Functional Impact of Macular Atrophy and Fibrosis in Neovascular Age-Related Macular Degeneration by Defect-Mapping Microperimetry
- 1Centre for Eye Research Australia
Abstract
PurposeTo understand the functional impact of macular atrophy (MA) and fibrosis in eyes with treated neovascular age-related macular degeneration (nAMD) based on deep visual sensitivity losses.
DesignCross-sectional study.
ParticipantsOne-hundred and nine eyes from 97 individuals with nAMD that had been treated for [≥]12 months without significant retinal fluid.
MethodsAll participants underwent defect-mapping microperimetry (DMP) testing - a strategy optimized to quantify the spatial extent of deep visual sensitivity losses through single 10 decibel stimuli presentations - where 208 locations were sampled in the central 8{o} radius region.
Participants also underwent color fundus photography, fundus autofluorescence and OCT imaging, which were co-registered and manually annotated for MA and fibrosis to determine their two-dimensional pointwise extent at individual test locations, and global extent in the corresponding region where DMP was performed.
Main Outcome MeasuresPointwise association between the presence of MA and fibrosis with missing a stimulus on DMP and global association between the extent of MA and fibrosis with the proportion of locations missed (PLM) on DMP.
ResultsAt a pointwise level, the presence of MA and fibrosis were independently associated with an increased likelihood of missing a stimulus on DMP (odds ratio = 42.5 and 2.5 respectively; P <0.001 for both). However, at a global level, only an increasing extent of MA was associated with a significantly higher PLM on DMP (P < 0.001), but not fibrosis (P [≥] 0.227). MA extent explained a substantial proportion of the variance in the PLM (R2 = 0.97) and there was a very strong correlation between the two parameters ({rho} = 0.93).
ConclusionsThis study confirmed the expected functional impact of MA and fibrosis on DMP testing at a pointwise level. However, it showed at the global level that only the extent of MA, and not fibrosis, was independently associated with functional loss on DMP, and that there was a very strong structure-function correlation based on MA. These findings thus suggest that evaluating MA alone may be sufficient for capturing structural changes strongly associated with the global extent of deep visual sensitivity losses in those with treated nAMD.
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BibTeX
@misc{glover2026functional,
title = {{Functional Impact of Macular Atrophy and Fibrosis in Neovascular Age-Related Macular Degeneration by Defect-Mapping Microperimetry}},
author = {E. K. Glover and R. H. Guymer and C. J. Abbott and M. Jannaud and X. Hadoux and Z. Wu},
howpublished = {medRxiv},
year = {2026},
month = sep,
doi = {10.64898/2026.09.27.26364134},
url = {https://www.medrxiv.org/content/10.64898/2026.09.27.26364134v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Functional Impact of Macular Atrophy and Fibrosis in Neovascular Age-Related Macular Degeneration by Defect-Mapping Microperimetry
AU - E. K. Glover
AU - R. H. Guymer
AU - C. J. Abbott
AU - M. Jannaud
AU - X. Hadoux
AU - Z. Wu
PY - 2026
DA - 2026/09/27
PB - medRxiv
DO - 10.64898/2026.09.27.26364134
UR - https://www.medrxiv.org/content/10.64898/2026.09.27.26364134v1
AB - PurposeTo understand the functional impact of macular atrophy (MA) and fibrosis in eyes with treated neovascular age-related macular degeneration (nAMD) based on deep visual sensitivity losses. DesignCross-sectional study. ParticipantsOne-hundred and nine eyes from 97 individuals with nAMD that had been treated for [≥]12 months without significant retinal fluid. MethodsAll participants underwent defect-mapping microperimetry (DMP) testing - a strategy optimized to quantify the spatial extent of deep visual sensitivity losses through single 10 decibel stimuli presentations - where 208 locations were sampled in the central 8{o} radius region. Participants also underwent color fundus photography, fundus autofluorescence and OCT imaging, which were co-registered and manually annotated for MA and fibrosis to determine their two-dimensional pointwise extent at individual test locations, and global extent in the corresponding region where DMP was performed. Main Outcome MeasuresPointwise association between the presence of MA and fibrosis with missing a stimulus on DMP and global association between the extent of MA and fibrosis with the proportion of locations missed (PLM) on DMP. ResultsAt a pointwise level, the presence of MA and fibrosis were independently associated with an increased likelihood of missing a stimulus on DMP (odds ratio = 42.5 and 2.5 respectively; P <0.001 for both). However, at a global level, only an increasing extent of MA was associated with a significantly higher PLM on DMP (P < 0.001), but not fibrosis (P [≥] 0.227). MA extent explained a substantial proportion of the variance in the PLM (R2 = 0.97) and there was a very strong correlation between the two parameters ({rho} = 0.93). ConclusionsThis study confirmed the expected functional impact of MA and fibrosis on DMP testing at a pointwise level. However, it showed at the global level that only the extent of MA, and not fibrosis, was independently associated with functional loss on DMP, and that there was a very strong structure-function correlation based on MA. These findings thus suggest that evaluating MA alone may be sufficient for capturing structural changes strongly associated with the global extent of deep visual sensitivity losses in those with treated nAMD.
ER -