Prospective Study Comparing Quantitative Self-Monitoring Metamorphopsia Measurement Tools in Myopic Choroidal Neovascularization (mCNV).

Purpose: To assess the ability of two self-monitoring digital devices to detect metamorphopsia in myopic choroidal neovascularization (mCNV) and compare their usability. Patients and Methods: This was a 12-month prospective observational study at a tertiary care eye hospital, Switzerland. Twenty-three Caucasian patients with mCNV were recruited, 21 eyes were analyzed. Primary and secondary outcome measures: Primary outcome measures were the metamorphopsia index scores as assessed by the two self-monitoring digital devices (Alleye App and AMD - A-Metamorphopsia-Detector software) at baseline, at 6 and 12 months and individual optional visits in between. Secondary outcome measures included best corrected visual acuity and morphological parameters (including disease activity) as evaluated by spectral-domain optical coherence tomography and fundus autofluorescence imaging. Location of mCNV was graded using the Early Treatment of Diabetic Retinopathy Study grid overlay. A usability questionnaire was administered at 12 months. Bland-Altman plots evaluated the limits of agreement of both devices. Linear regression analysis assessed the correlation between the difference and the average of the two scores. Results: A total of 202 tests were performed. Disease activity of mCNV was observed at least once in 14 eyes. Both scores concordantly detected metamorphopsia exhibiting a displaced scale of measurement yielding a coefficient of determination of 0.99. Concordance rate for pathological scores was 73.3%. Both scores were not significantly different in active and inactive mCNV. Overall, the usability scores were higher for the Alleye App than the AMD - A-Metamorphopsia-Detector software (4.61±0.56 vs 3.31±1.20; p<0.001). In subjects aged >75 years, scores were slightly lower (4.08±0.86 vs 2.97±1.16; p= 0.032). Conclusion: Whilst both self-monitoring devices concordantly identified metamorphopsia, they might act as an adjunct to hospital visits, but due to slight reactivations in mCNV and presence of metamorphopsia also in inactive disease the ability of detecting early mCNV activity might be limited.

Change in Sub-aspects of Vision-Related Quality of Life after Three Months of Using an App to Categorize Metamorphopsia. / Veränderung von Teilaspekten der sehbezogenen Lebensqualität nach 3-monatiger Verwendung einer App zur Kategorisierung von Metamorphopsien.

AIM: Distorted vision (metamorphopsia) is a leading symptom in retinal disease and can be categorized with the app MacuFix. This prospective controlled pilot study examined the influence of the app MacuFix as a method to assess metamorphopsia on vision-related quality of life. METHODS: Forty-five patients suffering from metamorphopsia in at least one eye were recruited for the study. Vision-related quality of life before and after 3 months of optional home monitoring using the app MacuFix were compared with the questionnaire National Eye Institute Visual Function Questionnaire-25. RESULTS: The 45 participants (18 women, 27 men) were, on average, 68 years old (SD ± 9.7) and had a mean best-corrected visual acuity of 0.6 (SD ± 0.25). Of 90 eyes, 18 revealed no maculopathy. Age-related macular degeneration existed in 52 eyes, epiretinal gliosis in 6, and macular hole in 1 eye. Macular edema was present in two eyes due to diabetes, four eyes due to uveitis, one eye after retinal venous thrombosis, four eyes because of an Irvine Gass syndrome, and two eyes caused by central serous thrombosis. After 3 months, 35 persons used the app for home monitoring, 8 persons applied the Amsler Grid, and 2 did not use any test. App users showed a highly significant improvement in vision-related quality of life in questions on mental health and concern about vision, and a significant improvement in performance, dejection, control, and embarrassing situations. CONCLUSION: The results suggest that MacuFix can possibly ameliorate partial aspects of vision-related quality of life.

MacuFix® versus Amsler grid for metamorphopsia categorization for macular diseases.

PURPOSE: Macular diseases often lead to metamorphopsia, which is traditionally tested using the Amsler grid. This study evaluates a novel method for assessing metamorphopsia, based on the software AMD-A Metamorphopsia Detector, application MacuFix®. METHODS: In this observational study, the usability of a new smartphone-based testing method to assess metamorphopsia was evaluated in 45 patients experiencing metamorphopsia in at least one eye using the questionnaire "System Usability Score (SUS)." Additionally, the diagnostic adherence of self-monitoring with the Amsler grid was compared to self-monitoring with the novel software MacuFix®. RESULTS: The average score of the SUS questionnaire in this study was 76.7 ± 15.5, corresponding to the "good" score on the grading scale. The average interval between two home administered tests was significantly shorter (6 days) when the application was used as compared to using the Amsler grid (19 days). The odds ratio of the frequency of patients using the application to the patients using the home test was 4. CONCLUSION: MacuFix® application can help in effective home monitoring of macular function as high user satisfaction and increased testing frequency was observed in its use in patients with macular diseases.

Test-Retest-Reliability of Computer-Based Metamorphopsia Measurement in Macular Diseases. / Test-Retest-Reliabilität der computergestützten Metamorphopsiemessung bei Makulaerkrankungen.

In this study, the test-retest-reliability as one aspect of reliability of metamorphopsia measurements using a computer-based measuring method was determined in patients with macular diseases. Metamorphopsia amplitude, position, and area were quantified using AMD - A Metamorphopsia Detector software (app4eyes GmbH & Co. KG, Germany) in patients with diabetic, myopic, or uveitic macular edema, intermediate or neovascular age-associated macular degeneration, epiretinal membrane, vitelliform maculopathy, Irvine-Gass syndrome, or macular edema due to venous retinal occlusion. The intraclass correlation coefficient (ICC) was calculated in order to determine the repeatability of two repeated measurements and was used as an indicator of the reliability of the measurements. In this study, metamorphopsia measurements were conducted on 36 eyes with macular diseases. Metamorphopsia measurements made using AMD - A Metamorphopsia Detector software were highly reliable and repeatable in patients with maculopathies. The intraclass correlation coefficient of all indices was excellent (0.95 - 0.97). For diseases of the vitreoretinal interface or macular diseases with intra- or subretinal edema, this metamorphopsia measurement represents a supplement for visual function testing in the clinic, as well as in clinical studies.

[Correlation of Quantitative Metamorphopsia Measurement and Central Retinal Thickness in Diabetic Macular Edema and Age-Related Exsudative Macular Degeneration]. / Korrelation der quantitativen Metamorphopsiemessung und der zentralen Netzhautdicke bei diabetischem Makulaödem und altersassoziierter exsudativer Makuladegeneration.

BACKGROUND: Amsler Test is the standard used to detect metamorphopsia. To develop a tool to quantitatively measure and monitor metamorphopsia, the computer-based test "AMD - A Metamorphopsia Detector®" was developed. This study was performed to examine the correlation of metamorphopsia index (MI) and central retinal thickness (CRT) in exsudative age-related macular degeneration (AMD) and diabetic macular edema (DME). MATERIAL AND METHODS: Sixty-six eyes of 66 patients, DME: 19 (11 males, 8 females; age 42 - 76); AMD: 47 (13 male, 34 female; age 56 - 93) were included in this convenient sample study and classified as having or not having macular edema (central 500 µm, Cirrus HD-OCT). Best corrected monocular distance visual acuity (BCVA), Amsler Test, Metamorphopsia Index of AMD - A Metamorphopsia Detector, binocular ophthalmoscopy, central retinal thickness (SD-OCT) and fluorescein angiography, if necessary, were performed. Correlation of central retinal thickness and metamorphopsia index was evaluated by Spearman correlation. RESULTS: Mean BCVA (logMAR) was 0.27 (SD 0.3) in DME and 0.29 (SD 0.2) in AMD. Spearman's rho as a measure for correlation between CRT and MI was 0.88 (p < 0.001) in DME and 0.56 (p < 0.001) in AMD. CONCLUSIONS: Correlation of CRT und MI was high in DME and moderate in AMD. Future studies will examine if metamorphopsia measurement is a feasible tool for detection of conversion into neovascular AMD and for (self-)monitoring.