Efficacy of the Amsler Grid Test in Evaluating Glaucomatous Central Visual Field Defects.

PURPOSE To investigate the efficacy of the Amsler grid test in detecting central visual field (VF) defects in glaucoma. DESIGN Prospective, cross-sectional study. PARTICIPANTS Patients with glaucoma with reliable Humphrey 10-2 Swedish Interactive Threshold Algorithm standard VF on the date of enrollment or within the previous 3 months. METHODS Amsler grid tests were performed for each eye and were considered "abnormal" if there was any perceived scotoma with missing or blurry grid lines within the central 10 degrees ("Amsler grid scotoma"). An abnormal 10-2 VF was defined as ≥3 adjacent points at P < 0.01 with at least 1 point at P < 0.005 in the same hemifield on the pattern deviation plot. Sensitivity, specificity, and positive and negative predictive values of the Amsler grid scotoma area were calculated with the 10-2 VF as the clinical reference standard. Among eyes with an abnormal 10-2 VF, regression analyses were performed between the Amsler grid scotoma area and the 10-2 VF parameters (mean deviation [MD], scotoma extent [number of test points with P < 0.01 in total deviation map] and scotoma mean depth [mean sensitivity of test points with P < 0.01 in total deviation map]). MAIN OUTCOME MEASURES Sensitivity, specificity, and positive and negative predictive values of the Amsler grid scotoma area. RESULTS A total of 106 eyes (53 patients) were included (mean ± standard deviation age, 24-2 MD and 10-2 MD = 66±12 years, -9.61±8.64 decibels [dB] and -9.75±9.00 dB, respectively). Sensitivity, specificity, and positive and negative predictive values of the Amsler grid test were 68%, 92%, 97%, and 46%, respectively. Sensitivity was 40% in eyes with 10-2 MD better than -6 dB, 58% in eyes with 10-2 MD between -12 and -6 dB, and 92% in eyes with 10-2 MD worse than -12 dB. The area under the receiver operating characteristic curve of the Amsler grid scotoma area was 0.810 (95% confidence interval, 0.723-0.880, P < 0.001). The Amsler grid scotoma area had the strongest relationship with 10-2 MD (quadratic R(2)=0.681), followed by 10-2 scotoma extent (quadratic R(2)=0.611) and 10-2 scotoma mean depth (quadratic R(2)=0.299) (all P < 0.001). CONCLUSIONS The Amsler grid can be used to screen for moderate to severe central vision loss from glaucoma.

[1]  J. White,et al.  Early Age-Related Macular Degeneration Impairs Tolerance to Stimulus Degradation , 2010, Optometry and vision science : official publication of the American Academy of Optometry.

[2]  M. Wall,et al.  Threshold Amsler grid testing. Cross-polarizing lenses enhance yield. , 1986, Archives of ophthalmology.

[3]  R A Schuchard,et al.  Validity and interpretation of Amsler grid reports. , 1993, Archives of ophthalmology.

[4]  M AMSLER,et al.  Earliest Symptoms of Diseases of the Macula *† , 1953, The British journal of ophthalmology.

[5]  Kolker Ae.  Visual prognosis in advanced glaucoma: a comparison of medical and surgical therapy for retention of vision in 101 eyes with advanced glaucoma. , 1977 .

[6]  A. Vingrys,et al.  Visual Losses in Early Age-Related Maculopathy , 1993, Optometry and vision science : official publication of the American Academy of Optometry.

[7]  D. Friedman,et al.  The utilization of eye care services by persons with glaucoma in rural south India. , 2004, Transactions of the American Ophthalmological Society.

[8]  S. Azen,et al.  Sensitivity, specificity, and predictive values of screening tests for eye conditions in a clinic-based population. , 1996, Ophthalmology.

[9]  R. Malach,et al.  RESULTS OF A MULTICENTER CLINICAL TRIAL TO EVALUATE THE PREFERENTIAL HYPERACUITY PERIMETER FOR DETECTION OF AGE-RELATED MACULAR DEGENERATION , 2005, Retina.

[10]  A. Coleman,et al.  Factors associated with undiagnosed open-angle glaucoma: the Thessaloniki Eye Study. , 2008, American journal of ophthalmology.

[11]  Wolfgang Fink,et al.  Early detection of glaucoma by means of a novel 3D computer-automated visual field test , 2007, British Journal of Ophthalmology.

[12]  Roberta McKean-Cowdin,et al.  Impact of visual field loss on health-related quality of life in glaucoma: the Los Angeles Latino Eye Study. , 2008, Ophthalmology.

[13]  Wolfgang Fink,et al.  Three-dimensional computer-automated threshold Amsler grid test. , 2004, Journal of biomedical optics.

[14]  R. Ritch,et al.  Initial parafoveal versus peripheral scotomas in glaucoma: risk factors and visual field characteristics. , 2011, Ophthalmology.

[15]  Ilana Traynis,et al.  Prevalence and nature of early glaucomatous defects in the central 10° of the visual field. , 2014, JAMA ophthalmology.

[16]  D. Machin,et al.  The prevalence of glaucoma in Chinese residents of Singapore: a cross-sectional population survey of the Tanjong Pagar district. , 2000, Archives of ophthalmology.

[17]  Douglas R. Anderson,et al.  Clinical Decisions In Glaucoma , 1993 .

[18]  Song Zhang,et al.  Handheld shape discrimination hyperacuity test on a mobile device for remote monitoring of visual function in maculopathy. , 2013, Investigative ophthalmology & visual science.

[19]  C Bunce,et al.  Deprivation and late presentation of glaucoma: case-control study , 2001, BMJ : British Medical Journal.

[20]  Chris A Johnson,et al.  Classification of visual field abnormalities in the ocular hypertension treatment study. , 2000, Archives of ophthalmology.

[21]  Wiebo H Brouwer,et al.  The effect of visual field defects on driving performance: a driving simulator study. , 2002, Archives of ophthalmology.

[22]  N. Yasuda,et al.  [Reading performance in patients with central visual field disturbance due to glaucoma]. , 2006, Nippon Ganka Gakkai zasshi.

[23]  H. Bedell,et al.  Orientation Discrimination with Macular Changes Associated with Early AMD , 2009, Optometry and vision science : official publication of the American Academy of Optometry.

[24]  Rafael Malach,et al.  Replacing the Amsler grid: a new method for monitoring patients with age-related macular degeneration. , 2003, Ophthalmology.

[25]  R S Nickerson,et al.  The Framingham Eye Study. I. Outline and major prevalence findings. , 1977, American journal of epidemiology.