Microperimetry in Age-Related Macular Degeneration: An Evidence-Base for Pattern Deviation Probability Analysis in Microperimetry

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Abstract

Purpose

The “traffic light” color designation of differential light sensitivity used in a number of microperimeters does not encompass the conventional Total and Pattern Deviation probability analyses adopted by standard automated perimetry. We determined whether the color designation is indicative of abnormality as represented by the “gold standard” Pattern Deviation probability analysis.

Methods

Total and Pattern Deviation probability levels, using two different methods, were derived at each of 40 stimulus locations, within 7° eccentricity, from 66 ocular healthy individuals (66 eyes) who had undergone microperimetry with the Macular Integrity Assessment microperimeter. The probability levels were applied to the corresponding fields from each of 45 individuals (45 eyes) with age-related macular degeneration (AMD) and evaluated in relation to the color designation.

Results

Sensitivities designated in orange encompassed the entire range of Pattern Deviation probability levels (from normal to P ≤ 1%). Those designated in green were mostly normal; those in red/black generally corresponded to the ≤1% probability level.

Conclusions

The green and the red/black designations are generally indicative of normal and abnormal probability values, respectively. The orange designation encompassed all probability outcomes and should not be relied upon for visual field interpretation. The evidence base indicates replacement of the color designation of sensitivity in AMD by Total Deviation and Pattern Deviation analyses.

Translational Relevance

The use of Total and Pattern Deviation probability analyses is not universal in all microperimeters, and the derivation of these values indicates that color coding will lead to errors in evaluating visual field loss.

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Most cited references 40

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Internal validation of predictive models: efficiency of some procedures for logistic regression analysis.

E Steyerberg, F Harrell, G Borsboom … (2001)

The performance of a predictive model is overestimated when simply determined on the sample of subjects that was used to construct the model. Several internal validation methods are available that aim to provide a more accurate estimate of model performance in new subjects. We evaluated several variants of split-sample, cross-validation and bootstrapping methods with a logistic regression model that included eight predictors for 30-day mortality after an acute myocardial infarction. Random samples with a size between n = 572 and n = 9165 were drawn from a large data set (GUSTO-I; n = 40,830; 2851 deaths) to reflect modeling in data sets with between 5 and 80 events per variable. Independent performance was determined on the remaining subjects. Performance measures included discriminative ability, calibration and overall accuracy. We found that split-sample analyses gave overly pessimistic estimates of performance, with large variability. Cross-validation on 10% of the sample had low bias and low variability, but was not suitable for all performance measures. Internal validity could best be estimated with bootstrapping, which provided stable estimates with low bias. We conclude that split-sample validation is inefficient, and recommend bootstrapping for estimation of internal validity of a predictive logistic regression model.

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Normal variability of static perimetric threshold values across the central visual field.

J Olsson, G Lindgren, A Heijl (1987)

We assessed the variability of results in normal subjects of computerized static threshold perimetry of the central 30 degrees field. Variability of measured threshold values was highly dependent on eccentricity. This included variability among individuals, test-to-test variability within individuals, and intratest variability. All values were significantly larger in the midperiphery than centrally. We found that the mean sensitivity decrement with age was eccentricity dependent, so that the age-corrected normal visual field became not only depressed but also steeper with age. Distributions of individual pointwise deviations from the age-corrected normal mean thresholds were significantly nongaussian. The dependency of variability on test point location, the nongaussian distributions of deviations from age-corrected means, and the variability of age-induced sensitivity reduction should all be considered in the interpretation of computerized visual fields, and particularly in the design of statistical programs for field analysis. Programs not considering these factors are likely to result in misleading analyses.

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Effects of lutein supplementation on macular pigment optical density and visual acuity in patients with age-related macular degeneration.

Günther Weigert, Semira Kaya, Stefan Sacu … (2011)

There is evidence from several large-scale clinical trials that reduced intake of lutein, a major component of the macular pigment, is a risk factor for the development of AMD. In the present study (LISA; Lutein Intervention Study Austria) it was hypothesized that lutein supplementation increases macular pigment optical density (MPOD). In addition, an investigation was conducted into whether lutein supplementation improves visual acuity (VA) and macular function (mean differential light threshold; MDLT), as assessed with microperimetry. One hundred twenty-six patients with AMD (AREDS [Age-related Eye Disease Study] stages 2, 3, and 4) were included in this randomized (2:1), placebo-controlled, double-masked parallel group study. Lutein or placebo was administered for 6 months. MPOD was measured with a custom-built reflectometer. VA was assessed with ETDRS (Early Treatment Diabetic Retinopathy Study) charts, and MDLT was assessed with a microperimeter. Lutein significantly increased MPOD by 27.9% ± 2.9% (P < 0.001 versus placebo). No significant effect of lutein supplementation on MDLT or VA was seen, although a tendency toward an increase was seen for both parameters (MDLT, P = 0.096 versus placebo; VA, P = 0.070 versus placebo). A significant correlation was found, however, between the increase in MPOD after 6 months and the increase in MDLT after 6 months (r = 0.25, P = 0.027), as well as between the increase in MPOD after 6 months and the increase in VA after 6 months (r = 0.27, P = 0.013). The present study demonstrates that lutein supplementation increases MPOD, as assessed with an objective The correlation between the change in MPOD and the change in VA and MDLT indicates that patients who show a pronounced increase in MPOD also benefit in terms of visual function. (ClinicalTrials.gov number, NCT00879671.).

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Author and article information

Journal

Journal ID (nlm-ta): Transl Vis Sci Technol

Journal ID (iso-abbrev): Transl Vis Sci Technol

Journal ID (hwp): tvst

Journal ID (pmc): Transl Vis Sci Technol

Journal ID (publisher-id): TVST

Title: Translational Vision Science & Technology

Publisher: The Association for Research in Vision and Ophthalmology

ISSN (Electronic): 2164-2591

Publication date Collection: November 2019

Publication date (Electronic): 31 December 2019

Volume: 8

Issue: 6

Electronic Location Identifier: 48

Affiliations

[1 ]College of Biological and Life Sciences, Cardiff University, Cardiff, UK

[2 ]Department of Ophthalmology, University Hospital of Wales, Cardiff, UK

[3 ]Department of Ophthalmology, University of Oxford, Oxford, UK

Author notes

Correspondence: Jennifer H. Acton, College of Biological and Life Sciences, Cardiff University, Maindy Road, Cardiff, CF24 4HQ, UK. e-mail: actonj@ 123456cardiff.ac.uk

Article

Serial Item and Contribution ID: tvst-08-06-09 Publisher ID: TVST-19-1620

DOI: 10.1167/tvst.8.6.48

PMC ID: 6944141

SO-VID: df5f72c5-28a9-46bd-9eaa-3359ceda6256

License:

This work is licensed under a Creative Commons Attribution 4.0 International License.

Microperimetry in Age-Related Macular Degeneration: An Evidence-Base for Pattern Deviation Probability Analysis in Microperimetry

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Abstract

Purpose

Methods

Results

Conclusions

Translational Relevance

Related collections

Karger: Ophthalmology

Most cited references 40

Internal validation of predictive models: efficiency of some procedures for logistic regression analysis.

Normal variability of static perimetric threshold values across the central visual field.

Effects of lutein supplementation on macular pigment optical density and visual acuity in patients with age-related macular degeneration.

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