Functional mapping of the central retina: a PRISMA-guided systematic review comparing microperimetry and standard automated perimetry

Microperimetry (MP), also referred to as fundus-controlled perimetry, enables retinal sensitivity (RS) assessment with real-time eye tracking and direct fundus visualisation. Standard automated perimetry (SAP), commonly performed using the Humphrey field analyser (HFA), remains the clinical standard for visual field evaluation. A systematic literature search of PubMed, Scopus, and Web of Science was conducted to identify adult human studies directly comparing MP (MP-1, MAIA, MP-3) with SAP. Inclusion criteria comprised within-subject comparative designs, quantitative RS outcomes, and peer-reviewed English-language publications. Data extracted included RS measures, fixation stability indices, structure, function correlations with optical coherence tomography (OCT), reproducibility metrics, and clinical applicability. Study selection and synthesis followed PRISMA guidelines. Due to methodological heterogeneity, a narrative comparative synthesis was performed. Comparative evidence across glaucoma, diabetic macular oedema, (DME) retinitis pigmentosa, and other macular disorders demonstrated good agreement between MP and SAP for central visual field sensitivity. MP consistently provided superior fixation control, improved test-retest reliability, and closer spatial correlation with OCT-derived structural parameters. In macular-predominant or early central disease, MP is frequently identified with localised functional deficits not evident on SAP. Conversely, SAP remained superior for peripheral visual field assessment and global disease staging. MP offers a precise and reproducible assessment of central retinal function, particularly valuable in macular disease and central glaucomatous damage. SAP remains indispensable for peripheral field evaluation. An integrated use of MP and SAP provides the most comprehensive strategy for clinical assessment and longitudinal monitoring.