The Amsler grid test is easily accessible for home-monitoring, but it’s not sensitive enough for patients who are at risk of neovascular AMD. Photo: Carolyn Majcher, OD. Click image to enlarge.

Clinicians widely recommend and commonly use Amsler grids for detecting metamorphopsia and scotoma in macular disorders, but a recently published study in JAMA Ophthalmology suggests that self-assessing with Amsler grids for potential neovascular AMD is by no means a replacement for regular eye exams.

Researchers screened 523 studies examining the diagnostic accuracy of Amsler grids in wet AMD. A total of 10 studies were selected for inclusion in the analysis (1,890 eyes, mean age ranging from 62 to 83). The researchers reported Amsler grid sensitivity and specificity for diagnosing neovascular AMD of 67% and 99%, respectively, when the comparison group was composed of healthy controls. When the control group was made up of neovascular AMD patients, sensitivity was 71% and specificity was 63%. The researchers noted the potential sources of bias were low in all studies.

They concluded that the Amsler grid should be conducted with caution in certain patients. “Although the Amsler grid test is inexpensive, readily available, easy to use and independent of electronics or devices, it is important to note that when patients have signs of early or dry AMD and, thus, are at risk of developing neovascular AMD, the actual performance of the Amsler grid is not at a level typically recommended for monitoring,” the researchers wrote in their paper, adding that this test may give some patients a false sense of security so they should be encouraged to undergo ophthalmic testing regularly, no matter their Amsler grid test findings.

Bjerager J, Schneider M, Potapenko I, et al. Diagnostic accuracy of the Amsler grid test for detecting neovascular age-related macular degeneration: a systematic review and meta-analysis. JAMA Ophthalmology. February 16, 2023. [Epub ahead of print].