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Chapter 1
Microperimetry
in Macular Disease
Klaus Rohrschneider
Core Messages
■ Macular diseases typically result in the
deterioration of visual function. For accurate
evaluation of macular disorders,
conventional visual field determination
has proven to be insufficient, because the
accuracy of the conventional visual field
relies on the assumption that fixation
happens at the fovea and remains stable.
■ Fundus perimetry is the only reliable
method of visual field testing in patients
with instable or eccentric fixation due to
macular pathologies. While static threshold
perimetry may be preferred in eyes
with diffuse functional deterioration or
irregular scotoma, kinetic test strategies
allow for exact delineation of the border
of the deep scotoma.
■ In eyes with macular holes exact delineation
of size of functional deterioration is
very helpful, even in surgery.
1.1 Introduction
Macular diseases typically result in the deterioration
of visual function. While central visual
acuity represents a parameter of this function,
difficulties in daily life, such as reduced reading
performance frequently caused by (para)central
1
■ Counseling patients with choroidal neovascularization
(CNV) due to age-related
macular degeneration is much easier
with the help of microperimetry due to
knowledge of the paracentral scotoma
influencing visual function and reading
ability.
■ In central serous chorioretinopathy the
symptoms are often difficult to understand
because visual acuity is normal.
Fundus perimetry demonstrates a deep
paracentral scotoma that is often very
concordant with the increase in retinal
thickness, explaining visual disturbance.
■ Patients with Stargardt’s disease exhibit a
characteristic behavior of fixation, which
can be documented only via fundus examination.
■ Fundus perimetry provides a more complete
assessment of macular function for
diagnostic purposes as well as for evaluation
of new treatment methods and expertise
in simulation or aggravation in
patients with macular diseases.
scotomas, are often missed. As far back as 1856,
the famous German ophthalmologist Albrecht
von Graefe remarked that central visual acuity is
only one aspect of visual function and additional
knowledge of the visual field is of equal importance.
In the meantime, lots of different methods
for visual field measurement have been devel-