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Review
. 2024 Jun;262(6):1723-1736.
doi: 10.1007/s00417-023-06272-1. Epub 2023 Nov 8.

Additional measures of macular function beyond visual acuity

Hernán Andrés Ríos  1 , Monica Lövestam-Adrian  2 , Sotiris Plainis  3 , Miltiadis Tsilimbaris  3 , Antonia M Joussen  4 , David Keegan  5 , Martin Charles  6 , José Cunha-Vaz  7 , Edoardo Midena  8   9
Affiliations
Review

Additional measures of macular function beyond visual acuity

Hernán Andrés Ríos et al. Graefes Arch Clin Exp Ophthalmol. 2024 Jun.

Abstract

Purpose: Visual function is a complex process in which external visual stimuli are interpreted. Patients with retinal diseases and prolonged follow-up times may experience changes in their visual function that are not detected by the standard visual acuity measure, as they are a result of other alterations in visual function. With the advancement of different methods to evaluate visual function, additional measurements have become available, and further standardization suggests that some methods may be promising for use in clinical trials or routine clinical practice. The objectives of this article are to review these additional measurements and to provide guidance on their application.

Methods: The Vision Academy's membership of international retinal disease experts reviewed the literature and developed consensus recommendations for the application of additional measures of visual function in routine clinical practice or clinical trials.

Results: Measures such as low-luminance visual acuity, contrast sensitivity, retinal fixation and microperimetry, and reading performance are measures which can complement visual acuity measurements to provide an assessment of overall visual function, including impact on patients' quality of life. Measures such as dark adaptation, color vision testing, binocular vision testing, visual recognition testing, and shape discrimination require further optimization and validation before they can be implemented in everyday clinical practice.

Conclusion: Additional measurements of visual function may help identify patients who could benefit from earlier diagnosis, detection of disease progression, and therapeutic intervention. New and additional functional clinical trial endpoints are required to fully understand the early stages of macular disease, its progression, and the response to treatment.

Keywords: Electrophysiological test; Psychophysical test; Vision; Visual acuity.

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Conflict of interest statement

The Vision Academy is a group of over 100 international experts who, through their collective expertise, provide consensus guidance for managing clinically challenging situations, especially in areas of controversy or with insufficient conclusive evidence. The Vision Academy is funded and facilitated by Bayer. The opinions and guidance of the Vision Academy outputs are those of its members and do not necessarily reflect the opinions of Bayer. Financial arrangements of the authors with companies whose products may be related to the present report are listed below, as declared by the authors:

• Hernán Andrés Ríos: no financial interest related to the topic of this manuscript.

• Monica Lövestam-Adrian: consultant for Allergan, Bayer, Novartis, Roche, and Santen.

• Sotiris Plainis: research funding from Alcon Laboratories, Johnson & Johnson, and Novartis.

• Miltiadis Tsilimbaris: personal fees from Allergan, Bayer Hellas, Mavrogenis, and Novartis Hellas; grants from Alcon, Bayer, Johnson & Johnson, and Novartis.

• Antonia M. Joussen: personal fees from Allergan, Bayer HealthCare Pharmaceuticals, Boehringer Ingelheim, and Novartis; grants from Bayer HealthCare Pharmaceuticals and Novartis.

• David Keegan: grant support from Bayer, Novartis, and Samsara Vision; consultant for Samsara Vision.

• Martin Charles: consultant for Alcon, Bayer, Novartis, and OcuDyne.

• José Cunha-Vaz: Adverum Biotechnologies, Alimera Sciences, Allergan, Bayer, Carl Zeiss Meditec, Gene Signal, Novartis, Oxular, Pfizer, Roche, Sanofi, and Vifor Pharma.

• Edoardo Midena: no financial interest related to the topic of this manuscript.

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