Environmental Amsler test as a monitoring tool for retreatment with ranibizumab for neovascular age-related macular degeneration

Purpose To assess the ability of patients to predict the need for retreatment with intravitreal ranibizumab in neovascular age-related macular degeneration (NVAMD) based on their perception of visual deterioration or distortion of objects in their everyday environment (environmental Amsler). Methods A questionnaire was given to 89 patients undergoing optical coherence tomography (OCT)-guided retreatment with intravitreal ranibizumab for NVAMD following an initial loading regimen of three injections and with at least 12-month follow-up. The patient's opinion on the need for an injection on the current visit, based on their perception of change in environmental Amsler, was recorded. This subjective measure was compared with the objective evaluation of retreatment, based on predefined retreatment criteria comprising of changes in visual acuity and morphological changes on OCT. The patients were then instructed on the technique of environmental Amsler, and this evaluation was repeated. The sensitivity and specificity of patient prediction were analyzed at baseline and after the training. Results The ability of patients to predict disease activity at baseline showed a sensitivity of 61% and specificity of 96.6%. The area under the receiver operating characteristic curve was 0.8. The presence of macular fluid correlated well with the patient's perception of an abnormal environmental Amsler. After training, the sensitivity and specificity improved to 87.5% and 98.5%, respectively. Conclusion In real life, most patients are able to predict the reactivation of the disease in NVAMD, after 12-month follow-up, after training to monitor their symptoms using the environmental Amsler test. Eye (2012) 26, 389-393; doi: 10.1038/eye. 2011.326; published online 16 December 2011