PURPOSE Growing interest in microperimetry (MP) or fundus-controlled perimetry (FCP) as targeted psychometric testing method in geographic atrophy (GA) is warranted due to the disease subclinical/extra-foveal appearance or preexisting foveal loss with visual acuity becoming unreliable. We provide comprehensive pointwise test-retest repeatability reference values on the most widely used MP devices and combine them with targeted testing in areas of retinal pigment epithelium (RPE) as well as photoreceptor (PR) integrity loss, guiding the interpretation of sensitivity loss during the long-term follow-up of GA patients. DESIGN Prospective reliability study METHODS: Patients with GA underwent consecutive testing on CenterVue (iCare) MAIA and NIDEK MP3 devices. Obtained PWS measurements were spatially co-registered to an optical coherence tomography (OCT) volume scan acquired during the same visit. Areas with RPE and PR integrity loss, drusen and PR thickness as well as the volume of hyperreflective foci (HRF) where identified and quantified using a set of validated deep learning-based algorithms. Test-retest repeatability was assessed according to areas defined by biomarker-specific morphologic changes using Bland-Altmann coefficients of repeatability (CoR). Furthermore, the inter-device correlation, the repeatability of scotoma point detection as well as any potential effects on fixation stability were assessed. RESULTS 900 stimuli per device from twenty subjects were included. Identical overall PWS test-retest variance could be detected for MAIA (±6.57) and MP3 (±6.59). PR integrity loss was associated with a higher test-retest variance on both devices (MAIA: p=0.002; MP3: p<0.001). Higher CoR for stimuli in areas presenting RPE loss (±10.99 vs ±5.34) or HRF (±9.21 vs ±6.25) could only be detected on MP3 examinations (p<0.001 and p=0.01, respectively). An excellent intra-device correlation (MAIA: 0.94[0.93-0.95] MP3: 0.94[0.94-0.95]) and a good mean inter-device correlation (0.84[0.53-0.92]) could be demonstrated. The chosen device, run order or absence of foveal sparing had no significant effect on fixation stability. CONCLUSION Areas presenting automatically quantified PR integrity loss with and without underlying RPE loss are associated with higher test-retest variance for both MAIA and MP3. These findings are crucial for an accurate interpretation of GA progression during long-term follow-up and the planning of future trials with microperimetry testing as functional study endpoint.

中文翻译：

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基于 AI 的 OCT 生物标志物量化支持的地理萎缩中 RPE 和光感受器损失区域的显微视野计的可重复性。


目的 由于疾病亚临床/中心凹外外观或先前存在的中心凹丧失伴视力变得不可靠，因此有必要将显微视野计 （MP） 或眼底控制视野计 （FCP） 作为地图样萎缩 （GA） 的靶向心理测量测试方法。我们在最广泛使用的 MP 设备上提供全面的逐点重测重复性参考值，并将其与视网膜色素上皮 （RPE） 和感光器 （PR） 完整性丧失区域的靶向测试相结合，指导 GA 患者长期随访期间敏感性损失的解释。设计前瞻性可靠性研究方法： GA 患者在 CenterVue （iCare） MAIA 和 NIDEK MP3 设备上进行了连续测试。获得的 PWS 测量值在空间上与在同一次就诊期间获得的光学相干断层扫描 （OCT） 体积扫描共配准。使用一组经过验证的基于深度学习的算法识别和量化具有 RPE 和 PR 完整性损失、玻璃膜疣和 PR 厚度以及高反射病灶 （HRF） 体积的区域。使用 Bland-Altmann 重复性系数 （CoR） 根据生物标志物特异性形态学变化定义的区域评估重测重复性。此外，还评估了设备间相关性、暗点检测的可重复性以及对固定稳定性的任何潜在影响。结果 包括 20 名受试者的每台设备 900 个刺激。对于 MAIA （±6.57） 和 MP3 （±6.59），可以检测到相同的总体 PWS 重测方差。PR 完整性损失与两种设备上较高的重测方差相关 （MAIA： p=0.002;MP3：p<0.001）。在出现 RPE 损失的区域（±10.99 对 ±5.34）或 HRF（±9.21 对 ±6）的区域刺激的 CoR 更高。25） 只能在 MP3 检查中检测到 （分别为 p<0.001 和 p=0.01）。可以证明出色的设备内相关性 （MAIA： 0.94[0.93-0.95] MP3： 0.94[0.94-0.95]） 和良好的平均设备间相关性 （0.84[0.53-0.92]）。所选装置、运行顺序或没有中央凹保留对固定稳定性没有显着影响。结论 呈现自动量化的 PR 完整性损失的区域，有和没有潜在的 RPE 损失，与 MAIA 和 MP3 的较高重测方差相关。这些发现对于在长期随访期间准确解释 GA 进展以及规划以显微视野计测试作为功能研究终点的未来试验至关重要。