Microperimetry, sometimes called fundus-controlled perimetry, is a type of

visual field test A visual field test is an eye examination that can detect dysfunction in central and peripheral vision which may be caused by various medical conditions such as glaucoma, stroke, pituitary disease, brain tumours or other neurological deficits. ...

which uses one of several technologies to create a "retinal sensitivity map" of the quantity of light perceived in specific parts of the retina in people who have lost the ability to fixate on an object or light source. The main difference with traditional perimetry instruments is that, microperimetry includes a system to image the retina and an eye tracker to compensate eye movements during visual field testing.

Usage

Intermediate age related macular degeneration

Visual field testing is widely used to monitor pathologies affecting the periphery of vision such as

glaucoma Glaucoma is a group of eye diseases that result in damage to the optic nerve (or retina) and cause vision loss. The most common type is open-angle (wide angle, chronic simple) glaucoma, in which the drainage angle for fluid within the eye rem ...

. During a conventional test, patients are asked to look steady (fixate) at a visual target, while light stimuli are projected at varying intensities in different retinal locations. This process is not, however, considered accurate in the evaluation of pathologies affecting the central part of the retina (

macula The macula (/ˈmakjʊlə/) or macula lutea is an oval-shaped pigmented area in the center of the retina of the human eye and in other animals. The macula in humans has a diameter of around and is subdivided into the umbo, foveola, foveal av ...

and

fovea centralis The fovea centralis is a small, central pit composed of closely packed cones in the eye. It is located in the center of the macula lutea of the retina. The fovea is responsible for sharp central vision (also called foveal vision), which is ne ...

) as patients with these pathologies are often unable to fixate reliably. By contrast, fundus perimetry, produces reliable results even in patients with unstable or eccentric fixation., or advance

macular degeneration Macular degeneration, also known as age-related macular degeneration (AMD or ARMD), is a medical condition which may result in blurred or no vision in the center of the visual field. Early on there are often no symptoms. Over time, however, som ...

. When central vision is compromised, as in the case of macular

scotoma A scotoma is an area of partial alteration in the field of vision consisting of a partially diminished or entirely degenerated visual acuity that is surrounded by a field of normal – or relatively well-preserved – vision. Every normal mam ...

, patients develop an eccentric or extra-foveal vision, normally with unstable fixation. The retinal area used by eccentric viewers to substitute the foveal vision is known as the Preferred Retinal Locus (PRL) In Microperimetry systems, the

fundus (eye) The fundus of the eye is the interior surface of the eye opposite the lens and includes the retina, optic disc, macula, fovea, and posterior pole.Cassin, B. and Solomon, S. ''Dictionary of Eye Terminology''. Gainesville, Florida: Triad Publi ...

is imaged in real time, while an

eye tracker Eye tracking is the process of measuring either the point of gaze (where one is looking) or the motion of an eye relative to the head. An eye tracker is a device for measuring eye positions and eye movement. Eye trackers are used in research ...

compensates eye movements during stimuli projection, allowing correct matching between expected and projected stimulus position onto the retina. Simultaneously, the eye tracker plots the retinal movement during fixation attempt defining the PRL zone as well as fixation stability. Some microperimetry instruments calculate 2 different PRL zones during the examination. To create the fundus image an infrared telecamera is used, as in the case of the "Nidek-MP1", or a Scanning Laser Ophthalmoscope (SLO), as in the case of the "Centervue-MAIA".

Microperimetry with Biofeedback

In patients with central vision loss, microperimetry experts are able to analyse the eccentric retina in order to find zones with good retinal sensitivity. Once the best retinal area is selected, patients are asked to move their gaze towards that direction, while audio signals guide them to the desired target. This process is called biofeedback, and is based on the theory of brain plasticity. With several training sessions, some patients are able to gain better use of their peripheral vision.

Usage

Microperimetry with Biofeedback

References

Further reading