Date of Award

January 2017

Document Type


Degree Name

Medical Doctor (MD)



First Advisor

Ron A. Adelman

Second Advisor

Jimmy Z. Zhou


Age-Related Macular Degeneration (AMD) is the leading cause of irreversible blindness in the United States, and can be managed with intravitreal anti-VEGF injections. However, delay of treatment by even a few weeks can lead to decreased visual outcomes. Patients should monitor vision at home to detect choroidal neovascularization as early as possible. The objective of this study is to investigate the potential for the Hyperacuity (HAC) exam app as a screen for progression of treatable disease in exudative AMD. Specifically, the study aims to determine the sensitivity and specificity of the HAC exam app for detecting when the spectral-domain optical coherence tomography (SD-OCT) has pathology concerning for choroidal neovascularization. A secondary aim is to determine whether the patient population of AMD is capable of using the HAC exam app. A cross-sectional single-center study was performed with 33 subjects. Consent was obtained, and subjects were trained and then tested with the HAC exam app. After the study, subjects were asked about the usability of the HAC exam app. A masked retinal subspecialist then graded the SD-OCT to determine which subject eyes required treatment. Further data about the patient visit was obtained through chart review. Subject eyes were each considered a separate data point, and classified as either non-exudative, exudative without requiring immediate treatment (-tx), and exudative requiring immediate treatment (+tx). The HAC exam app was shown to have 92.3% sensitivity and 61.50% specificity in distinguishing between subjects who required treatment and did not require treatment. Age, laterality of the eye, presence of a cataract, and central thickness of the macula on OCT were found to have no correlation with the HAC score. This study shows that the HAC exam app is successful at detecting eyes which require treatment and is correlated with pathology observed on the OCT while not being significantly affected by age or cataracts. The researcher believes that the HAC exam app has strong potential for screening choroidal neovascularization in AMD.


This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.