PURPOSE:

To evaluate whether foveal flicker sensitivity and fundus appearance are good predictors of exudative age-related maculopathy (ARM) when the effects of aging, retinal illuminance, and criterion differences are controlled.

METHODS:

Fellow eyes of monocular exudative ARM patients were tested at baseline. Seven of these eyes have now developed exudative ARM. Therefore, at baseline they were in pre-exudative stages of ARM. The foveal flicker sensitivity and fundus appearance of the pre-exudative and nonconverted eyes were compared with healthy, age-matched eyes. The flicker stimulus was a uniform, 2.8 deg circular field at 660 nm, modulated sinusoidally at frequencies from 2.5 to 50 Hz. Fundus photographs were evaluated using the Wisconsin ARM grading system.

RESULTS:

Flicker modulation sensitivity at two frequencies discriminated pre-exudative from healthy older eyes with 100% accuracy. Using the same criterion, pre-exudative eyes also were discriminated from nonconverted eyes with 100% accuracy. Whereas an overall fundus ARM risk score discriminated pre-exudative from healthy older eyes with 100% accuracy, it did not discriminate pre-exudative from nonconverted eyes at better than chance levels.

CONCLUSIONS:

There were functional changes in the retina preceding development of exudative ARM. Foveal flicker sensitivity at low- to mid-temporal frequencies seemed highly sensitive to these pre-exudative changes in this relatively small group of subjects. The authors hypothesize that foveal flicker sensitivity is a good predictor of exudative ARM and a sensitive monitor of retinal function in pre-exudative ARM. These predictions are being tested on a larger, independent sample.