What You See Is Not Always What You Get in Atrophic Macular Disease

In Brief Purpose: To show that the area of atrophy seen on ophthalmoscopy may not correspond with the area of scotoma in some macular diseases. Methods: Three cases are presented, one with geographic atrophy (GA) from age-related macular degeneration, one with Stargardt disease, and one with a macular dystrophy. Nidek MP-1 microperimetry was performed and the correspondence of the dense scotoma to the visible atrophy is reported. Results: In the GA patient, the dense scotoma corresponds with the atrophy. In the patient with Stargardt disease, the dense scotoma is larger than the area of visible atrophy. In the patient with a macular dystrophy, the dense scotoma is smaller than the area of visible atrophy. Conclusions: In GA from age-related macular degeneration, the dense scotoma generally corresponds with the atrophy, so that measurement of the enlargement rate of the atrophy is a direct measure of enlargement of the scotoma. This may not be true of other macular diseases. While in geographic atrophy from age-related macular degeneration the dense scotoma generally corresponds exactly with the visible atrophic lesion, this may not be the case in Stargardt disease and other macular disorders.