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Efficacy of a Novel Technique in Predicting a Diagnosis of AgeRelated Macular Degeneration B249

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Title: Efficacy of a Novel Technique in Predicting a Diagnosis of AgeRelated Macular Degeneration B249


1
Efficacy of a Novel Technique in Predicting a
Diagnosis of Age-Related Macular Degeneration
(B249)
Joshua Robinson1, Jonathan L Prenner2, Daniel B
Roth2, Kenneth Darvin3, Richard S Kaiser4 1
Robert Wood Johnson Medical School, New
Brunswick, NJ (robinsjo_at_umdnj.edu) 2 Retina
Vitreous Center, Robert Wood Johnson Medical
School, New Brunswick, NJ 3 Santamaria Eye
Center, Perth Amboy, NJ 14The Retina Service,
Wills Eye Hospital, Thomas Jefferson University,
Philadelphia, PA
METHODS
INTRODUCTION
59 eyes of 49 patients with documented AMD of
varying severity as well as 26 eyes of 14
patients with no known macular pathology were
enrolled into the study cohort. Each study eye
was tested individually, without visual
correction. In all cases, the test was performed
on the dilated eyes of fully consented patients
prior to ophthalmologic examination. The test
consisted of three 15-second trials with the
MacScopeTM. Patients were then asked to describe
what they observed. Color fundus photographs
(CFPs) were obtained and subsequently categorized
by two masked retina specialists into one of
seven categories (no macular pathology, AREDS I,
AREDS II, AREDS III, AREDS IV5, neovascular
non-disciform AMD or AMD with disciform scar).
Additionally, they reported as to whether they
expected the subject to perceive a scotoma given
the location and severity of macular pathology on
CFP. A third investigator, blinded to the CFP
categorization, graded each of the patient
observations by a number of characteristics
including scotoma area.
Age-related macular degeneration (AMD) is a
leading cause of blindness affecting nearly 2
million Americans including roughly one in four
people over 74 years of age. 1-2 Until very
recently, most patients diagnosed with
neovascular AMD carried a grim prognosis with
respect to preservation of visual acuity. The
emergence of various anti-angiogenic agents has
allowed for well-tolerated and highly effective
treatment modalities to limit and even induce
regression of neovascular lesions especially when
administered early in the course of disease.
Presently, patients monitor for disease
progression at home with the use of an Amsler
grid, which is convenient and cost-effective, but
is associated with sub-optimal sensitivity 36
to 53 sensitivity for detection of neovascular
AMD.3-4 Newer screening methods such as
preferential hyperacuity perimeter and Macular
Computerized Psychophysical Test are highly
sensitive, but may be prohibitively expensive to
implement as home screening methods. The need
for cost-effective yet sensitive screening tool
for home monitoring of disease progression
becomes apparent in light of increasing longevity
and the availability of effective treatment
modalities. The current study evaluates a
device that was designed to help address this
disparity. The MacScopeTM (Sensory Arts
Science, King of Prussia, PA) is a handheld
device that emits a strobed pattern of white
light at various frequencies, thereby assessing
responses to photostress in patients with AMD to
assess disease severity.
RESULTS
Of the 85 eyes enrolled in the study, 21 were
graded as no macular pathology, 5 as AREDS I, 8
as AREDS II, 14 as AREDS III, 15 as AREDS IV, 14
as neovascular non-disciform AMD and 8 as AMD
with disciform scar. Intraocular pressure and
cataract severity were not found to be
significantly different among CFP categories.
Statistically significant relationships exist
with increasing age and decreasing VA with
disease severity. All patients who perceived a
scotoma gt 700mm2 had AREDS III disease or
worse. Data reflecting frequency of perceived
scotoma and size of scotoma as drawn by the
patient are summarized in the figures to the
left. The sensitivity/specificity of the MacScope
versus whether a scotoma would be expected to be
perceived was 80/80 (RK) and 80.4/82.4 (JP).
Examples of CFPs and corresponding patient
drawings of findings with the MacScope. Top AMD
with disciform scar, Middle AREDS IV, Bottom
No macular pathology.
CONCLUSION
This initial study of a novel device for
monitoring disease progression in patients with
AMD demonstrates a strong correlation of test
findings with disease severity as assessed by
CFP.
  • REFERENCES
  • R Klein, T Peto, A Bird, MR Vannewkirk. The
    epidemiology of age-related macular degeneration.
    Am J Ophthalmol 2004137486-495.
  • OP Gupta, GC Brown, MM Brown. Age-related
    macular degeneration the costs to society and
    the patient. Curr Opin Ophthalmol
    200718201205.
  • PHP Research Group. Results of a multicenter
    clinical trial of preferential hyperacuity
    perimeter for detection of age-related macular
    degeneration. Retina 200525296303.
  • A Loewenstein, R Malach, M Goldstein, et al.
    Replacing the Amsler grid a new method for
    monitoring patients with age-related macular
    degeneration. Ophthalmology 2003110966970.
  • Age-Related Eye Disease Study Research Group.
    AREDS design implications AREDS report no. 1.
    Contr Clin Trials 199920573600.
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