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New outcome measures for treatment trials for Stargardt disease type 1 (STGD1) and other macular diseases are needed. Microperimetry allows mapping of light sensitivity of the macula and provides topographic information on visual function beyond visual acuity.To measure and analyze retinal light sensitivity of the macula in STGD1 using fundus-controlled perimetry (microperimetry).This was a multicenter prospective cohort study. A total of 199 patients and 326 eyes with molecularly confirmed (ABCA4) STGD1 underwent testing with the Nidek MP-1 microperimeter as part of the multicenter, prospective Natural History of the Progression of Atrophy Secondary to Stargardt Disease (ProgStar) study. Sensitivity of 68 retinal loci was tested, and the mean sensitivity (MS) was determined; each point was categorized as "normal," "relative," or "deep" scotoma.Mean sensitivity and the number of points with normal sensitivity, relative, or deep scotomas.Mean (SD) patient age was 34.2 (14.7) years, mean (SD) best-corrected visual acuity of all eyes was 47.8 (16.9) Early Treatment Diabetic Retinopathy Study letter score (approximately 20/100 Snellen equivalent), and mean MS of all eyes of all 68 points was 11.0 (5.0) dB. The median number of normal points per eye was 49 (mean [SD], 41.3 [20.8]; range, 0-68); abnormal sensitivity and deep scotomas were more prevalent in the central macula. Mean sensitivity was lower in the fovea (mean [SD], 2.7 [4.4] dB) than in the inner (mean [SD], 6.8 [5.8] dB) and outer ring (mean [SD], 12.7 [5.3] dB). Overall MS per eye was 0.086 dB lower per year of additional age (95% CI, -0.13 to -0.041; P .001) and 0.21 dB lower per additional year of duration of STGD1 (95% CI, -0.28 to -0.14; P .001). Longer duration of STGD1 was associated with worse MS (β = -0.18; P .001), with a lower number of normal test points (β = -0.71; P .001), and with a higher number of deep scotoma points (β = -0.70; P .001). We found 11 eyes with low MS (6 dB) but very good best-corrected visual acuity of at least 72 Early Treatment Diabetic Retinopathy Study letter score (20/40 Snellen equivalent).We provide an extensive analysis of macular sensitivity parameters in STGD1 and demonstrate their association with demographic characteristics and vision. These data suggest microperimetry testing provides a more comprehensive assessment of retinal function and will be an important outcome measure in future clinical trials.

We screened 32 ophthalmology journals that had published articles during the period from 1850 through 1949 to identify top-cited articles in the field of ophthalmology (hereafter referred to as citation classics) using the online database Science Citation Index Expanded (Thompson Reuters, Chicago, Illinois). The 101 most frequently cited articles were published in 16 journals. Archives of Ophthalmology had the most top-cited articles (n = 31), followed by American Journal of Ophthalmology (n = 24) and Albrecht von Graefe's Archiv für Ophthalmologie (n = 9). These articles originated from 14 countries, with the United States publishing the majority (n = 58). Most of the citation classics are clinical studies on topics such as rubella cataract, retinopathy of prematurity, keratoconjunctivitis sicca, sympathetic ophthalmia, and the first report of eponymous diseases (eg, Leber hereditary optic neuropathy, Duane retraction syndrome, and Stargardt disease). A considerable number of these articles were ignored initially and for several decades after publication, but, like the classic fairy tale Sleeping Beauty, they have been rediscovered. Our study provides a historical perspective on the classic papers in the literature that are still influential in ophthalmology.

Various stages of fundus flavimaculatus seen ophthalmoscopically were correlated with findings on electrophysiologic and psychophysical tests. A new classification of fundus flavimaculatus into stages recognizes the nuances in genetic expression and their correlation with findings on retinal function testing.