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Mesopic Microperimetry Captures Extensive Macular Atrophy with Pseudodrusen-Like Appearance Progression Beyond Visual Acuity: A Longitudinal Analysis

Year: 2026

Type: article

Abstract: Purpose: To quantify longitudinal changes in mesopic and scotopic retinal sensitivity (RS) and evaluate their relationship with retinal pigment epithelium (RPE) atrophy progression and foveal involvement in extensive macular atrophy with pseudodrusen-like appearance (EMAP). Design: Retrospective longitudinal observational study. Participants: One hundred twenty-eight eyes from 66 patients with clinically confirmed EMAP followed at a tertiary inherited retinal diseases clinic. Methods: Eyes with ≥1 visit including mesopic and red scotopic microperimetry using a validated 20-stimulus grid and multimodal imaging (blue autofluorescence and spectral-domain OCT) were included. Associations between square root-transformed RPE atrophy size and functional metrics (best-corrected visual acuity [BCVA], mesopic RS [mRS], and scotopic RS [sRS]) were analyzed using mixed-effects models adjusted for age and intereye correlation. Longitudinal rates of functional and structural change were estimated in eyes with ≥2 visits. Cox proportional hazards regression evaluated predictors of foveal involvement. Main Outcome Measures: Structure-function relationships, yearly rates of functional decline, and predictors of foveal involvement. Results: = 0.04), corresponding to a 133% increased risk per 1-dB decrease. Conclusions: In EMAP, mRS demonstrated stronger structure-function associations with RPE atrophy and a more consistent longitudinal decline than BCVA and sRS. Decline in macular mRS independently predicted subsequent foveal involvement, supporting microperimetry as a sensitive functional endpoint for patient stratification and interventional trials. Financial Disclosures: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Source: Ophthalmology Science

DOI: 10.1016/j.xops.2026.101383