OSLI Retina

January 2020

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January 2020 · Vol. 51, No. 1 11 ■ C L I N I C A L S C I E N C E ■ Digital Nullification of Visual Distortion to Quantify Metamorphopsia: A Pilot Study Jacob A. Lifton, BA; Andrew A. Moshfeghi, MD, MBA BACKGROUND AND OBJECTIVE: To evaluate a novel digital method of metamorphopsia quantification in patients with symptomatic visual distortion as determined by M-CHARTS. PATIENTS AND METHODS: In this institutional re- view board-approved, prospective, cross-sectional observational study, subjects were presented with an objectively straight dotted line that bisects a central fixation point. The subjects digitally altered the line's contour until it appeared straight. Calcu- lation of the area between the original objectively straight line presented to the subject and their new- ly manipulated line was performed to determine the manipulated area under the curve (M-AUC). RESULTS: Sixty-two percent of test targets were fully or significantly straightened by affected sub- jects. M-AUC was significantly correlated with M- CHARTS scores in both the horizontal (P < .001) and vertical (P = .05) orientations. CONCLUSIONS: The deformation of an objectively straight line by a subject with metamorphopsia may be a viable way of both quantifying and spa- tially characterizing visual distortions. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:11-20.] INTRODUCTION Metamorphopsia, or visual distortion, is a patho- logical visual phenomenon seen commonly in dis- eases that deform normal macular architecture, such as age-related macular degeneration (AMD), central serous chorioretinopathy (CSCR), epiretinal mem- brane (ERM), vitreomacular traction (VMT), or full- thickness macular hole. To the affected patient, areas of vision may appear to be bulging outward or pinch- ing inward, and objectively straight lines may seem wavy or bent, often in an irregular or asymmetric pat- tern. Increasing severity of metamorphopsia has been shown to have a proportionately negative effect on vision-related quality of life (VR-QoL). 1-4 Neverthe- less, testing for visual distortion in the clinic setting is typically rudimentary and is not conducted using a quantifiable metric. The Amsler grid, for instance, is still commonly used to detect and monitor meta- morphopsia, yet the test — in its most commonly administered format — provides virtually no reliable quantitative or spatial information about visual dis- tortions, as it is not interactive on the part of the user (apart from a binary "yes/no" response regarding the presence or absence of distortion) and is subject to inconstant fixation and cortical "filling-in" of scoto- mata. 5-7 Furthermore, recent evidence suggests that the degree of metamorphopsia is not adequately cap- tured by traditional metrics of visual quality, such as best-corrected visual acuity (BCVA), 8 indicating the importance of developing and validating newer tools that can quantify visual distortions. From Keck School of Medicine, University of Southern California, Los Angeles (JAL); and USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine University of Southern California, Los Angeles (AAM). Originally submitted May 27, 2019. Revision received May 27, 2019. Accepted for publication July 29, 2019. Supported in part by an unrestricted grant to the Department of Ophthalmology from Research to Prevent Blindness, New York. Presented, in part, at the 42nd Annual Meeting of the Macula Society in Bonita Springs, FL, and at the Annual Meeting of the Association for Research and Vision in Ophthalmology in Vancouver, Canada, in 2019. The authors report no relevant financial disclosures. Address correspondence to Andrew A. Moshfeghi, MD, MBA, USC Roski Eye Institute, 1450 San Pablo St., Los Angeles, CA 90033; email: moshfega@med. usc.edu. doi: 10.3928/23258160-20191211-02

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