IMPORTANCE Patients with nonneovascular age-related macular degeneration (AMD) are
encouraged to use the Amsler grid test for self-assessment to facilitate early diagnosis.
The test is widely recommended, suggesting a belief that it signals worsening AMD,
warranting its use in home monitoring.OBJECTIVE To systematically review studies of
the diagnostic test accuracy of the Amsler grid in the diagnosis of neovascular AMD
and to perform diagnostic test accuracy meta-analyses.DATA SOURCES A systematic literature
search was conducted in 12 databases for relevant titles from database inception until
May 7, 2022.STUDY SELECTION Studies included those with groups defined as having (1)
neovascular AMD and (2) either healthy eyes or eyes with nonneovascular AMD. The index
test was the Amsler grid. The reference standard was ophthalmic examination. After
removal of obviously irrelevant reports, 2 authors (J.B. and M.S.) independently screened
the remaining references in full text for potential eligibility. Disagreements were
resolved by a third author (Y.S.).DATA EXTRACTION AND SYNTHESIS Two authors (J.B.
and I.P.) independently extracted all data and evaluated quality and applicability
of eligible studies using the Quality Assessment of Diagnostic Accuracy Studies 2.
Disagreements were resolved by a third author (Y.S.).MAIN OUTCOMES AND MEASURES Sensitivity
and specificity of the Amsler grid for detecting neovascular AMD with comparators
being either healthy control participants or patients with nonneovascular AMD.RESULTS
Of 523 records screened, 10 studies were included with a total of 1890 eyes (mean
participant age ranging from 62 to 83 years). Sensitivity and specificity to diagnose
neovascular AMD were 67% (95% CI, 51%-79%) and 99% (95% CI, 85%-100%), respectively,
when comparators were healthy control participants and 71% (95% CI, 60%-80%) and 63%
(95% CI, 49%-51%), respectively, when control participants were patients with nonneovascular
AMD. Overall, potential sources of bias were low across studies. CONCLUSIONS AND RELEVANCE
Although the Amsler grid is easy and inexpensive to use for detection of metamorphopsia,
its sensitivity may be at levels typically not recommended for monitoring. Coupling
this lower sensitivity with only moderate specificity to identify neovascular AMD
in a population at risk, these findings suggest that such patients typically should
be encouraged to undergo ophthalmic examination regularly, regardless of any results
of Amsler grid self-assessment.
