Jessica Boyle BHlthSc(Hons) BOrth&OphthSc1, 2
Meri Vukicevic PhD1, 3
Konstandina Koklanis PhD1, 4
Catherine Itsiopoulos PhD5
Wilson J Heriot MBBS FRANZCO FRACS2, 6
1 Department of Community & Clinical Allied Health, La Trobe University, Melbourne, Australia
2 Retinology Institute, Melbourne, Australia
3 Eye Surgery Associates, Melbourne, Australia
4 Department of Ophthalmology, Royal Children’s Hospital, Melbourne, Australia
5 Department of Rehabilitation, Nutrition & Sport, La Trobe University, Melbourne, Australia
6 Department of Surgery, Ophthalmology, University of Melbourne, Parkville, Melbourne, Australia
Conventional parameters such as best-corrected visual acuity (BCVA) often grossly underestimate the profound visual limitations experienced by patients with perifoveal geographic atrophy (GA) secondary to dry age-related macular degeneration (AMD). Foveal preservation in these patients means that BCVA is often only moderately impaired, despite significant challenges often reported in undertaking day-to-day vision-requiring tasks. BCVA may lead to a misrepresentation of the extent of real-world visual dysfunction in this clinical population and yet, is widely used as the gold standard measure in assessing patient eligibility for disability entitlements and driving. This systematic review investigated the relationship between microperimetry thresholds and performance on tests of functional vision and visual function in patients with perifoveal GA.
A systematic search of the Embase, CINAHL, Medline, PubMed and Web of Science electronic databases was conducted to identify all relevant studies published between January 2002 and December 2017 in the English language and involving human participants. A search of the grey literature was also conducted. Ten relevant articles were found and a critical appraisal undertaken.
Only two of the 10 studies investigated functional deficits specifically in patients with perifoveal GA. The remaining eight studies were more broadly defined and failed to subclassify participants according to GA location. Microperimetry was found to represent a valuable tool in quantifying visual deficits in these patients and was much more sensitive than conventional measures, including BCVA and low-luminance visual acuity. This review highlighted the importance of a multimodal approach to assessment to better capture the real-world visual dysfunction experienced by patients with perifoveal GA.
