Program/Poster: 730/D784, Poster Session: 130 – AMD Clinical II
ARVO 2009 Annual Meeting, Ft. Lauderdale FL, 3-7 May 2009
Presentation: Sunday, May 03, 2009, 11:15 AM – 1:00 PM
Authors
F. Sabeti(1A), T.L. Maddess(1A), R.W. Essex(1B), A.C. James(1A)
(1) Australian National University, Canberra, Australia, (A) ARC Centre of Excellence in Vision Science, Centre for Visual Sciences, (B) College of Medicine, Biology and Environment, Department of Ophthalmology Canberra Hospital
Purpose
To investigate the sensitivity and specificity of 4 stimulus variations of multifocal pupillographic perimetry in unilateral exudative macular degeneration (MD).
Methods
Pupillary contraction amplitudes and time to peak contraction were analysed for 29 normal (mean age 70.9 ±6.0) and 20 unilateral exudative MD (mean age 78.0 ±5.3) subjects with 4 different stimulus protocols. Stimuli were presented dichoptically and pupil responses were measured concurrently. All protocols presented multifocal stimulus arrays subtending ±15° of visual field. A dart board layout having 24 or 44 independent test regions/eye with a mean presentation interval of 1 or 4 s/region and a presentation duration of 33 ms on each presentation was employed. Luminance of the stimulus regions was 250 cd/m2 and background 10 cd/m2. Test duration was 4 minutes separated into 8 segments of 30 second recording intervals. Cameras under infrared illumination monitored pupil responses. Data during blinks and fixation losses were excluded to a maximum of 15% of responses beyond which a segment was repeated.
Results
Stimuli presented in a 24 region layout with a 4 s/region presentation rate achieved the largest responses by a factor of 2.3 (b = 3.63 dB, t = 3.57, p <.00001); however this was not found to be most diagnostic, achieving an ROC area under the curve (AUC) of 83.31%. A linear discriminant model incorporating contraction amplitude and time to peak found the 44 region layout with 4 s/region presentation rate to be the most diagnostic achieving an AUC of 89.51%.
Conclusion
The clinical application of multifocal pupillography utilizing a 44 region stimulus with a slow presentation rate can produce ROC AUC of 89% in the diagnosis of unilateral exudative MD. Further investigation into the assessment of non-exudative MD through pupillography may facilitate early diagnosis and therapeutic intervention.
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