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Comparative Study
. 2025 Mar 3;66(3):59.
doi: 10.1167/iovs.66.3.59.

Comparison Between MAIA and MP-3 In Healthy Subjects and Patients With Diabetes, Diabetic Retinopathy, and Age-Related Macular Degeneration

Anna Marmalidou  1 , Haleema Siddiqui  1   2 , Muhammad Usman Jamil  1 , Kwang Min Woo  1 , Antonio Yaghy  1 , A Yasin Alibhai  3 , Hiroyuki Takahashi  1   4 , Stephanie Kaiser  1 , Keith Effert  5 , Peter Y Zhao  1 , Shilpa J Desai  1 , Christopher C Robinson  1 , Jay S Duker  1 , Nadia K Waheed  1
Affiliations
Comparative Study

Comparison Between MAIA and MP-3 In Healthy Subjects and Patients With Diabetes, Diabetic Retinopathy, and Age-Related Macular Degeneration

Anna Marmalidou et al. Invest Ophthalmol Vis Sci. .

Abstract

Purpose: The purpose of this study was to assess the comparability of mean sensitivity (MS) values obtained using the Macular Integrity Assessment (MAIA; CenterVue S.p.A. [iCare], Padova, Italy) and Microperimeter-3 (MP-3; NIDEK CO., Ltd., Gamagori, Japan) microperimetry (MP) devices.

Methods: This cross-sectional study includes subjects with healthy eyes, eyes with diabetes mellitus without diabetic retinopathy (DM no DR), diabetic retinopathy (DR), and non-exudative age-related macular degeneration (AMD). Patients underwent testing on both MAIA and MP-3 MP devices, using a 10-2 macular grid with 68 stimuli and identical parameters. A diagnosis-adjusted linear regression model and mixed modeling mapped MP-3 MS to MAIA MS and Bland-Altman analysis were used to assess the agreement.

Results: One hundred eleven eyes (43 healthy eyes, 14 eyes with DM no DR, 32 eyes with DR, and 22 eyes with AMD) from 80 subjects (age = 57.2 ± 20.3 years) were enrolled. MAIA consistently showed higher MS than MP-3. The MP-3 device detected absolute scotomatous points in more eyes than MAIA (6 eyes [MAIA] vs. 10 eyes [MP-3]). Healthy eyes exhibited stronger agreements than those with DR (P < 0.001) or AMD (P = 0.015). Converting MP-3 to MAIA MS improved agreement and reduced coefficients of repeatability (CoRs) but did not fully account for inter-device variability. MP-3 classified more eyes as having relatively unstable or unstable fixation than MAIA (P = 0.014).

Conclusions: Both devices effectively detect retinal functional changes and scotomas. The conversion methods developed in this study can aid cross-device comparisons, but retinal pathologies (DM and AMD) introduce additional inter-device variability. Future studies incorporating multiple devices should account for this variability in their study design.

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Conflict of interest statement

Disclosure: A. Marmalidou, None; H. Siddiqui, None; M.U. Jamil, None; K.M. Woo, None; A. Yaghy, Beacon Therapeutics (C); A.Y. Alibhai, Beacon Therapeutics (C), Boston Image Reading Center (E); H. Takahashi, None; S. Kaiser, None; K. Effert, Nidek (E); P.Y. Zhao, OliX Pharmaceuticals (C), Beacon Therapeutics (C), Alkeus Pharmaceuticals (C); S. Desai, None; C.C. Robinson, None; J.S. Duker, EyePoint Pharma (E), Hubble Therapeutics (S); N.K. Waheed, Carl Zeiss Meditec (F), Nidek (C, F), Topcon (C, F), Olix Pharma (C), Iolyx Pharmaceuticals (C, I), Aavantgarde Bio (C), Samsung Bioepis (C), Alkeus Pharmaceuticals (C), Ocudyne (I), Valitor (I), Beacon Therapeutics (I), Ocular Therapeutix (S)

Figures

Figure 1.
Figure 1.
Microperimetry (MP) images from the left eye of a healthy subject obtained using the (A) MAIA and (B) MP-3 devices. The 10-2 grid consisting of 68 individual test locations and covering 10 degrees of the macula was used in both devices. The numbers shown represent pointwise sensitivity values in decibel (dB).
Figure 2.
Figure 2.
Bland-Altman plots of MS measurements between MAIA and MP-3 (A), MAIA_reg (C), and MAIA_diag (D), and Scatterplot of MAIA MS measurements plotted against MP-3 (B). In the Bland Altman Plot, the dashed red lines and shaded region denote 95% limits of agreement (LoAs) and the solid black line shows the mean difference. In the scatterplot, the black solid line is the best-fit regression line and the dashed red lines and shaded region denote 95% confidence interval of the regression line. Conversion using MAIA diagram exhibited the smallest interval between LoAs. (UB = upper bound; LB = lower bound; dB = decibels; Black cross = healthy; unfilled orange dot = DM no DR; filled orange dot = DR; filled blue dot = AMD).
Figure 3.
Figure 3.
(A) shows a Bland-Altman plot for the difference in the number of absolute scotomatous points between MAIA and MP-3 with upper limit of agreement (LoA) as 1.15 points and lower LoA as −1.06 points. The solid black line denotes the meaning difference, and the dashed red lines denote the 95% LoAs. DR and AMD study groups are highlighted by orange and blue colors, respectively. (B) Shows a representative image with the location of the absolute scotomatous points identified on MAIA and MP-3 from contiguous scotomatous points, defined as having two or more adjacent absolute scotomatous points on a grid. Blue dots represent absolute scotomatous points detected with MP-3, and red dots represent absolute scotomatous points detected with MAIA. Black dots represent absolute scotomatous points detected with both devices. Absolute scotomatous points correspond to test locations where the brightest stimuli could not be detected, with a retinal sensitivity of −1 dB. (UB = upper bound; LB = lower bound; DR = diabetic retinopathy; AMD = age-related macular degeneration; PDR = proliferative diabetic retinopathy).
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