Structure-Function Correlation Using a Targeted Image-Guided Microperimetry Approach for Retinal Atrophic Diseases: A Methods Study.

Purpose: This proof-of-concept study aimed to evaluate the feasibility of targeted, image-guided microperimetry (IGMP) by integrating optical coherence tomography (OCT) and fundus autofluorescence (FAF) for lesion mapping and functional assessment in retinal atrophic diseases. Methods: Twenty-two eyes were identified, of which 17 had early geographic atrophy (GA) and 5 had Stargardt disease (SD). Disease transition zones (TZs) on OCT and FAF were annotated onto en face infrared images. These were then exported with microperimetry (MP) assessments to custom MATLAB applications. IGMP patterns were thereafter created and imported using macular integrity assessment (MAIA) system and Nidek-MP3/S microperimeters for subsequent scans. Mean procedure and examination times (minutes), retinal sensitivity (decibel [dB]), approach feasibility, and algorithm compatibility of targeted IGMP were reported as outcomes. Results: Targeted IGMP was quicker than the standard 10-2 grid for both SD and GA lesion assessments. SD cases showed longer mean procedure and examination times and lower mean retinal sensitivity in all zones compared with GA lesions. The targeted IGMP procedure was lengthier for Nidek-MP3/S (29.2 ± 7.1 minutes) than MAIA (17.4 ± 4.3 minutes), although the examination took longer on MAIA (4.0 ± 1.0 minutes) than on Nidek-MP3/S (3.6 ± 1.2 minutes). Overall, the IGMP approach is feasible (100.0%) and the algorithm is compatible (100.0%) on both MP devices for all subjects tested. Conclusions: This study establishes the feasibility of an IGMP workflow in providing targeted functional assessments in retinal degenerative diseases. Further validation in larger cohorts is needed to assess its broader clinical applicability. Translational Relevance: Our approach may help enhance structure-function correlation and optimize the efficiency of MP integration for clinical trials.