The document discusses the importance of macular function surveillance for earlier detection and intervention in conditions like choroidal neovascularization (CNV). It evaluates various techniques such as the Amsler grid, entoptic perimetry, and hyperacuity perimetry, highlighting their sensitivities and challenges, particularly in home monitoring settings. Recommendations for improving compliance and effectiveness of these methods are also provided.

1. Macular Function Surveillance Revisited Rick Trevino, OD VA Outpatient Clinic Evansville, IN

2. Macular Function Surveillance Earlier intervention improves outcome Argon Laser Photodynamic Therapy Anti-VEGF Home surveillance of macular function can result in earlier detection of the symptoms of CNV More effective in younger patients

3. Macular Function Surveillance Richard Förster (1862) Marc Amsler (1953) Ted Schlaegel (1968) MPS (1983) Entoptic Perimetry (2000) Hyperacuity Perimetry (2003) Computerized Amsler Grid (2004)

4. Disadvantages of Amsler Grid Low Sensitivity 50% of scotomas missed Only 30% of pts on Amsler surveillance that develop CNV detected their lesion using the grid (Zaidi, et al. Eye. 2004;18:503.) Completion Phenomena Perceptual filling-in of defects Eccentric Fixation Poor Compliance (50%)

5. Improving the Amsler Grid Red Grid Threshold Grid Cross-Polarizing Lenses Low Contrast Cards Computerized Amsler grid

6. Non-Grid Surveillance Techniques Environmental Amsler Entoptic Perimetry Hyperacuity Perimetry Internet-based Programs

7. Environmental Amsler Monocular inspection of straight lines in your surroundings for signs of distortion Door frames Telephone poles Ceiling or floor tiles Crossword puzzles Lines of text Encourage pts to develop the habit of monocularly assessing their vision

8. Entoptic Perimetry Random flickering of black and white dots on video display (TV “snow”) Makes scotomas visible to the patient so they can be monitored for change 89% more sensitive than Amsler grid in detecting diabetic macular edema Home surveillance with TV or computer

9. Entoptic Perimetry Advantages Simultaneous examination of the whole visual field Subjective experience of visual field defects Can be performed at home using a conventional TV Disadvantages Low sensitivity for congenital or suprageniculate lesions (blind spot, most hemianopic defects) Qualitative examination

10. Hyperacuity Perimetry Utilizes Vernier acuity More sensitive than Amsler grid in detecting late-stage vision defects in AMD Early AMD (PHP: 30%, AG: 30%) Interm AMD (PHP: 46%, AG: 52%) GA (PHP: 87%, AG: 67 %) Wet AMD (PHP: 84%, AG: 80 %) Potentially able to differentiate pts with CNV Home surveillance?

11. Hyperacuity Perimetry PreView preferential hyperacuity perimeter Macular perimetry using a dot deviation signal Tests central 14 ˚ with 500 data points in 5 min Preferential looking analysis: Quantitatively maps field defects using artificial distortions of the deviation signal Algorithm analysis of the data is designed to detect the presence of CNV

12. Hyperacuity Perimetry Advantages Quantitative Positive predictive value Disadvantages Requires expensive specialized equipment Not suitable for home monitoring

13. Internet-Based Programs Currently available: Downloadable Amsler Great potential for newer generation tests Entoptic perimetry Hyperacuity perimetry Threshold Amsler

14. Internet-Based Program Free web-based entoptic perimetry computer program Record scotomas and alert patient to significant changes Research study to compare defects on Amsler grid and entoptic perimetry in pts with AMD

15. Home Surveillance Amsler Grid Reinforce compliance Environmental Amsler Make it a habit to check monocular vision Television Entoptic Perimetry More sensitive than Amsler

16. Thank You!