Evaluation of a Portable Handheld Heterochromatic Flicker Photometer in Measuring Macular Pigment Optical Density

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Abstract
Macular pigment optical density (MPOD) is an important clinical biomarker for ocular conditions like macular degeneration, diabetic eye disease, and digital eye strain. Additionally, its measurements can be essential in health assessment for visual function, systemic diseases, and brain health. We aimed to assess the repeatability, agreement, and effects of the learning curve of the new portable handheld heterochromatic flicker photometer, Zx Pro, in measuring MPOD in a wide age range of ocular-healthy adults, compared to the MPOD measurements obtained using the clinically available QuantifEye device. Seventy-six participants performed one practice at-tempt and two study-related MPOD measurements with the Zx Pro and the QuantifEye. The Pearson correlation between the study-related MPOD measurements for Zx Pro and QuantifEye devices was 90% and 85%, respectively. Altman and Bland plots show excellent agreement between the device's MPOD data, with 95% limits of an agreement being -0.10 to +0.11 du. The mean difference between the practice attempt and the study-related measurements was not statistically significant for Zx Pro but was significant for QuantifEye (Repeated measures ANOVA p=0.325 and p=0.015, respectively). The Zx Pro provides excellent repeatable MPOD measurements, has an insignificant learning curve, and is in good agreement with the predicate device.
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