Purpose To examine the added predictive value of microperimetric sensitivity and low luminance deficit (LLD; difference between photopic and low luminance visual acuity (VA)) to information from colour fundus photography (CFP) for progression to late age-related macular degeneration (AMD) in individuals with bilateral large drusen.
Methods 140 participants with bilateral large drusen underwent baseline microperimetry testing, VA measurements and CFP. They were then reviewed at 6-monthly intervals to 36 months, to determine late AMD progression. Microperimetry pointwise sensitivity SD (PSD), LLD and the presence of pigmentary abnormalities on CFPs were determined. Predictive models based on these parameters were developed and examined.
Results Baseline microperimetry PSD and presence of pigmentary abnormalities were both significantly associated with time to develop late AMD (p≤0.004), but LLD was not (p=0.471). The area under the receiver operating characteristic curve (AUC) for discriminating between eyes that progressed to late AMD based on models using microperimetry PSD (AUC=0.68) and LLD (AUC=0.58) alone was significantly lower than that based on CFP grading for the presence of pigmentary abnormalities (AUC=0.80; both p<0.005). Addition of microperimetry and/or LLD information to a model that included CFP grading did not result in any improvement in its predictive performance (AUC=0.80 for all; all p≥0.66).
Conclusions While microperimetry, but not LLD, was significantly and independently associated with AMD progression at the population level, this study observed that both measures were suboptimal at predicting progression at the individual level when compared to conventional CFP grading and their addition to the latter did not improve predictive performance.
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Funding This study was supported by National Health & Medical Research Council of Australia (project grant no.: APP1027624 (RHG and CDL), and fellowship grant no.: GNT1103013 (RHG), APP1104985 (ZW), APP1054712 (FKC) and APP1142962 (FKC)) and BUPA Health Foundation (Australia) (RHG and CDL). CERA receives operational infrastructure support from the Victorian Government. The web-based Research Electronic Data Capture (REDCap) application and open-source platform OpenClinica allowed secure electronic data capture. The study is sponsored by the Centre for Eye Research Australia (CERA), an independent medical research institute and a not-for-profit company.
Competing interests RHG reports personal fees from Bayer, Novartis, Roche Genentech and Apellis outside the submitted work and research grant from Bayer outside the submitted work. FKC reports personal fees from Bayer, Novartis, Allergan, Heidelberg Engineering, Alcon and Pfizer outside the submitted work and aresearch grant from Novartis and Bayer outside the submitted work. UC reports personal fees from Bayer, Novartis, Roche outside the submitted work and aresearch grant from Bayer, Novartis, Roche outside the submitted work. JJA reports personal fees from Allergan, Bayer and Novartis. WJH reports personal fees from Alcon, Bayer and Novartis outside the submitted work. JR reports personal fees from Ellex Medical Lasers Ltd outside the submitted work. ZW, CDL, LABH and EC report nothing to declare.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Data are available upon reasonable request.