Parafoveal contributions to retinal function during ranibizumab therapy for age-related macular degeneration

Can J Ophthalmol. 2015 Feb;50(1):37-43. doi: 10.1016/j.jcjo.2014.08.004.


Objective: The standard measure for the assessment of functional vision in the central retina is best corrected visual acuity (VA). Our aim was to investigate whether it is an advantage to include tests for functional changes in the near retinal periphery to monitor treatment effects in patients receiving multiple injections of anti-vascular endothelial growth factor (anti-VEGF) agents for advanced exudative age-related macular degeneration (AMD).

Design: Prospective pilot study.

Participants: Our cohort consisted of 24 patients with exudative AMD (mean age ± SD: 77.46 ± 7.82 years) treated at an ophthalmology clinic.

Methods: We compared data from standard functional measurements, VA-near, and contrast sensitivity (CS), with results from the macular mapping test (MMT) at 10% and 100% contrast. Measurements of retinal thickness by optical coherence tomography (OCT) were used to document the morphologic efficacy of the anti-VEGF agent. Tests were performed at baseline and 4 weeks after 3 monthly ranibizumab injections.

Results: All 4 functional tests yielded successes (equal or better visual performance after treatment) in 79.2% to 83.3% of cases. Including test locations in the near periphery yielded the highest success rate in the MMT at 10% contrast. Values for VA-near and CS also improved in a majority of cases. OCT measurements of retinal thickness indicated that the agent was effective in the fovea and near periphery.

Conclusions: Our findings indicate that using the MMT adds information about functional changes in the near periphery of the retina and allows more sensitive assessment of treatment effects or disease progression without the high expense of other techniques.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Angiogenesis Inhibitors / therapeutic use*
  • Antibodies, Monoclonal, Humanized / therapeutic use*
  • Contrast Sensitivity / physiology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pilot Projects
  • Prospective Studies
  • Ranibizumab
  • Retina / physiopathology*
  • Tomography, Optical Coherence
  • Vascular Endothelial Growth Factor A / antagonists & inhibitors
  • Visual Acuity / physiology*
  • Wet Macular Degeneration / drug therapy*
  • Wet Macular Degeneration / physiopathology


  • Angiogenesis Inhibitors
  • Antibodies, Monoclonal, Humanized
  • VEGFA protein, human
  • Vascular Endothelial Growth Factor A
  • Ranibizumab