruch’s membrane–retinal pigment epithelium (RPE) complex, including eyes with geographic atrophy (GA) and angioid streaks.MethodsRetrospective single-centre review of all consecutive newly presenting AFVD. Multimodal imaging with spectral domain optical coherence tomography, fundus photographs, red-free/blue light images, and fundus fluorescein angiograms were graded for the presence of RPD. For comparison, all consecutive newly presenting cases of GA and eyes with angioid streaks were studied.ResultsFifteen (15) patients were identified with AFVD (mean age of 77.3 years; 73.3% female). Mean age of patients with AFVD and RPD was 80.5 years (SD 3.7), whereas that of patients with AFVD without RPD was 75.1 years (SD 7.0). This age difference did not reach statistical significance, P=0.1. Six (40%) had identifiable RPD; being a bilateral finding in 100% of patients. No males with AFVD and RPD were identified. A total of 92 eyes presented with GA. Twenty-three (23) of these (25.0%) had RPD. Twelve (12) patients presented with identifiable angioid streaks, with 4 (36.4%) having RPD.ConclusionRPD are a frequent finding in eyes with newly presenting AFVD; not being restricted to AMD, but a finding common among diseases where pathophysiological mechanisms involve damage to Bruch’s membrane and the RPE, whether genetic or degenerative. Our study supports the concept that they occur with high but variable frequencies in eyes with various pathologies.

Compass fundus automated perimetry

Background: Compass (CenterVue, Padova, Italy) is a fundus automated perimeter which has been introduced in the clinical practice for glaucoma management in 2014. The aim of the article is to review Compass literature, comparing its performances against Humphrey Field Analyzer (Zeiss Humphrey Systems, Dublin, CA, USA). Results: Analyses on both normal and glaucoma subjects agree on the fact that Humphrey Field Analyzer and Compass are interchangeable, as the difference of their global indices is largely inferior than test -retest variability for Humphrey Field Analyzer. Compass also enables interesting opportunities for the assessment of morphology, and the integration between morphology and function on the same device. Conclusion: Visual field testing by standard automated perimetry is limited by a series of intrinsic factors related to the psychophysical nature of the examination; recent papers suggest that gaze tracking is closely related to visual field reliability. Compass, thanks to a retinal tracker and to the active dislocation of stimuli to compensate for eye movements, is able to provide visual fields unaffected by fixation instability. Also, the instrument is a true colour, confocal retinoscope and obtains high-quality 60° × 60° photos of the central retina and stereo-photos details of the optic nerve. Overlapping the image of the retina to field sensitivity may be useful in ascertaining the impact of comorbidities. In addition, the recent introduction of stereoscopic photography may be very useful for better clinical examination.