Publisher: Invest Ophthalmol Vis Sci. 2017; 58(6): BIO158-BIO167

Authors: Maximilian Pfau; Moritz Lindner; Philipp L. Müller; Johannes Birtel; Robert P. Finger; Wolf M. Harmening; Monika Fleckenstein; Frank G. Holz; Steffen Schmitz-Valckenberg

Effective Dynamic Range and Retest Reliability of Dark-Adapted Two-Color Fundus-Controlled Perimetry in Patients With Macular Diseases


Purpose: To determine the effective dynamic range (EDR), retest reliability, and number of discriminable steps (DS) for mesopic and dark-adapted two-color fundus-controlled perimetry (FCP) using the S-MAIA (Scotopic-Macular Integrity Assessment) “micro-perimeter.”

Methods: In this prospective cross-sectional study, each of the 52 eyes of 52 subjects with various macular diseases (mean age 62.0 ± 16.9 years; range, 19.1-90.1 years) underwent duplicate mesopic (achromatic stimuli, 400-800 nm), dark-adapted cyan (505 nm), and dark-adapted red (627 nm) FCP using a grid of 61 stimuli covering 18° of the central retina. The EDR, the number of DS, and the retest reliability for point-wise sensitivity (PWS) were analyzed. The effects of fixation stability, sensitivity, and age on retest reliability were examined using mixed-effects models.

Results: The EDR was 10 to 30 dB with five DS for mesopic and 4 to 17 dB with four DS for dark-adapted cyan and red testing. PWS retest reliability was good among all three types of retinal sensitivity assessments (coefficient of repeatability ±5.79, ±4.72, and ±4.77 dB, respectively) and did not depend on fixation stability or age. PWS had no effect on retest variability in dark-adapted cyan and dark-adapted red testing but had a minor effect in mesopic testing.

Conclusions: Combined mesopic and dark-adapted two-color FCP allows for reliable topographic testing of cone and rod function in patients with various macular diseases with and without foveal fixation. Retest reliability is homogeneous across eccentricities and various degrees of scotoma depth, including zones at risk for disease progression. These reliability estimates can serve for the design of future clinical trials.