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  • Amsler grid may not be as reliable as once thought for self-monitoring AMD

    Comprehensive Ophthalmology, Ocular Pathology/Oncology, Retina/Vitreous

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    Review of: Diagnostic accuracy of the Amsler grid test for detecting neovascular age-related macular degeneration: A systematic review and meta-analysis

    Bjerager J, Schneider M, Potapenko I, et al. JAMA Ophthalmology, April 2023

    Despite its cost-efficiency and ease of use, the Amsler grid may not have adequate sensitivity or specificity to make it a reliable tool for at-home monitoring of non-neovascular age-related macular degeneration (AMD) progression to neovascular AMD.

    Study design

    This was a systematic review and meta-analysis of studies conducted between 2003 and 2015 investigating the use of the Amsler grid test for evaluating AMD progression. From a pool of 523 records, 10 studies (1890 eyes) met inclusion criteria; most studies were cross-sectional (1 was a case-control study) and prospective (1 was retrospective).

    Outcomes

    The Amsler grid test was able to identify neovascular AMD with 67% sensitivity and 99% specificity when compared to healthy controls. However, when evaluating the ability of the test to differentiate patients with neovascular AMD from those with non-neovascular AMD, the calculated sensitivity and specificity were 71% (60%–80%) and 63% (49%–51%), respectively.

    Limitations

    This meta-analysis included studies with different designs (retrospective vs prospective; cross-sectional vs case-control) and different eligibility criteria. The definitions of neovascular and non-neovascular AMD were also not uniform across all studies. Moreover, there could have been significant differences in the use of OCT due to the extended time period over which the included studies were conducted (2003–2015). Whereas the Amsler grid test is generally intended for home monitoring, the test was instead performed in a facility under supervision in these studies, which could have affected test results.

    Clinical significance

    Despite its widespread use and ease of administration, the Amsler grid test appears to have an unacceptably low sensitivity and specificity for the detection of choroidal neovascularization in patients with non-neovascular AMD. Until more sensitive methods of central vision self-monitoring become available, patients with non-neovascular AMD should undergo regular eye examinations regardless of the results of an Amsler grid test.

    Financial Disclosures: Dr. Arman Mashayekhi discloses no financial relationships.