Quantifying metamorphopsia with M-CHARTS in patients with idiopathic macular hole

Iori Wada, Shigeo Yoshida, Yoshiyuki Kobayashi, Yedi Zhou, Keijiro Ishikawa, Shintaro Nakao, Toshio Hisatomi, Yasuhiro Ikeda, Tatsuro Ishibashi, Koh-Hei Sonoda, Iori Wada, Shigeo Yoshida, Yoshiyuki Kobayashi, Yedi Zhou, Keijiro Ishikawa, Shintaro Nakao, Toshio Hisatomi, Yasuhiro Ikeda, Tatsuro Ishibashi, Koh-Hei Sonoda

Abstract

Purpose: The purpose of this study was to determine the degree of metamorphopsia using M-CHARTS™ in patients with idiopathic macular hole before and after pars plana vitrectomy and internal limiting membrane (ILM) peeling.

Patients and methods: The records of 22 eyes of 22 patients with a full-thickness macular hole who underwent pars plana vitrectomy and ILM peeling were reviewed. All patients underwent a complete ophthalmic examination including spectral-domain optical coherence tomography (OCT). Horizontal metamorphopsia (MH) and vertical metamorphopsia (MV) scores were determined using M-CHARTS at the same time. The time course of changes in metamorphopsia and the relationship between best-corrected visual acuity (BCVA) and OCT parameters were assessed.

Results: Sealing of the macular hole was noted in all eyes after surgery. BCVA improved significantly from 1 month after surgery (P<0.001). The MV score was significantly higher than the MH score before surgery (P<0.05) and improved significantly from 1 month after surgery (P<0.03). The MH score improved significantly at 6 months after surgery (P<0.001). The postoperative MV and MH scores became closer to one another from 1 month after surgery. Moreover, the MV score was higher than the MH score at all postoperative assessments. There was a significant correlation between the MV and MH scores at all follow-up assessments. There was no significant correlation between BCVA and the MV or MH score at any follow-up assessment.

Conclusion: The satisfaction of the patients with macular hole after surgery cannot be necessarily measured by BCVA alone, because M-scores were not correlated to BCVA in postoperative evaluation. Therefore, evaluation of the MV and MH scores can be an independent treatment outcome in addition to BCVA.

Keywords: macular hole; metamorphopsia; optical coherence tomography.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
M-CHARTS™ (Inami & Co., Ltd., Tokyo, Japan) has 19 charts and two types: one dotted line for patients with general macular disease (type 1) and two dotted lines for patients with a macular hole (type 2). Notes: The visual angle denoting the dot interval of the line seen as straight is used as the patient’s M-CHARTS score. Scores were obtained for vertical and horizontal tests separately.
Figure 2
Figure 2
Minimum (a) and base (b) diameters of the macular hole, the average angle of the macular hole (c), and the fluid cuff (b–a) were measured preoperatively on OCT images. Abbreviation: OCT, optical coherence tomography.
Figure 3
Figure 3
Time course of logMAR BCVA (mean and standard deviation) in patients after macular hole surgery. Notes: BCVA improved significantly from 0.65±0.27 logMAR before surgery to 0.31±0.20 logMAR at 1 month after surgery and continued to improve significantly to 0.23±0.20 logMAR at 3 months and 0.20±0.21 logMAR at 6 months after surgery. **P<0.001, Wilcoxon rank-sum test. The bars indicate the mean ± standard error of the mean. Abbreviations: logMAR, logarithm of the minimum angle of resolution; BCVA, best-corrected visual acuity.
Figure 4
Figure 4
Comparison of preoperative scores for MV and MH. Notes: The preoperative MV score is significantly larger than the MH score. *P<0.05, Wilcoxon rank-sum test. Abbreviations: MV, vertical metamorphopsia; MH, horizontal metamorphopsia.
Figure 5
Figure 5
Time course of MV and MH scores in patients after macular hole surgery. Notes: (A) The MV score (mean and standard deviation) improved significantly from 0.95±0.55 before surgery to 0.62±0.48 at 1 month after surgery (P<0.001) and continued to improve significantly to 0.51±0.43 at 3 months and 0.46±0.39 at 6 months after surgery (P<0.001). (B) The MH score improved significantly from 0.58±0.40 before surgery to 0.36±0.44 at 6 months after surgery (P<0.001). *P<0.05 and **P<0.001, Wilcoxon rank-sum test. Bars indicate the mean ± standard error of the mean. Abbreviations: MV, vertical metamorphopsia; MH, horizontal metamorphopsia.
Figure 6
Figure 6
The relationship between the MV and MH scores after macular hole surgery at each postoperative assessment. Notes: At all observation times, there is a significant correlation between the MV score and the MH score (r=0.54, P<0.05 before surgery; r=0.54, P<0.05 at 1 month; r=0.79, P<0.001 at 3 months; r=0.69, P<0.001 at 6 months; Spearman rank correlation coefficient). Abbreviations: MV, vertical metamorphopsia; MH, horizontal metamorphopsia.

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