Entoptic perimetry screening for central diabetic scotomas and macular edema

Abstract Objective The aim of this study was to compare entoptic perimetry, using conventional television, to Amsler grid and patient-reported visual loss for the detection of functional diabetic maculopathy and macular edema. Design Observational case series. Participants A single eye from each of 104 consecutive patients with diabetes in an academic retina clinic. Intervention Each eye was screened by Amsler grid, entoptic perimetry, and Humphrey 10-2 threshold visual field testing (HVF 10-2; Humphrey Instruments Inc., San Leandro, CA) in random order. Eyes were then examined clinically. Main outcome measures The presence or absence of new visual decline since the patient's last clinical examination, the presence or absence of central visual field abnormalities using an Amsler grid, entoptic perimetry, HVF 10-2, and the presence or absence of clinically significant macular edema (CSME). Results The sensitivities and specificities for the detection of central diabetic scotomas as evidenced by HVF 10-2 abnormalities were: subjective impression, 31 of 90 eyes (34.4%) and 11 of 14 eyes (78.6%); Amsler grid, 29 of 90 eyes (32.2%) and 13 of 14 eyes (92.9%); and entoptic perimetry, 58 of 90 eyes (64.4%) and 11 of 14 eyes (78.6%). Entoptic perimetry was statistically more sensitive than both subjective impression ( P P P = 0.007 and P = 0.011, respectively) and Amsler grid ( P = 0.008 and P Conclusions Entoptic perimetry is 87% more sensitive than the subjective impression of visual decline ( P P P = 0.007) and 89% more sensitive than Amsler grid ( P = 0.008). Hence, entoptic perimetry, performed using conventional television, has the potential to be an effective, inexpensive, and widespread adjunct to surveillance examinations for the early detection of diabetic maculopathy.