Association of Mesopic and Dark-Adapted Retinal Sensitivity With Type 1 Macular Neovascularization in Age-Related Macular Degeneration

Purpose: To assess the impact of type 1 macular neovascularization (MNV) on mesopic and dark-adapted (DA) cyan retinal sensitivity using fundus-controlled perimetry (FCP [microperimetry]) in patients with age-related macular degeneration (AMD). Methods: This index study includes baseline data from AMD patients with type 1 MNV without complete retinal pigment epithelium and outer retinal atrophy (cRORA). Mesopic and DA-cyan sensitivity were measured using FCP with standardized and MNV-lesion-tailored test grids. We applied linear mixed-effects models to compare retinal sensitivity in regions with versus without co-localized type 1 MNV. Age-specific hill-of-vision data that served as reference were estimated using Bayesian quantile regressions. Results: Of the 55 eyes with baseline data, 27 eyes without cRORA (27 patients; mean age, 76.8 ± 6.7 years; 74.1% female) were included in this detailed analysis. In regions co-localizing with type 1 MNV, unadjusted mesopic sensitivity was significantly increased by a mean of 2.10 dB (95% confidence interval [CI], 1.58-2.63; P < 0.001), whereas unadjusted DA-cyan sensitivity was significantly reduced by 3.12 dB (95% CI, 2.38-3.86; P < 0.001) compared to regions without evidence of MNV. When adjusting for age-specific hill-of-vision reference data, mesopic sensitivity remained significantly higher by 0.78 dB (95% CI, 0.29-1.28; P = 0.002) and DA-cyan sensitivity remained significantly lower by 2.07 dB (95% CI, 1.33-2.80; P < 0.001) in regions co-localizing with type 1 MNV versus those without MNV. Conclusions: In AMD, areas overlying type 1 MNV showed higher mesopic but reduced DA-cyan sensitivity, suggesting localized preservation yet subtype-specific vulnerability. These findings will be further examined through structural analyses and prospective validation in our ongoing study.