Diagnostic accuracy of the Amsler grid and the preferential hyperacuity perimetry in the screening of patients with age-related macular degeneration: systematic review and meta-analysis

Eye (2014) 28, 788796 & 2014 Macmillan Publishers Limited All rights reserved 0950-222X/14

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L Faes1, NS Bodmer1, LM Bachmann1, MA Thiel2 and MK Schmid2

Diagnostic accuracy of the Amsler grid and the preferential hyperacuity perimetry in the screening of patients with age-related macular degeneration: systematic review and meta-analysis

REVIEW

1Medignition Inc, Research Consultants, Zug, Switzerland

2Eye Clinic, Cantonal Hospital of Lucerne, Lucerne, Switzerland

Correspondence:MK Schmid, Eye Clinic, Cantonal Hospital of Lucerne, Lucerne, Switzerland, Spitalstrasse, CH-6000 Luzern 16, SwitzerlandTel: [phone]; Fax: [phone]. E-mail: mailto:[email protected]

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Received: 10 February 2014 Accepted: 2 April 2014 Published online: 2 May 2014

Abstract

Objective To clarify the screening potential of the Amsler grid and preferential hyperacuity perimetry (PHP) in detecting or ruling out wet age-related macular degeneration (AMD).

Evidence acquisition Medline, Scopus and Web of Science (by citation of reference) were searched. Checking of reference lists of review articles and of included articles complemented electronic searches. Papers were selected, assessed, and extracted in duplicate.

Evidence synthesis Systematic review and meta-analysis. Twelve included studies enrolled 903 patients and allowed constructing 27 two-by-two tables. Twelve tables reported on the Amsler grid and its modications, twelve tables reported on the PHP, one table assessed the MCPT and two tables assessed the M-charts. All but two studies had a casecontrol design. The pooled sensitivity of studies assessing the Amsler grid was 0.78 (95% condence intervals; 0.640.87), and the pooled specicity was 0.97 (95% condence intervals;0.910.99). The corresponding positive and negative likelihood ratios were 23.1 (95% condence intervals; 8.464.0) and 0.23 (95% condence intervals; 0.140.39), respectively. The pooled sensitivity of studies assessing the PHP was 0.85 (95% condence intervals;0.800.89), and specicity was 0.87(95% condence intervals; 0.820.91). The

corresponding positive and negative likelihood ratios were 6.7 (95% condence intervals; 4.69.8) and 0.17 (95% condence intervals; 0.130.23). No pooling was possible for MCPT and M-charts.

Conclusion Results from small preliminary studies show promising test performance characteristics both for the Amsler grid and PHP to rule out wet AMD in the screening setting. To what extent these ndings can be transferred to a real clinic practice still needs to be established.

Eye (2014) 28, 788796; doi:http://dx.doi.org/10.1038/eye.2014.104

Web End =10.1038/eye.2014.104 ;...