Quantification of metamorphopsia using M-CHARTS in myopic choroidal neovascularization treated with aflibercept: a prospective case series

Background Metamorphopsia is a frequent and clinically meaningful symptom in macular disease, yet it is often assessed qualitatively rather than quantitatively. Although M-CHARTS have been used in several macular disorders, their role in myopic choroidal neovascularization (mCNV) has not been established. We aimed to quantify short-term changes in metamorphopsia after intravitreal aflibercept in patients with symptomatic mCNV managed with a pro re nata regimen. Methods This prospective, longitudinal, observational case series included 33 eyes of 33 patients with symptomatic mCNV. Best-corrected visual acuity (BCVA), vertical metamorphopsia, and horizontal metamorphopsia were recorded at baseline and 4 weeks after a single intravitreal injection of aflibercept 2 mg. Optical coherence tomography (OCT) was used in all eyes to assess activity, and fluorescein angiography was obtained when OCT findings were inconclusive. Because normality could not be assumed, paired comparisons were performed with the Wilcoxon signed-rank test. Results Median vertical metamorphopsia improved from 0.40 (interquartile range [IQR] 0.25–0.65) at baseline to 0.20 (IQR 0.00–0.40) at week 4 (p = 0.01). Median horizontal metamorphopsia improved from 0.50 (IQR 0.30–0.80) to 0.30 (IQR 0.20–0.40) (p = 0.01). Median BCVA improved from 0.60 logMAR (IQR 0.43–0.94) to 0.47 logMAR (IQR 0.30–0.69), without reaching statistical significance (p = 0.07). Conclusions Metamorphopsia quantified with M-CHARTS improved significantly 4 weeks after aflibercept in eyes with mCNV, whereas BCVA did not change significantly over the same interval. Quantitative metamorphopsia assessment may therefore provide a useful functional biomarker to complement imaging and visual acuity in pro re nata management.