FLICKER SENSITIVITY AND FUNDUS APPEARANCE IN PRE-EXUDATIVE AGE-RELATED MACULOPATHY

Purpose. To evaluate whether foveal flicker sensitivity and fundus app earance are good predictors of exudative age-related maculopathy (ARM) when the effects of aging, retinal illuminance, and criterion differe nces are controlled. Methods. Fellow eyes of monocular exudative ARM p atients were tested at baseline. Seven of these eyes have now develope d exudative ARM. Therefore, at baseline they were in pre-exudative sta ges of ARM. The foveal flicker sensitivity and fundus appearance of th e pre-exudative and nonconverted eyes were compared with healthy, age- matched eyes. The flicker stimulus was a uniform, 2.8 deg circular fie ld at 660 nm, modulated sinusoidally at frequencies from 2.5 to 50 Hz. Fundus photographs were evaluated using the Wisconsin ARM grading sys tem. Results. Flicker modulation sensitivity at two frequencies discri minated pre-exudative from healthy older eyes with 100% accuracy. Usin g the same criterion, pre-exudative eyes also were discriminated from nonconverted eyes with 100% accuracy. Whereas an overall fundus ARM ri sk score discriminated pre-exudative from healthy older eyes with 100% accuracy, it did not discriminate pre-exudative from nonconverted eye s at better than chance levels. Conclusions. There were functional cha nges in the retina preceding development of exudative ARM. Foveal flic ker sensitivity at low- to mid-temporal frequencies seemed highly sens itive to these pre-exudative changes in this relatively small group of subjects. The authors hypothesize that foveal flicker sensitivity is a good predictor of exudative ARM and a sensitive monitor of retinal f unction in pre-exudative ARM. These predictions are being tested on a larger, independent sample.