Although combination therapy can help to improve and prolong patients' sight after age-related macular degeneration (AMD) is diagnosed, early detection remains the vital precursor to maximizing the effects of any type of treatment. Treating AMD lesions while in their earliest stages promotes optimal visual outcomes for patients, reflecting the importance of administering regular eye exams to detect the presence of choroidal neovascularization before significant vision loss occurs. Earlier detection of neovascular AMD could mean a substantially better outcome for the average patient.
The Amsler grid, which has long been the standard tool for patient monitoring, is useful for helping patients be more proactive in their monitoring, but because of the cortical completion and crowding phenomena, it is often not effective at early detection. One diagnostic tool that is assisting clinicians in making accurate early diagnoses is preferential hyperacuity perimetry or PHP.
This technology, marketed as the Foresee PHP (Notal Vision Ltd., Tel Aviv, Israel), maps defects within a patient's visual field by analyzing responses to dot deviation signals flashing on a computer screen. Patients are typically tested quarterly, and their response patterns are analyzed and compared to a normative database, producing a report revealing the relative location of the defects in the macular area. The device has been shown to produce results with 82% sensitivity and 88% specificity,1 which gives optometrists and ophthalmologists a greater likelihood of making a timely diagnosis and referral.
My ability to screen and treat patients with neovascular AMD has been greatly enhanced with PHP. Take for example one patient and how early detection with this technology had a considerable impact on the efficacy of her treatment and vision outcome. The patient came to me with vague complaints of vision loss, but with no clinical evidence of choroidal neovascularization (CNV) present. It is easy to dismiss these types of complaints, especially when the administration of optical coherence tomography (OCT) and fluorescein angiography (FA) is not convenient at the time the patient is seen. PHP and its comprehensible use and accuracy, however, enhanced my decision making as to whether she needed further testing. The PHP test (Figure 1) produced abnormal results, and OCT/FA confirmed th presence of CNV (Figures 2 and 3). She was then promptly treated with antivascular endothelial growth factor intravitreal injections, and her vision was restored. This would not have been the case if the disease had not been caught in its early stages. Without PHP, she may have developed profound vision loss before coming into the office.
Earlier detection of CNV can help enhance treatment options and maximize a patient's defense against visual impairment. Implementing PHP testing assures physicians and patients alike that every preventive measure and treatment option are being explored in AMD management.
Paul Garfinkle, MD, is a retina and comprehensive ophthalmologist at Ohio EyeAlliance. He has experience in the diagnosis and treatment of medical retinal disease, age-related macular degeneration, and small incision cataract surgery. He states that he has no financial interest in the company or product mentioned. He may be reached at eyedoc7@neo.rr.com; phone; +1 330 823 1680.
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