Rapid Objective Testing of Visual Function Matched to the ETDRS Grid and Its Diagnostic Power in Age-Related Macular Degeneration

Bhim B Rai; Faran Sabeti; Corinne F Carle; Emilie M Rohan; Josh P van Kleef; Rohan W Essex; Richard C Barry; Ted Maddess

doi:10.1016/j.xops.2022.100143

Rapid Objective Testing of Visual Function Matched to the ETDRS Grid and Its Diagnostic Power in Age-Related Macular Degeneration

Ophthalmol Sci. 2022 Mar 18;2(2):100143. doi: 10.1016/j.xops.2022.100143. eCollection 2022 Jun.

Authors

Bhim B Rai^{1

2}, Faran Sabeti^{1

3}, Corinne F Carle¹, Emilie M Rohan¹, Josh P van Kleef¹, Rohan W Essex⁴, Richard C Barry⁵, Ted Maddess¹

Affiliations

¹ The John Curtin School of Medical Research, Australian National University, Canberra, Australia.
² Department of Ophthalmology, Jigme Dorji Wangchuck National Referral Hospital, Ministry of Health, Royal Government of Bhutan, Thimphu, Bhutan.
³ School of Optometry, Faculty of Health, University of Canberra, Canberra, Australia.
⁴ Academic Unit of Ophthalmology, Australian National University, Canberra, Australia.
⁵ Blink Eye Clinic, Canberra, Australia.

Abstract

Purpose: To study the power of an 80-second multifocal pupillographic objective perimetry (mfPOP) test tailored to the ETDRS grid to diagnose age-related macular degeneration (AMD) by Age-Related Eye Disease Study (AREDS) severity grade.

Design: Evaluation of a diagnostic technology.

Methods: We compared diagnostic power of acuity, ETDRS grid retinal thickness data, new 80-second M18 mfPOP test, and two wider-field 6-minute mfPOP tests (Macular-P131, Widefield-P129). The M18 stimuli match the size and shape of bifurcated ETDRS grid regions, allowing easy structure-function comparisons. M18, P129, and P131 stimuli test both eyes concurrently. We recruited 34 patients with early-stage AMD with a mean ± standard deviation (SD) age of 72.6 ± 7.06 years. The M18 and P129 plus P131 stimuli had 26 and 51 control participants, respectively with mean ± SD ages of 73.1 ± 8.17 years and 72.1 ± 5.83 years, respectively. Multifocal pupillographic objective perimetry testing used the Food and Drug Administration-cleared Objective FIELD Analyzer (OFA; Konan Medical USA).

Main outcome measures: Percentage area under the receiver operator characteristic curve (AUC) and Hedge's g effect size.

Results: Acuity and OCT ETDRS grid thickness and volume produced reasonable diagnostic power (percentage AUC) for AREDS grade 4 eyes at 83.9 ± 9.98% and 90.2 ± 6.32% (mean ± standard error), respectively, but not for eyes with less severe disease. By contrast, M18 stimuli produced percentage AUCs from 72.8 ± 6.65% (AREDS grade 2) to 92.9 ± 3.93% (AREDS grade 4), and 82.9 ± 3.71% for all eyes. Hedge's g effect sizes ranged from 0.84 to 2.32 (large to huge). Percentage AUC for P131 stimuli performed similarly and for P129 performed somewhat less well.

Conclusions: The rapid and objective M18 test provided diagnostic power comparable with that of wider-field 6-minute mfPOP tests. Unlike acuity or OCT ETDRS grid data, OFA tests produced reasonable diagnostic power in AREDS grade 1 to 3 eyes.

Keywords: AMD, age-related macular degeneration; AREDS, Age-Related Eye Disease Study; AUC, area under the receiver operating characteristic curve; BCVA, best-corrected visual acuity; ETDRS-grid OCT; OFA, Objective FIELD Analyzer; PD, pattern deviation; ROC, receiver operating characteristic; SD, standard deviation; TD, total deviation; abs(DelayDiff), delay difference; macular function; mfPOP, multifocal pupillographic objective perimetry; mfVEP, multifocal visual evoked potential; multifocal pupillography; objective perimetry; rapid perimetry.