Abstract:
Visual fields under mesopic and scotopic lighting are increasingly being used for macular functional assessment. This review evaluates its statistical significance and clinical relevance, and the optimal testing protocol for early/intermediate age-related macular degeneration (AMD). PubMed and Embase were searched from inception to 14/05/2022. All quality assessments were performed according to GRADE guidelines. The primary outcome was global mean sensitivity (MS), further meta-analysed by: AMD classification scheme, device, test pattern, mesopic/scotopic lighting, stimuli size/chromaticity, pupil dilation, testing radius (area), background luminance, adaptation time, AMD severity, reticular pseudodrusen presence, and follow-up visit. From 1489 studies screened, 42 observational study results contributed to the primary meta-analysis. Supported by moderate GRADE certainty of the evidence, global MS was significantly reduced across all devices under mesopic and scotopic lighting with large effect size (-0.9 [-1.04, -0.75] Hedge\'s g, P < 0.0001). The device (P < 0.01) and lighting (P < 0.05) used were the only modifiable factors affecting global MS, whereby the mesopic MP-1 and MAIA produced the largest effect sizes and exceeded test-retest variabilities. Global MS was significantly affected by AMD severity (intermediate versus early AMD; -0.58 [-0.88, -0.29] Hedge\'s g or -2.55 [3.62, -1.47] MAIA-dB) and at follow-up visit (versus baseline; -0.62 [-0.84, -0.41] Hedge\'s g or -1.61[-2.69, -0.54] MAIA-dB). Magnitudes of retinal sensitivity changes in early/intermediate AMD are clinically relevant for the MP-1 and MAIA devices under mesopic lighting within the central 10° radius. Other factors including pupil dilation and dark adaptation did not significantly affect global MS in early/intermediate AMD.
摘要: 中明视和暗视照明下的视野越来越多地用于黄斑功能评估。这篇综述评估了其统计学意义和临床相关性, 以及早期/中期年龄相关性黄斑变性 (AMD) 的最佳检测方案。检索PubMed和Embase自建库起至2022年5月14日的文献。所有质量评估均根据GRADE指南进行。主要结局是全局平均敏感性 (MS), 进一步meta分析指标包括: AMD分类方案、设备、测试模式、中位/暗位照明、刺激大小/色度、瞳孔扩张、测试半径 (面积) 、背景亮度、适应时间、AMD严重程度、网状假性玻璃膜疣的存在和随访。我们对筛选的 1489 项中的42 项观察性研究结果进行了meta分析。在中等GRADE质量证据的支持下及在中明视和暗视照明下, 所有设备的全、全视野MS均显著降低 (−0.9 [−1.04, −0.75] Hedge’s g, P < 0.0001) 。所使用的设备 (P < 0.01) 和照明 (P < 0.05) 是影响全视野MS的唯一可改变的变量, 因此中视MP-1和MAIA受影响最大, 并超过了重新测试的可变性。AMD严重程度 (中度 vs 早期AMD;−0.58 [−0.88, −0.29] Hedge’s g或−2.55[3.62, −1.47]MAIA-dB) 和随访 (与基线相比;−0.62[−0.84, −0.41]Hedge’s g或−1.61[−2.69, −0.54]MAIA-dB) 对全视野MS有显著影响。早期/中期AMD的视网膜敏感性变化幅度与MP-1和MAIA装置在中心10°半径内的中明视照明下具有临床相关性。瞳孔扩张和暗适应等其他因素对早期/中期AMD的全视野MS没有显著影响。.