Association between hyperacuity defects and retinal microstructure in polypoidal choroidal vasculopathy

Purpose: To improve our understanding of hyperacuity defects measured with preferential hyperacuity perimetry (PHP) by correlating PHP findings with the retinal microstructural changes visible on spectral-domain optical coherence tomography (OCT) in patients with polypoidal choroidal vasculopathy (PCV). Materials and Methods: Twenty-eight eyes of 28 patients with PCV were retrospectively reviewed. All patients underwent a complete ophthalmologic examination, including best-corrected visual acuity (logMAR) testing, PHP, and OCT. The functional 'PHP test score' and 'total volume of hyperacuity defect zone' were also analyzed. Results: Patients were classified based on the hyperacuity defect by PHP, as follows: Hyperacuity defect (n = 17 eyes) group and hyperacuity intact (n = 11 eyes) group. The mean best-corrected visual acuity in the hyperacuity intact group (0.46 +/- 0.39) was better than that in the hyperacuity defect group (0.82 +/- 0.37) (P = 0.014). The presence of serous retinal detachment and retinal pigment epithelial detachment did not differ significantly between groups (P = 0.120 and P = 0.689, respectively). A disrupted photoreceptor layer was more common in the hyperacuity defect group compared with the hyperacuity intact group (P = 0.0001). Among 17 eyes with a hyperacuity defect, 9 eyes showing intra-retinal pathology (intra-retinal cyst or hard exudates) and had a significantly higher PHP test score and larger total volume of the hyperacuity defect zone than 8 eyes without intra-retinal pathology (P = 0.006 and P = 0.021, respectively). Conclusion: A hyperacuity defect in PCV was associated with photoreceptor disarrangement. Furthermore, PCV lesions on the inner retina that invaded the photoreceptor layer were associated with a more severe hyperacuity defect.