CORRELATION BETWEEN MICROPERIMETRY AND IMAGING IN EXTENSIVE MACULAR ATROPHY WITH PSEUDODRUSEN-LIKE APPEARANCE

Retina, vol. 44, pp. 246–254

Abstract

PURPOSE: To determine the correlation between microperimetry and imaging findings in extensive macular atrophy with pseudodrusen-like appearance (EMAP). METHODS: This cross-sectional, observational study included 44 consecutive patients with EMAP (88 eyes) and 30 healthy subjects (60 eyes). Both groups underwent visual acuity assessment, mesopic and scotopic microperimetry, fundus photography, autofluorescence, optical coherence tomography, and optical coherence tomography angiography. Retinal sensitivity was also subdivided in macular (0-4°) and paramacular areas (8-10°). Scotopic sensitivity loss was defined as the difference between scotopic and mesopic sensitivities for each tested point. Eyes with EMAP were further classified into the three stages described by Romano et al: 19 eyes in Stage 1, 31 in Stage 2, and 38 in Stage 3. RESULTS: Mesopic and scotopic retinal sensitivity were significantly reduced in patients with EMAP compared with controls, particularly in the macular area (all P < 0.001). Mesopic retinal sensitivity progressively declined in more advanced EMAP stages (all P < 0.01), but no scotopic differences were observed between Stages 2 and 3 ( P = 0.08). Remarkably, scotopic sensitivity loss was significantly higher in Stage 1 ( P < 0.05).On multivariate analysis, mesopic dysfunction was associated with larger atrophic areas ( P < 0.01), foveal involvement ( P = 0.03), and fibrosis ( P = 0.02). Conversely, no independent variable was associated with a reduced scotopic retinal sensitivity (all P > 0.05). CONCLUSION: The findings highlight that patients with EMAP suffer from a severe cone- and rod-mediated dysfunction on microperimetry. The predominant rod impairment in the early cases (Stage 1) emphasizes the importance of dark-adapted scotopic microperimetry as a clinical end point and suggests defective transportation across the RPE-Bruch membrane complex in its pathogenesis.

Authors 13

1. Francesco Romano corresponding

   Massachusetts Eye and Ear Infirmary · Harvard University · University of Milan · Luigi Sacco Hospital

   Affiliation as printed

   Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy;

   Harvard Retinal Imaging Laboratory, Mass Eye and Ear, Boston, Massachusetts;

   Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy

   Harvard Retinal Imaging Lab, Mass Eye and Ear, Boston, MA, USA

2. Camiel J. F. Boon Aachen Department of Ophthalmology, Leiden University Medical Center Department of Ophthalmology, Leiden

   Leiden University Medical Center · Amsterdam University Medical Centers

   Affiliation as printed

   Department of Ophthalmology, Amsterdam University Medical Center, Amsterdam, the Netherlands;

   Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands;

   Amsterdam University Medical Center, Department of Ophthalmology, Amsterdam, the Netherlands

   Leiden University Medical Center, Department of Ophthalmology, Leiden, the Netherlands

3. Alessandro Invernizzi corresponding

   The University of Sydney · University of Milan · Luigi Sacco Hospital

   Affiliation as printed

   Department of Ophthalmology, Save Sight Institute, University of Sydney, Sydney, NSW, Australia;

   Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy;

   Department of Ophthalmology, Save Sight Institute, University of Sydney, Sydney, NSW, Australia

   Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy

4. Francesca Bosello corresponding

   University of Verona

   Affiliation as printed

   Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy;

   Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy

5. Stefano Casati corresponding

   University of Verona

   Affiliation as printed

   Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy;

   Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy

6. Chiara Zaffalon corresponding

   University of Verona · University of Milan · Luigi Sacco Hospital

   Affiliation as printed

   Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy;

   Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy;

   Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy

   Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy

7. Ester Riva corresponding

   University of Milan · Luigi Sacco Hospital

   Affiliation as printed

   Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy;

   Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy

8. Alice Ingrid Bertoni corresponding

   University of Milan · Luigi Sacco Hospital

   Affiliation as printed

   Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy;

   Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy

9. Aniruddha Kishandutt Agarwal

   Cleveland Clinic Abu Dhabi

   Affiliation as printed

   Eye Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates; and

   Eye Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates

10. Gagan Kalra

    Cleveland Clinic

    Affiliation as printed

    Cleveland Clinic, Cole Eye Institute, Cleveland, Ohio

    Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA

11. Mariano Cozzi corresponding

    University of Milan · Luigi Sacco Hospital

    Affiliation as printed

    Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy;

    Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy

12. Giovanni Staurenghi corresponding

    University of Milan · Luigi Sacco Hospital

    Affiliation as printed

    Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy;

    Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy

13. Anna Paola Salvetti corresponding

    University of Milan · Luigi Sacco Hospital

    Affiliation as printed

    Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy;

    Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco Hospital, University of Milan, Milan, Italy