Visual function following photodynamic therapy for central serous chorioretinopathy: a comparison of automated macular microperimetry versus best-corrected visual acuity.

BACKGROUND: The study compares the change in best-corrected visual acuity with the change in central retinal sensitivity before treatment and 6 months after treatment with photodynamic therapy in patients with symptomatic central serous chorio retinopathy. DESIGN: Prospective, single-centre, interventional case series. PARTICIPANTS: Eleven consecutive patients with previously untreated central serous chorio retinopathy. METHODS: Patients had microperimetry and best-corrected visual acuity recorded before and 6 months after treatment with photodynamic therapy. Refracted best-corrected visual acuity was assessed at 2 m and adjusted to give the number of letters read at 1 m. Threshold microperimetry was performed by presenting a Goldman III stimulus to 29 points over the central 12° around fixation. Significant visual improvement at 6 months was defined as a best-corrected visual acuity ≥10 letters or, microperimetry change in mean retinal sensitivity ≥2 decibels (dB). MAIN OUTCOME MEASURES: Improvement in best-corrected visual acuity compared with microperimetry following photodynamic therapy treatment in patients with central serous chorio retinopathy. RESULTS: All patients reported a subjective improvement in vision and had complete resolution of subretinal fluid at 6 months. Two patients had a significant improvement in best-corrected visual acuity (mean ± SD +4.2 ± 5.8 letters), compared with all 11 patients who recorded a significant improvement in mean retinal sensitivity (mean ± SD 4.6 ± 1.9 dB) (P < 0.001). CONCLUSIONS: These data suggest that compared with microperimetry, best-corrected visual acuity is underestimating the effectiveness of photodynamic therapy in the treatment of central serous chorio retinopathy.

Visual outcome after intravitreal ranibizumab for wet age-related macular degeneration: a comparison between best-corrected visual acuity and microperimetry.

PURPOSE: The purpose of this study was to compare the observed change in best-corrected visual acuity (BCVA) with the change in central retinal sensitivity pretreatment and 1 month after 3 consecutive treatments with ranibizumab in patients with wet age-related macular degeneration. METHODS: Ten consecutive patients with untreated age-related macular degeneration underwent microperimetric and BCVA assessment before and 1 month after 3 consecutive treatments with ranibizumab. Best-corrected visual acuity was assessed at 2 m by using the Early Treatment Diabetic Retinopathy Study chart. Threshold microperimetry was performed using a Goldman III stimulus to 45 points over the central 12 degrees of the macula. Significant visual improvement after treatment was defined as a change in BCVA >/=10 letters or, on microperimetry, a change in mean retinal sensitivity > or = 2 dB. RESULTS: One month after treatment, the median change in BCVA was +6 letters (range, -15 to +12), and the mean change in the mean retinal sensitivity was +2.86 dB (standard deviation, 1.55 dB). One patient recorded a significant improvement in BCVA compared with 8 patients who recorded a significant improvement in mean retinal sensitivity (P = 0.016). CONCLUSION: Compared with microperimetry, BCVA seems to significantly underestimate the change in visual function experienced by patients treated with ranibizumab.

To investigate the prevalence of polypoidal choroidal vasculopathy in presumed age-related peripapillary subretinal neovascular membranes.

BACKGROUND: To investigate the prevalence and angiographic appearances of polypoidal choroidal vasculopathy (PCV) masquerading as age-related peripapillary subretinal neovascular membranes (PSRNVM). METHODS: A consecutive case series of all patients investigated for presumed age-related PSRNVM in our tertiary referral centre over the period September 2006-2007. The presenting clinical features and fundus fluorescein angiographic (FFA) characteristics of each patient's lesion were identified. Any accompanying Indocyanine Green Angiogram (ICGA) was also reviewed, and on the basis of this investigation patients were classified into one of three groups: proven PCV, probable PCV and PSRNVM. RESULTS: Thirty patients with presumed age-related PSRNVM were identified. The FFA leakage pattern was occult in 21 patients and classic in nine patients. Sixteen patients also had ICGA performed. In 14 of these patients the original FFA leakage pattern was occult, and in two it was classic. Of the 14 patients with occult leakage on FFA who subsequently underwent ICGA all were found to have PCV. CONCLUSIONS: PCV is important and underrecognized in presumed age-related PSRNVMs. In such cases, particularly when the pattern of leakage on the fluorescein angiogram is occult, ICGA should be performed to identify the site of the polyps and if required to direct treatment.

The impact of age-related macular degeneration on health status utility values.

PURPOSE: To estimate health status utility values in patients with age-related macular degeneration (ARMD) associated with visual impairments, by using preference-based measures of health. METHOD: This was a cross-sectional study involving patients with unilateral or bilateral ARMD who attended a large teaching hospital. Patients underwent visual tests (near and distant visual acuity [VA] and contrast sensitivity [CS]) and completed health status questionnaires including the Index of Visual Function (VF)-14 and three preference-based measures (the Health Utilities Index Mark III [HUI-3], the EuroQoL Health Questionnaire [EQ-5D], and the Short Form 6D Health Status Questionnaire [SF-6D]) and the time tradeoff (TTO). The mean health status is presented for five groups, defined according to the VA in the better-seeing eye and for four CS groups. RESULTS: Two hundred nine patients were recruited with substantial loss of visual function as obtained by visual tests (mean decimal VA in the better-seeing eye: 0.2) and self-report (mean VF-14 score: 41.5). The mean (+/-SD) utilities were 0.34 +/- 0.28 for HUI-3, 0.66 +/- 0.14 for SF-6D, 0.72 +/- 0.22 for EQ-5D, and 0.64 +/- 0.31 for TTO. The HUI-3 had the highest correlation with VA and CS (0.40 and -0.34), followed by TTO (0.25 and -0.21). Across the VA and CS groups, only HUI3 and TTO had a significant linear trend (P < 0.05). In a regression model with CS and VA as explanatory variables, only the coefficient on CS was statistically significant. CONCLUSIONS: ARMD is associated with a substantial impact on patients' health status, but this was not reflected in two of the generic preference-based measures used. The HUI-3 seems to be the instrument of choice for use in economic evaluations in which community data are needed. It may be more appropriate to base economic models on CS or some combination of CS and VA rather than on VA alone.