Abstract
Objective
To clarify the screening potential of the Amsler grid and preferential hyperacuity perimetry (PHP) in detecting or ruling out wet age-related macular degeneration (AMD).
Evidence acquisition
Medline, Scopus and Web of Science (by citation of reference) were searched. Checking of reference lists of review articles and of included articles complemented electronic searches. Papers were selected, assessed, and extracted in duplicate.
Evidence synthesis
Systematic review and meta-analysis. Twelve included studies enrolled 903 patients and allowed constructing 27 two-by-two tables. Twelve tables reported on the Amsler grid and its modifications, twelve tables reported on the PHP, one table assessed the MCPT and two tables assessed the M-charts. All but two studies had a case–control design. The pooled sensitivity of studies assessing the Amsler grid was 0.78 (95% confidence intervals; 0.64–0.87), and the pooled specificity was 0.97 (95% confidence intervals; 0.91–0.99). The corresponding positive and negative likelihood ratios were 23.1 (95% confidence intervals; 8.4–64.0) and 0.23 (95% confidence intervals; 0.14–0.39), respectively. The pooled sensitivity of studies assessing the PHP was 0.85 (95% confidence intervals; 0.80–0.89), and specificity was 0.87 (95% confidence intervals; 0.82–0.91). The corresponding positive and negative likelihood ratios were 6.7 (95% confidence intervals; 4.6–9.8) and 0.17 (95% confidence intervals; 0.13–0.23). No pooling was possible for MCPT and M-charts.
Conclusion
Results from small preliminary studies show promising test performance characteristics both for the Amsler grid and PHP to rule out wet AMD in the screening setting. To what extent these findings can be transferred to a real clinic practice still needs to be established.
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References
Heier JS, Boyer DS, Ciulla TA, Ferrone PJ, Jumper JM, Gentile RC et al. Ranibizumab combined with verteporfin photodynamic therapy in neovascular age-related macular degeneration: year 1 results of the FOCUS Study. Arch Ophthalmol 2006; 124 (11): 1532–1542.
Rosenfeld PJ, Brown DM, Heier JS, Boyer DS, Kaiser PK, Chung CY et al. Ranibizumab for neovascular age-related macular degeneration. N Engl J Med 2006; 355 (14): 1419–1431.
Martin DF, Maguire MG, Ying GS, Grunwald JE, Fine SL, Jaffe GJ . Ranibizumab and bevacizumab for neovascular age-related macular degeneration. N Engl J Med 2011; 364 (20): 1897–1908.
Ying GS, Huang J, Maguire MG, Jaffe GJ, Grunwald JE, Toth C et al. Baseline predictors for one-year visual outcomes with ranibizumab or bevacizumab for neovascular age-related macular degeneration. Ophthalmology 2013; 120 (1): 122–129.
Amsler M . L'Examen qualitatif de la fonction maculaire. Ophthalmologica 1947; 114: 248–261.
Goldstein M, Loewenstein A, Barak A, Pollack A, Bukelman A, Katz H et al. Results of a multicenter clinical trial to evaluate the preferential hyperacuity perimeter for detection of age-related macular degeneration. Retina 2005; 25 (3): 296–303.
Kaiser PK, Wang YZ, He YG, Weisberger A, Wolf S, Smith CH . Feasibility of a novel remote daily monitoring system for age-related macular degeneration using mobile handheld devices: results of a pilot study. Retina 2013; 33 (9): 1863–1870.
Wang YZ, Wilson E, Locke KG, Edwards AO . Shape discrimination in age-related macular degeneration. Invest Ophthalmol Vis Sci 2002; 43 (6): 2055–2062.
Lim JH, Wickremasinghe SS, Xie J, Chauhan DS, Baird PN, Robman LD et al. Delay to treatment and visual outcomes in patients treated with anti-vascular endothelial growth factor for age-related macular degeneration. Am J Ophthalmol 2012; 153 (4): 678–686 686 e671-672.
Moher D, Liberati A, Tetzlaff J, Altman DG . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 2009; 339: b2535.
Lijmer JG, Mol BW, Heisterkamp S, Bonsel GJ, Prins MH, van der Meulen JH et al. Empirical evidence of design-related bias in studies of diagnostic tests. JAMA 1999; 282 (11): 1061–1066.
Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 2011; 155 (8): 529–536.
Harbord RM, Whiting P, Sterne JA, Egger M, Deeks JJ, Shang A et al. An empirical comparison of methods for meta-analysis of diagnostic accuracy showed hierarchical models are necessary. J Clin Epidemiol 2008; 61 (11): 1095–1103.
Zwinderman AH, Bossuyt PM . We should not pool diagnostic likelihood ratios in systematic reviews. Stat Med 2008; 27 (5): 687–697.
Chou R, Dana T, Bougatsos C . Screening older adults for impaired visual acuity: a review of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 2009; 1511: 44–58 W11-20.
Crossland M, Rubin G . The Amsler chart: absence of evidence is not evidence of absence. Br J Ophthalmol 2007; 91 (3): 391–393.
Bachmann LM, Juni P, Reichenbach S, Ziswiler HR, Kessels AG, Vogelin E . Consequences of different diagnostic "gold standards" in test accuracy research: Carpal Tunnel Syndrome as an example. Int J Epidemiol 2005; 34 (4): 953–955.
Chew EY, Clemons TE, Bressler SB, Elman MJ, Danis RP, Domalpally A et al. Randomized trial of a home monitoring system for early detection of choroidal neovascularization home monitoring of the eye (HOME) study. Ophthalmology 2014; 121 (2): 535–544.
Chhetri AP, Wen F, Wang Y, Zhang K . Shape discrimination test on handheld devices for patient self-test. Proceedings of the 1st ACM International Health Informatics Symposium 2010 ACM New York, NY, USA 2010: 502–506.
Wang YZ, He YG, Mitzel G, Zhang S, Bartlett M . Handheld shape discrimination hyperacuity test on a mobile device for remote monitoring of visual function in maculopathy. Invest Ophthalmol Vis Sci 2013; 54 (8): 5497–5505.
Fine AM, Elman MJ, Ebert JE, Prestia PA, Starr JS, Fine SL . Earliest symptoms caused by neovascular membranes in the macula. Arch Ophthalmol 1986; 104 (4): 513–514.
Nowomiejska K, Oleszczuk A, Brzozowska A, Grzybowski A, Ksiazek K, Maciejewski R et al. M-charts as a tool for quantifying metamorphopsia in age-related macular degeneration treated with the bevacizumab injections. BMC Ophthalmol 2013; 13: 13.
Alster Y, Bressler NM, Bressler SB, Brimacombe JA, Crompton RM, Duh YJ et al. Preferential Hyperacuity Perimeter (PreView PHP) for detecting choroidal neovascularization study. Ophthalmology 2005; 112 (10): 1758–1765.
Isaac DL, Avila MP, Cialdini AP . Comparison of the original Amsler grid with the preferential hyperacuity perimeter for detecting choroidal neovascularization in age-related macular degeneration. Arq Bras Oftalmol 2007; 70 (5): 771–776.
Lai Y, Grattan J, Shi Y, Young G, Muldrew A, Chakravarthy U . Functional and morphologic benefits in early detection of neovascular age-related macular degeneration using the preferential hyperacuity perimeter. Retina 2011; 31 (8): 1620–1626.
Loewenstein A, Malach R, Goldstein M, Leibovitch I, Barak A, Baruch E et al. Replacing the Amsler grid: a new method for monitoring patients with age-related macular degeneration. Ophthalmology 2003; 110 (5): 966–970.
Loewenstein A, Ferencz JR, Lang Y, Yeshurun I, Pollack A, Siegal R et al. Toward earlier detection of choroidal neovascularization secondary to age-related macular degeneration: multicenter evaluation of a preferential hyperacuity perimeter designed as a home device. Retina 2010; 30 (7): 1058–1064.
Mathew R, Sivaprasad S . Environmental Amsler test as a monitoring tool for retreatment with ranibizumab for neovascular age-related macular degeneration. Eye 2012; 26 (3): 389–393.
Robison CD, Jivrajka RV, Bababeygy SR, Fink W, Sadun AA, Sebag J . Distinguishing wet from dry age-related macular degeneration using three-dimensional computer-automated threshold Amsler grid testing. Br J Ophthalmol 2011; 95 (10): 1419–1423.
Arimura E, Matsumoto C, Nomoto H, Hashimoto S, Takada S, Okuyama S et al. Correlations between M-CHARTS and PHP findings and subjective perception of metamorphopsia in patients with macular diseases. Invest Ophthalmol Vis Sci 2011; 52 (1): 128–135.
Klatt C, Sendtner P, Ponomareva L, Hillenkamp J, Bunse A, Gabel VP et al. Diagnostics of metamorphopsia in retinal diseases of different origins. Ophthalmologe 2006; 103 (11): 945–952.
Kampmeier J, Zorn MM, Lang GK, Botros YT, Lang GE . [Comparison of Preferential Hyperacuity Perimeter (PHP) test and Amsler grid test in the diagnosis of different stages of age-related macular degeneration]. Klin Monbl Augenheilkd 2006; 223 (9): 752–756.
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Faes, L., Bodmer, N., Bachmann, L. et al. Diagnostic accuracy of the Amsler grid and the preferential hyperacuity perimetry in the screening of patients with age-related macular degeneration: systematic review and meta-analysis. Eye 28, 788–796 (2014). https://doi.org/10.1038/eye.2014.104
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DOI: https://doi.org/10.1038/eye.2014.104
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