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AMD visual field testing of little clinical relevance, Sydney study finds

Automated perimetry Dr Lisa Nivison-Smith

Researchers from the Centre for Eye Health (CFEH) and UNSW have published a new review demonstrating visual field testing in early and intermediate age-related macular degeneration (AMD) reveals statistically significant, but not clinically relevant, differences in visual function.

They hope the findings finally clarify best practice regarding automated perimetry for AMD assessment.

Researcher Dr Lisa Nivison-Smith, who led the study, said even though there were research publications exploring visual function for AMD, particularly using new forms of perimetry, anecdotally it appeared visual field testing for AMD patients was not common in optometric practice. Descriptions for its use in various AMD clinical guidelines were also unclear.

“We found a clear gap between research and clinical practice regarding automated perimetry and AMD that needed to be addressed,” Nivison-Smith said.

The review assessed more than 26 papers using clinically available automated perimetry to assess eyes with early or intermediate AMD. They determined if a difference in visual function existed with disease and if these differences had any real-world patient outcomes.

The research unit found consistent evidence that there were visual field defects in early and intermediate AMD that were significant when compared to normal eyes, using clinically available automated perimetry.

However, these reductions when measured using a standard automated perimeter (SAP) under photopic conditions were not clinically meaningful when assessed with meta-analyses. They also found very little evidence on relevance of visual field outcomes to patient outcomes.

“Because this review only focused on devices that are clinically available, it provides results that are highly translatable to current clinical practice,” Nivison-Smith said.

“It highlights that research into other perimetry devices or other light testing conditions may become highly relevant in the future. It also highlights the need to study the real-word implications of these outcomes for these patients.”

The full review article entitled ‘Should clinical automated perimetry be considered for routine functional assessment of early/intermediate age-related macular degeneration (AMD)? A systematic review of current literature’, has been published in Ophthalmic and Physiological Optics.

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