Diagnostic accuracy of the Amsler grid and the preferential hyperacuity perimetry in the screening of patients with age-related macular degeneration: systematic review and meta-analysis

Objective

To clarify the screening potential of the Amsler grid and preferential hyperacuity perimetry (PHP) in detecting or ruling out wet age-related macular degeneration (AMD).

Evidence acquisition

Medline, Scopus and Web of Science (by citation of reference) were searched. Checking of reference lists of review articles and of included articles complemented electronic searches. Papers were selected, assessed, and extracted in duplicate.

Evidence synthesis

Systematic review and meta-analysis. Twelve included studies enrolled 903 patients and allowed constructing 27 two-by-two tables. Twelve tables reported on the Amsler grid and its modifications, twelve tables reported on the PHP, one table assessed the MCPT and two tables assessed the M-charts. All but two studies had a case–control design. The pooled sensitivity of studies assessing the Amsler grid was 0.78 (95% confidence intervals; 0.64–0.87), and the pooled specificity was 0.97 (95% confidence intervals; 0.91–0.99). The corresponding positive and negative likelihood ratios were 23.1 (95% confidence intervals; 8.4–64.0) and 0.23 (95% confidence intervals; 0.14–0.39), respectively. The pooled sensitivity of studies assessing the PHP was 0.85 (95% confidence intervals; 0.80–0.89), and specificity was 0.87 (95% confidence intervals; 0.82–0.91). The corresponding positive and negative likelihood ratios were 6.7 (95% confidence intervals; 4.6–9.8) and 0.17 (95% confidence intervals; 0.13–0.23). No pooling was possible for MCPT and M-charts.

Conclusion

Results from small preliminary studies show promising test performance characteristics both for the Amsler grid and PHP to rule out wet AMD in the screening setting. To what extent these findings can be transferred to a real clinic practice still needs to be established.