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Karuntu JS, Nguyen XT, Boon CJF. Correlations between the Michigan Retinal Degeneration Questionnaire and visual function parameters in patients with retinitis pigmentosa. Acta Ophthalmol 2024; 102:555-563. [PMID: 38158751 DOI: 10.1111/aos.16601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 10/19/2023] [Accepted: 12/08/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE To validate the use of best-corrected visual acuity (BCVA), low-luminance visual acuity (LLVA), low-luminance deficit (LLD; the difference between BCVA and LLVA), mean macular sensitivity and fixation stability as parameters of vision-related quality of life based on the novel Michigan Retinal Degeneration Questionnaire (MRDQ) in retinitis pigmentosa (RP) patients. METHODS In this prospective cross sectional study, 30 patients with RP (47% female) were included with a median age of 41.0 years (interquartile range: 24.1-58.3 years). BCVA, LLVA and LLD were measured with Early Treatment Diabetic Retinopathy Study (ETDRS) charts. Mesopic microperimetry was performed to measure mean macular sensitivity and fixation stability. Patients completed a Dutch translation of the MRDQ which results in an experienced disability (Θ-)score of seven domains. Spearman's rank correlation was used. RESULTS BCVA correlated significantly to the MRDQ domain of central vision (r = 0.657; p < 0.001) and colour vision (r = 0.524; p = 0.003). Lower LLVA significantly correlated to higher experienced disability in the MRDQ domains for central vision (=0.550; p = 0.002) and contrast sensitivity (r = 0.502; p = 0.005). LLD was significantly correlated to the MRDQ domains of scotopic function (r = -0.484; p = 0.007) and mesopic peripheral function (r = -0.533; p = 0.002). Lower mean macular sensitivity was significantly associated with high experienced disability in all domains except for photosensitivity. CONCLUSIONS The majority of the MRDQ domains is strongly associated with visual function parameters. These findings show that visual function measurements, especially LLVA, LLD and mean macular sensitivity on microperimetry, reflect vision-related quality of life and can be used as relevant outcome measures in clinical trials for RP.
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Affiliation(s)
- J S Karuntu
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - X T Nguyen
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - C J F Boon
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Ophthalmology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, The Netherlands
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2
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Trinh M, Kalloniatis M, Khuu SK, Nivison-Smith L. Retinal sensitivity changes in early/intermediate AMD: a systematic review and meta-analysis of visual field testing under mesopic and scotopic lighting. Eye (Lond) 2024; 38:1827-1835. [PMID: 38499857 PMCID: PMC11229509 DOI: 10.1038/s41433-024-03033-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 01/22/2024] [Accepted: 03/08/2024] [Indexed: 03/20/2024] Open
Abstract
Visual fields under mesopic and scotopic lighting are increasingly being used for macular functional assessment. This review evaluates its statistical significance and clinical relevance, and the optimal testing protocol for early/intermediate age-related macular degeneration (AMD). PubMed and Embase were searched from inception to 14/05/2022. All quality assessments were performed according to GRADE guidelines. The primary outcome was global mean sensitivity (MS), further meta-analysed by: AMD classification scheme, device, test pattern, mesopic/scotopic lighting, stimuli size/chromaticity, pupil dilation, testing radius (area), background luminance, adaptation time, AMD severity, reticular pseudodrusen presence, and follow-up visit. From 1489 studies screened, 42 observational study results contributed to the primary meta-analysis. Supported by moderate GRADE certainty of the evidence, global MS was significantly reduced across all devices under mesopic and scotopic lighting with large effect size (-0.9 [-1.04, -0.75] Hedge's g, P < 0.0001). The device (P < 0.01) and lighting (P < 0.05) used were the only modifiable factors affecting global MS, whereby the mesopic MP-1 and MAIA produced the largest effect sizes and exceeded test-retest variabilities. Global MS was significantly affected by AMD severity (intermediate versus early AMD; -0.58 [-0.88, -0.29] Hedge's g or -2.55 [3.62, -1.47] MAIA-dB) and at follow-up visit (versus baseline; -0.62 [-0.84, -0.41] Hedge's g or -1.61[-2.69, -0.54] MAIA-dB). Magnitudes of retinal sensitivity changes in early/intermediate AMD are clinically relevant for the MP-1 and MAIA devices under mesopic lighting within the central 10° radius. Other factors including pupil dilation and dark adaptation did not significantly affect global MS in early/intermediate AMD.
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Affiliation(s)
- Matt Trinh
- School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, Australia
| | - Michael Kalloniatis
- School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, Australia
- School of Medicine (Optometry), Deakin University, Geelong, VIC, Australia
| | - Sieu K Khuu
- School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, Australia
| | - Lisa Nivison-Smith
- School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, Australia.
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3
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Boscia G, Ricardi F, Gelormini F, Marica V, Conte F, Ghilardi A, Viggiano P, Marolo P, Bandello F, Borrelli E, Reibaldi M. INTERSESSION REPEATABILITY OF READING PERFORMANCE MEASURES IN PATIENTS WITH NEOVASCULAR AGE-RELATED MACULAR DEGENERATION. Retina 2024; 44:707-713. [PMID: 38064659 DOI: 10.1097/iae.0000000000004015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
PURPOSE To assess the intersession repeatability of reading performance measures in patients with previously treated neovascular age-related macular degeneration and good best-corrected visual acuity (≥20/40 Snellen). METHODS Ninety-one patients (91 eyes) with a diagnosis of previously treated neovascular age-related macular degeneration and good best-corrected visual acuity (≥20/40 Snellen) were prospectively enrolled. Reading performance metrics were assessed using Radner charts, and these measurements were repeated after 7 days to obtain the intersession repeatability. To test repeatability, we calculated the intraclass correlation coefficient, the 95% coefficient of repeatability, and the coefficient of variation for each reading parameter: 1) reading acuity (RA-LogRAD); 2) maximal reading speed-words per minute; 3) RA score (RA score-LogRAD); and 4) critical print size-LogRAD. RESULTS Mean ± standard deviation best-corrected visual acuity was 0.13 ± 0.01 logMAR [range: 0.00-0.30 logMAR]. The intraclass correlation coefficient values indicated a good reliability for all the analyzed metrics (0.901 for RA; 0.859 for max reading speed; 0.906 for RA score; and 0.868 for critical print size). The coefficient of repeatability was 0.2 LogRAD for RA, 63.2 words per minute for max reading speed, 0.2 LogRAD for RA score, and 0.2 LogRAD for critical print size. Coefficient of variation was 5.5% for RA, 8.9% for max reading speed, 5.8% for RA score, and 6.9% for critical print size. CONCLUSION Reading performance metrics are characterized by good values of intersession repeatability in patients with neovascular age-related macular degeneration with good best-corrected visual acuity. Our findings may grant the employment of such measures in trials assessing the visual outcome in these patients.
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Affiliation(s)
| | | | | | | | - Fabio Conte
- Department of Ophthalmology, University of Turin, Italy
| | | | - Pasquale Viggiano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Paola Marolo
- Department of Ophthalmology, University of Turin, Italy
| | - Francesco Bandello
- Vita-Salute San Raffaele University Milan, Italy; and
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Enrico Borrelli
- Vita-Salute San Raffaele University Milan, Italy; and
- IRCCS San Raffaele Scientific Institute, Milan, Italy
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Cheng AMS, Chalam KV, Brar VS, Yang DTY, Bhatt J, Banoub RG, Gupta SK. Recent Advances in Imaging Macular Atrophy for Late-Stage Age-Related Macular Degeneration. Diagnostics (Basel) 2023; 13:3635. [PMID: 38132220 PMCID: PMC10742961 DOI: 10.3390/diagnostics13243635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/02/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023] Open
Abstract
Age-related macular degeneration (AMD) is a leading cause of blindness worldwide. In late-stage AMD, geographic atrophy (GA) of dry AMD or choroidal neovascularization (CNV) of neovascular AMD eventually results in macular atrophy (MA), leading to significant visual loss. Despite the development of innovative therapies, there are currently no established effective treatments for MA. As a result, early detection of MA is critical in identifying later central macular involvement throughout time. Accurate and early diagnosis is achieved through a combination of clinical examination and imaging techniques. Our review of the literature depicts advances in retinal imaging to identify biomarkers of progression and risk factors for late AMD. Imaging methods like fundus photography; dye-based angiography; fundus autofluorescence (FAF); near-infrared reflectance (NIR); optical coherence tomography (OCT); and optical coherence tomography angiography (OCTA) can be used to detect and monitor the progression of retinal atrophy. These evolving diverse imaging modalities optimize detection of pathologic anatomy and measurement of visual function; they may also contribute to the understanding of underlying mechanistic pathways, particularly the underlying MA changes in late AMD.
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Affiliation(s)
- Anny M. S. Cheng
- Department of Ophthalmology, Broward Health, Fort Lauderdale, FL 33064, USA; (A.M.S.C.); (R.G.B.)
- Specialty Retina Center, Coral Springs, FL 33067, USA;
- Department of Ophthalmology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
| | - Kakarla V. Chalam
- Department of Ophthalmology, Loma Linda University, Loma Linda, CA 92350, USA;
| | - Vikram S. Brar
- Department of Ophthalmology, Virginia Commonwealth University, Richmond, VA 23298, USA;
| | - David T. Y. Yang
- College of Biological Science, University of California, Davis, Sacramento, CA 95616, USA;
| | - Jineel Bhatt
- Specialty Retina Center, Coral Springs, FL 33067, USA;
| | - Raphael G. Banoub
- Department of Ophthalmology, Broward Health, Fort Lauderdale, FL 33064, USA; (A.M.S.C.); (R.G.B.)
- Specialty Retina Center, Coral Springs, FL 33067, USA;
| | - Shailesh K. Gupta
- Department of Ophthalmology, Broward Health, Fort Lauderdale, FL 33064, USA; (A.M.S.C.); (R.G.B.)
- Specialty Retina Center, Coral Springs, FL 33067, USA;
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Nowomiejska K, Nasser F, Brzozowska A, Rejdak R, Zrenner E. Elaborate Evaluation of Farnsworth Dichotomous D-15 Panel Test Can Help Differentiate between Best Vitelliform Macular Dystrophy and Autosomal Recessive Bestrophinopathy. Ophthalmic Res 2023; 66:481-488. [PMID: 36634627 PMCID: PMC11149457 DOI: 10.1159/000528615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 11/29/2022] [Indexed: 01/14/2023]
Abstract
INTRODUCTION The colour vision in bestrophinopathies has not been assessed in detail so far. The aim of this study was to explore the extent to which distinct types of bestrophinopathies differ in regard to colour vision deficiencies using Farnsworth Dichotomous D-15 and Lanthony Desaturated D-15 panel tests. METHODS Both D-15 tests were performed in 52 eyes of 26 patients with Best vitelliform macular dystrophy (BVMD) and 10 eyes of 5 patients with autosomal recessive bestrophinopathy (ARB). Two methods were used for a quantitative assessment of the colour vision deficiencies: moment of inertia method and Bowman method. The following parameters were calculated: confusion angle, confusion index (C-index), selectivity index (S-index), total error score (TES), and colour confusion index (CCI). RESULTS The median value of confusion angle for all stages of BVMD fell into a narrow range around 62, indicating normal results. The median confusion angle value was 57 in ARB patients within a very wide range down to -82, indicating non-specific deficits. These differences were statistically significant. Significantly abnormal C-index and CCI values were found only in ARB patients, being 2.0 and 1.49, respectively. The majority of parameters of D-15 tests were independent of the visual acuity in both bestrophinopathies. CONCLUSIONS Elaborate evaluation of the D-15 panel tests might help establish a differential diagnosis between different bestrophinopathies, as the pattern of the colour vision loss is different between BVMD and ARB. The quantitative parameters of colour vision tests in bestrophinopathies are independent of the visual acuity.
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Affiliation(s)
- Katarzyna Nowomiejska
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, Lublin, Poland
- Center for Ophthalmology, Institute for Ophthalmic Research, Eberhard Karls University, Tuebingen, Germany
| | - Fadi Nasser
- Center for Ophthalmology, Institute for Ophthalmic Research, Eberhard Karls University, Tuebingen, Germany
| | - Agnieszka Brzozowska
- Department of Informatics and Medical Biostatistics, Medical University of Lublin, Lublin, Poland
| | - Robert Rejdak
- Chair and Department of General and Pediatric Ophthalmology, Medical University of Lublin, Lublin, Poland
| | - Eberhart Zrenner
- Center for Ophthalmology, Institute for Ophthalmic Research, Eberhard Karls University, Tuebingen, Germany
- Werner Reichardt Centre for Integrative Neuroscience, Eberhard Karls University, Tuebingen, Germany
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Owsley C, Swain TA, McGwin G, Clark ME, Kar D, Crosson JN, Curcio CA. How Vision Is Impaired From Aging to Early and Intermediate Age-Related Macular Degeneration: Insights From ALSTAR2 Baseline. Transl Vis Sci Technol 2022; 11:17. [PMID: 35861686 PMCID: PMC9315068 DOI: 10.1167/tvst.11.7.17] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Purpose We hypothesize the first visual dysfunction in transitioning to early and intermediate age-related macular degeneration (AMD) is delayed rod-mediated dark adaptation (RMDA), owing to impaired photoreceptor sustenance from the circulation. This analysis from the Alabama Study on Early Age-related Macular Degeneration 2 provides insight on our framework's validity, comparing RMDA and other visual tests among older normal, early, and intermediate AMD eyes. Methods AMD disease severity was determined via fundus photos using the Age-Related Eye Disease Study nine-step system. Visual functions evaluated were RMDA 5°, acuity, contrast sensitivity (photopic, mesopic), and light sensitivity for a macular grid (scotopic, mesopic, photopic). Presence versus absence of subretinal drusenoid deposits (SDD) was identified through multimodal imaging. Results One eye from each of 481 persons (mean age, 72 years) was evaluated. All visual functions were significantly worse with increasing AMD disease severity. Using z-scores to standardize visual function measures across groups, the greatest difference in probability density functions between older normal and intermediate AMD was for RMDA. Early and intermediate AMD eyes with SDD present had longer rod intercept times than eyes with SDD absent. SDD absent eyes also exhibited delayed RMDA and wide probability density functions relative to normal eyes. Conclusions Among the visual functions evaluated, RMDA best discriminates among normal, early AMD, and intermediate AMD eyes. The Alabama Study on Early Age-related Macular Degeneration 2 will evaluate whether AMD's natural history confirms our hypothesis at the 3-year follow-up. Translational Relevance Results support a sequence of visual function impairments in aging and AMD, suggesting RMDA as a promising outcome for evaluating interventions in early disease.
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Affiliation(s)
- Cynthia Owsley
- Department of Ophthalmology & Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Thomas A. Swain
- Department of Ophthalmology & Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA,Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Gerald McGwin
- Department of Ophthalmology & Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA,Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mark E. Clark
- Department of Ophthalmology & Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Deepayan Kar
- Department of Ophthalmology & Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jason N. Crosson
- Department of Ophthalmology & Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Christine A. Curcio
- Department of Ophthalmology & Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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7
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Shah N, Dakin SC, Mulholland PJ, Racheva K, Matlach J, Anderson RS. The Effect of Induced Intraocular Stray Light on Recognition Thresholds for Pseudo-High-Pass Filtered Letters. Transl Vis Sci Technol 2022; 11:4. [PMID: 35511149 PMCID: PMC9078078 DOI: 10.1167/tvst.11.5.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The Moorfields Acuity Chart (MAC)—comprising pseudo-high-pass filtered “vanishing optotype” (VO) letters—is more sensitive to functional visual loss in age-related macular degeneration (AMD) compared to conventional letter charts. It is currently unknown the degree to which MAC acuity is affected by optical factors such as cataract. This is important to know when determining whether an individual's vision loss owes more to neural or optical factors. Here we estimate recognition acuity for VOs and conventional letters with simulated lens aging, achieved using different levels of induced intraocular light scatter. Methods Recognition thresholds were determined for two experienced and one naive participant with conventional and VO letters. Stimuli were presented either foveally or at 10 degrees in the horizontal temporal retina, under varying degrees of intraocular light scatter induced by white resin opacity-containing filters (WOFs grades 1 to 5). Results Foveal acuity only became significantly different from baseline (no filter) for WOF grade 5 with conventional letters and WOF grades 4 and 5 with VOs. In the periphery, no statistical difference was found for any stray-light level for both conventional and VOs. Conclusions Recognition acuity measured with conventional and VOs is robust to the effects of simulated lens opacification, and thus its higher sensitivity to neural damage should not simultaneously be confounded by such optical factors. Translational Relevance The MAC may be better able to differentiate between neural and optical deficits of visual performance, making it more suitable for the assessment of patients with AMD, who may display both types of functional visual loss.
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Affiliation(s)
- Nilpa Shah
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Steven C Dakin
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.,School of Optometry & Vision Science, University of Auckland, Auckland, New Zealand
| | - Pádraig J Mulholland
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.,Centre for Optometry and Vision Science, School of Biomedical Sciences, University of Ulster at Coleraine, N Ireland, UK
| | - Kalina Racheva
- Institute of Neurobiology, Bulgarian Academy of Sciences, Sofia, Bulgaria
| | - Juliane Matlach
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.,Department of Ophthalmology, University Medical Centre, Johannes Gutenberg University Mainz, Germany
| | - Roger S Anderson
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.,Centre for Optometry and Vision Science, School of Biomedical Sciences, University of Ulster at Coleraine, N Ireland, UK
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Mahjoob M, Heravian Shandiz J, Anderson AJ. The effect of mental load on psychophysical and visual evoked potential visual acuity. Ophthalmic Physiol Opt 2022; 42:586-593. [PMID: 35150443 DOI: 10.1111/opo.12955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 01/05/2022] [Accepted: 01/05/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Under real-world conditions, tasks dependent on visual acuity may need to be performed in the presence of a mental load arising from concurrent, non-visual tasks. Therefore, measuring visual acuity concurrently with mentally demanding tasks may reflect a patient's vision more accurately. This study was designed to evaluate the impact of task-induced mental load on high contrast visual acuity, as measured using a letter chart and estimated via sweep visual evoked potentials (sweep VEP). METHODS Visual acuity was determined using the Freiburg Vision Test, and also using sweep VEP tested stepwise, from coarse to fine, over 13 spatial frequencies, in 31 healthy participants (aged 22.4 ± 3.6 years). Recordings were repeated while participants concurrently performed an auditory 2-back task. Mental load of the n-back task was confirmed through subjective ratings. RESULTS Visual acuity determined with the Freiburg Vision Test worsened from -0.02 ± 0.12 to 0.04 ± 0.15 logMAR under mental load (p = 0.03). Visual acuities estimated by sweep VEPs worsened from 0.38 ± 0.1 to 0.47 ± 0.1 logMAR (p < 0.001). While the slope of the VEP amplitude versus spatial frequency function steepened significantly with mental load (p = 0.01), VEP noise levels were not significantly affected (p = 0.07). CONCLUSION Visual acuity reduces significantly with a concurrent task that produces mental load. At least part of this reduction appears to be related to alterations in responses within the visual cortex, rather than being purely attributable to higher-level distraction effects.
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Affiliation(s)
- Monireh Mahjoob
- Health Promotion Research Center, Department of Optometry, Rehabilitation Faculty, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Javad Heravian Shandiz
- Refractive Eye Research Center, Department of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Andrew J Anderson
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, Australia
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Trinh M, Kalloniatis M, Nivison-Smith L. Should clinical automated perimetry be considered for routine functional assessment of early/intermediate age-related macular degeneration (AMD)? A systematic review of current literature. Ophthalmic Physiol Opt 2021; 42:161-177. [PMID: 34843120 PMCID: PMC9300202 DOI: 10.1111/opo.12919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/19/2021] [Accepted: 10/19/2021] [Indexed: 11/30/2022]
Abstract
Purpose There is growing interest in functional testing for early/intermediate age‐related macular degeneration (iAMD). However, systematic evaluation of existing clinical functional tests is lacking. This systematic review examines evidence for using clinical automated perimetry in routine assessment of early/iAMD. Recent findings PubMed, Web of Science Core Collection, and Embase were searched from inception to October 2020 to answer, is there evidence of visual field defects in early/iAMD, and if so, are early/iAMD visual field defects linked to real‐world patient outcomes? Articles using clinical automated perimetry (commercially accessible and non‐modified devices/protocols) were included. Microperimetry was excluded as this has yet to be incorporated into clinical guidelines. The primary outcome was global visual field indices including mean deviation (MD), pattern standard deviation (PSD), mean sensitivity (MS) and frequency of defects. The secondary outcome was any real‐world patient outcome including quality of life and/or activities of daily living indices. Twenty‐six studies were eligible for inclusion and all studies were observational. There was consistent evidence of worsened MD, PSD, MS and frequency of defects for early/iAMD compared to normal eyes under photopic, low‐photopic and scotopic conditions. Meta‐analysis of studies using standard automated perimetry (SAP) under photopic conditions revealed worsened MD (−1.52dB [−2.27, −0.78 dB]) and MS (−1.47dB [−2, −0.94 dB]) in early/iAMD compared to normal eyes, representing large statistical effect sizes but non‐clinically meaningful reductions. There was insufficient data for meta‐analyses regarding other clinical automated perimetry protocols. Only one study assessed a real‐world patient outcome (on‐road driving performance), with no significant link to visual field outcomes in early/iAMD. Summary Significant reduction of global visual field indices is present in early/iAMD, but not clinically meaningful using SAP under photopic conditions. Translational relevance of visual field outcomes to patient outcomes in early/iAMD remains unclear. Thus, SAP under photopic conditions is unlikely to be useful for routine assessment of early/iAMD.
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Affiliation(s)
- Matt Trinh
- Centre for Eye Health, University of New South Wales, Sydney, New South Wales, Australia.,School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Michael Kalloniatis
- Centre for Eye Health, University of New South Wales, Sydney, New South Wales, Australia.,School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Lisa Nivison-Smith
- Centre for Eye Health, University of New South Wales, Sydney, New South Wales, Australia.,School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
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10
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Sabeti F, Lane J, Rohan EMF, Rai BB, Essex RW, McKone E, Maddess T. Correlation of Central Versus Peripheral Macular Structure-Function With Acuity in Age-Related Macular Degeneration. Transl Vis Sci Technol 2021; 10:10. [PMID: 34003894 PMCID: PMC7881274 DOI: 10.1167/tvst.10.2.10] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose Patients with advanced age-related macular degeneration (AMD) may have preserved visual function despite significant retinal structural changes. We aimed to evaluate the relationships among retinal thickness, macular sensitivity, and visual acuity (VA) in advanced AMD. Methods We examined 43 eyes of 22 patients with advanced AMD (ages 66–93 years), prospectively recruited from the Canberra Hospital Ophthalmology Department. Visual function was measured on participants with low and high contrast visual acuity (LCVA and HCVA) and 10-2 Matrix visual fields. Retinal structure was determined with spectral domain optical coherence tomography (OCT), and customized software mapped the 64 OCT macular thickness regions onto the 44 regions of the 10-2 test. Results Median retinal thickness at each 10-2 region was near normal. Just 7 of 88 regions from the OCT analysis that were thicker than the median had sensitivity that declined significantly with increasing thickness (r = −0.698 ± 0.082, mean ± SD), whereas 17 of 88 thinner regions showed significantly decreasing sensitivity with decreasing thickness (r = 0.723 ± 0.078). The absolute value of deviations from median optical coherence tomography thickness (aOCT) outside the central eight degrees was significantly correlated with HCVA (r = −0.34, P = 0.047). Thickness in the central eight degrees was not. Similarly, matrix sensitivities inside the central eight degrees were significantly correlated with outer aOCT (r = −0.49, P = 0.002). Conclusions Retinal thickness outside eight degrees were significantly associated with HCVA and macular sensitivity. These results suggest that outer macular thickness may be a useful prognostic indicator in AMD. Translational Relevance Retinal structure at the borders of the macula may be a surrogate marker of vision and retinal thickness near fixation.
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Affiliation(s)
- Faran Sabeti
- Discipline of Optometry, Faculty of Health, University of Canberra, ACT, Australia.,John Curtin School of Medical Research (JCSMR), The Australian National University, Canberra, ACT Australia
| | - Jo Lane
- Research School of Psychology, The Australian National University, Canberra, ACT, Australia.,ARC Centre of Excellence in Cognition and its Disorders, The Australian National University, Canberra, ACT, Australia.,ARC Centre of Excellence in Cognition and its Disorders, The Australian National University, Canberra, ACT, Australia
| | - Emilie M F Rohan
- John Curtin School of Medical Research (JCSMR), The Australian National University, Canberra, ACT Australia
| | - Bhim B Rai
- John Curtin School of Medical Research (JCSMR), The Australian National University, Canberra, ACT Australia
| | - Rohan W Essex
- The Canberra Hospital, Canberra, Australia, and Academic Unit of Ophthalmology, ANU Medical School, Canberra, ACT, Australia
| | - Elinor McKone
- Research School of Psychology, The Australian National University, Canberra, ACT, Australia.,ARC Centre of Excellence in Cognition and its Disorders, The Australian National University, Canberra, ACT, Australia
| | - Ted Maddess
- John Curtin School of Medical Research (JCSMR), The Australian National University, Canberra, ACT Australia
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Brussee T, Alagahgi B, Nispen RMA, Rens GHMB. Measurement properties of reading tests in subjects with maculopathy. Acta Ophthalmol 2021; 99:275-287. [PMID: 32833321 DOI: 10.1111/aos.14574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 07/02/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE A reliable reading test provides a standardized measure of the visual component of reading performance. This study evaluated reproducibility, agreement and feasibility of five Dutch language continuous text reading tests used in clinical practice and research in visually impaired participants. METHODS In 42 participants with macular pathologies (mean age 77 years), the Colenbrander Reading Card (Colenbrander), International Reading Speed Texts (IReST), Laboratory of Experimental Ophthalmology (LEO) charts, 'de Nederlanders' (NED) and the Radner Reading Charts (Radner) were evaluated. The coefficient of repeatability was calculated for different reading parameters, and agreement between the reading tests was determined. RESULTS Between the reading tests, the differences found in repeatability for reading performance were mainly within the limit of one line (0.1 logMAR). Exceptions were the inter-session repeatability for critical print size: Colenbrander (0.35 logMAR), LEO (0.34), Radner (0.23). The highest agreement was found between the LEO and Radner; Reading acuity bias 0.03 logMAR (SD 0.10), CPS 0.03 (0.12). CONCLUSION This study shows that reading performance results obtained with reading tests are not always reliable and reading parameters could not always be properly assessed in participants with maculopathies. Therefore, choices regarding which reading test to use especially for research purposes should be based on both the feasibility and reliability of the reading test. The NED (a historical test) was the least feasible, and it is recommend that this test is no longer used. To allow standardized and comparable analysis of reading performance a highly standardized reading test, like the Radner is recommended.
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Affiliation(s)
- Tamara Brussee
- Ophthalmology Amsterdam Public Health Research Institute Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands
- Ophthalmology Elkerliek Hospital Helmond The Netherlands
| | - Basel Alagahgi
- Ophthalmology Amsterdam Public Health Research Institute Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Ruth M. A. Nispen
- Ophthalmology Amsterdam Public Health Research Institute Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Ger H. M. B. Rens
- Ophthalmology Amsterdam Public Health Research Institute Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands
- Ophthalmology Elkerliek Hospital Helmond The Netherlands
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12
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Abstract
PURPOSE To evaluate the feasibility in the clinical practice of a fast and simple mesopic microperimetry examination comparing the retinal sensitivity in eyes with drusen and reticular pseudodrusen by scotopic and mesopic testing. METHODS In eyes with only drusen and only reticular pseudodrusen, retinal sensitivity was assessed by mesopic testing and after 35 minutes of dark adaptation by scotopic testing using 2 grids of 6 and 10 stimulus points. RESULTS Fifteen eyes with drusen and 14 eyes with reticular pseudodrusen were enrolled with mean best-corrected visual acuity of 20/20. In mesopic and scotopic examination, we found significant higher retinal sensitivity of eyes with drusen compared with reticular pseudodrusen (P < 0.001). The mean duration of the examination of mesopic testing was less than 2 minutes, significantly reduced compared with scotopic testing (P < 0.01). CONCLUSION Eyes with reticular pseudodrusen presented a significantly reduced retinal sensitivity than eyes with drusen with scotopic and mesopic testing. The different retinal sensitivity between patients was found despite both group presenting good visual acuity. The retinal sensitivity evaluated by mesopic testing may replace the use of scotopic testing and best-corrected visual acuity examination, saving time and providing useful information in the assessment of macular function to identify patients with risk of disease progression.
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13
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Wu Z, Luu CD, Hodgson LA, Caruso E, Chen FK, Chakravarthy U, Arnold JJ, Heriot WJ, Runciman J, Guymer RH. Examining the added value of microperimetry and low luminance deficit for predicting progression in age-related macular degeneration. Br J Ophthalmol 2020; 105:711-715. [PMID: 32606079 DOI: 10.1136/bjophthalmol-2020-315935] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/21/2020] [Accepted: 06/01/2020] [Indexed: 11/04/2022]
Abstract
PURPOSE To examine the added predictive value of microperimetric sensitivity and low luminance deficit (LLD; difference between photopic and low luminance visual acuity (VA)) to information from colour fundus photography (CFP) for progression to late age-related macular degeneration (AMD) in individuals with bilateral large drusen. METHODS 140 participants with bilateral large drusen underwent baseline microperimetry testing, VA measurements and CFP. They were then reviewed at 6-monthly intervals to 36 months, to determine late AMD progression. Microperimetry pointwise sensitivity SD (PSD), LLD and the presence of pigmentary abnormalities on CFPs were determined. Predictive models based on these parameters were developed and examined. RESULTS Baseline microperimetry PSD and presence of pigmentary abnormalities were both significantly associated with time to develop late AMD (p≤0.004), but LLD was not (p=0.471). The area under the receiver operating characteristic curve (AUC) for discriminating between eyes that progressed to late AMD based on models using microperimetry PSD (AUC=0.68) and LLD (AUC=0.58) alone was significantly lower than that based on CFP grading for the presence of pigmentary abnormalities (AUC=0.80; both p<0.005). Addition of microperimetry and/or LLD information to a model that included CFP grading did not result in any improvement in its predictive performance (AUC=0.80 for all; all p≥0.66). CONCLUSIONS While microperimetry, but not LLD, was significantly and independently associated with AMD progression at the population level, this study observed that both measures were suboptimal at predicting progression at the individual level when compared to conventional CFP grading and their addition to the latter did not improve predictive performance.
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Affiliation(s)
- Zhichao Wu
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia .,Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Chi D Luu
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia.,Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Lauren Ab Hodgson
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Emily Caruso
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Fred K Chen
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Perth, Australia
| | | | | | | | - Jim Runciman
- Adelaide Eye and Retina Centre, Adelaide, Australia
| | - Robyn H Guymer
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia.,Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Australia
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14
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Nittala MG, Velaga SB, Hariri A, Pfau M, Birch DG, Haines J, Pericak-Vance MA, Stambolian D, Sadda SR. Retinal Sensitivity Using Microperimetry in Age-Related Macular Degeneration in an Amish Population. Ophthalmic Surg Lasers Imaging Retina 2020; 50:e236-e241. [PMID: 31589764 DOI: 10.3928/23258160-20190905-15] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 03/22/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVES To evaluate retinal sensitivity (RS) by mesopic and scotopic microperimetry (MP-1S) in an elderly Amish population with age-related macular degeneration (AMD). PATIENTS AND METHODS Mesopic and scotopic microperimetric testing was performed in 148 eyes of 77 elderly Amish subjects (age > 50 years) from Pennsylvania using a retinal function analyzer. Scotopic testing was performed using a 2.0 log unit neutral density filter following 30 minutes of dark adaptation. All subjects underwent complete ophthalmic examinations, including spectral-domain optical coherence tomography, fundus autofluorescence, infrared reflectance imaging, and flash color fundus photography. Certified graders at Doheny Image Reading Center identified subjects with evidence of AMD as defined by the Beckman classification and quantified drusen volume. RS in subjects with and without AMD was compared. Correlations between RS and drusen burden were analyzed. Ten eyes with incomplete MP-1S exams were excluded from the final analysis. RESULTS Among the 138 eyes from 77 subjects included in the final analysis, 42 eyes from 29 subjects had evidence of early or intermediate AMD. The mean age of subjects with AMD was 69.65 years ± 13.81 years versus 63.04 years ± 12.69 years in those without AMD (P = .06). Mesopic RS was 18.8 dB ± 2.1 dB in subjects with AMD and 19.6 dB ± 1.4 dB in those without AMD (P = .07). Scotopic RS was significantly lower (P = .04) in subjects with AMD (15.9 dB ± 2.9 dB) compared with those without AMD (17.3 dB ± 2.4 dB). There was no relationship between mesopic RS and either drusen area (r = -0.06; P = .32) or drusen volume (r = -0.08; P = .30). There was a trend for an association between scotopic RS and both drusen area (r = -0.39; P = .24) and drusen volume (r = -0.36; P = .30). CONCLUSIONS In an elderly Amish population, eyes with early or intermediate AMD show a greater reduction in scotopic RS than mesopic RS, suggesting that rod function is more severely affected than cone function. Drusen area and volume measurements better correlated with scotopic RS. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:e236-e241.].
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15
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Choi AYJ, Nivison-Smith L, Phu J, Zangerl B, Khuu SK, Jones BW, Pfeiffer RL, Marc RE, Kalloniatis M. Contrast sensitivity isocontours of the central visual field. Sci Rep 2019; 9:11603. [PMID: 31406197 PMCID: PMC6691009 DOI: 10.1038/s41598-019-48026-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 07/29/2019] [Indexed: 01/08/2023] Open
Abstract
Standard automated perimetry (SAP), the most common form of perimetry used in clinical practice, is associated with high test variability, impacting clinical decision making and efficiency. Contrast sensitivity isocontours (CSIs) may reduce test variability in SAP by identifying regions of the visual field with statistically similar patterns of change that can be analysed collectively and allow a point (disease)-to-CSI (normal) comparison in disease assessment as opposed to a point (disease)-to-point (normal) comparison. CSIs in the central visual field however have limited applicability as they have only been described using visual field test patterns with low, 6° spatial sampling. In this study, CSIs were determined within the central 20° visual field using the 10-2 test grid paradigm of the Humphrey Field Analyzer which has a high 2° sampling frequency. The number of CSIs detected in the central 20° visual field was greater than previously reported with low spatial sampling and stimulus size dependent: 6 CSIs for GI, 4 CSIs for GII and GIII, and 3 CSIs for GIV and GV. CSI number and distribution were preserved with age. Use of CSIs to assess visual function in age-related macular degeneration (AMD) found CSI guided analysis detected a significantly greater deviation in sensitivity of AMD eyes from normal compared to a standard clinical pointwise comparison (−1.40 ± 0.15 dB vs −0.96 ± 0.15 dB; p < 0.05). This work suggests detection of CSIs within the central 20° is dependent on sampling strategy and stimulus size and normative distribution limits of CSIs can indicate significant functional deficits in diseases affecting the central visual field such as AMD.
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Affiliation(s)
- Agnes Y J Choi
- Centre for Eye Health, The University of New South Wales, Kensington, New South Wales, Australia.,School of Optometry and Vision Science, The University of New South Wales, Kensington, New South Wales, Australia
| | - Lisa Nivison-Smith
- Centre for Eye Health, The University of New South Wales, Kensington, New South Wales, Australia.,School of Optometry and Vision Science, The University of New South Wales, Kensington, New South Wales, Australia
| | - Jack Phu
- Centre for Eye Health, The University of New South Wales, Kensington, New South Wales, Australia.,School of Optometry and Vision Science, The University of New South Wales, Kensington, New South Wales, Australia
| | - Barbara Zangerl
- Centre for Eye Health, The University of New South Wales, Kensington, New South Wales, Australia.,School of Optometry and Vision Science, The University of New South Wales, Kensington, New South Wales, Australia
| | - Sieu K Khuu
- School of Optometry and Vision Science, The University of New South Wales, Kensington, New South Wales, Australia
| | - Bryan W Jones
- Department of Ophthalmology, Moran Eye Center, University of Utah, Salt Lake City, Utah, United States
| | - Rebecca L Pfeiffer
- Department of Ophthalmology, Moran Eye Center, University of Utah, Salt Lake City, Utah, United States
| | - Robert E Marc
- Department of Ophthalmology, Moran Eye Center, University of Utah, Salt Lake City, Utah, United States
| | - Michael Kalloniatis
- Centre for Eye Health, The University of New South Wales, Kensington, New South Wales, Australia. .,School of Optometry and Vision Science, The University of New South Wales, Kensington, New South Wales, Australia.
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16
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Thompson AC, Luhmann UFO, Stinnett SS, Vajzovic L, Horne A, Toth CA, Cousins SW, Lad EM. Association of Low Luminance Questionnaire With Objective Functional Measures in Early and Intermediate Age-Related Macular Degeneration. Invest Ophthalmol Vis Sci 2018; 59:289-297. [PMID: 29340643 PMCID: PMC5770180 DOI: 10.1167/iovs.17-22528] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To determine whether Low Luminance Questionnaire (LLQ) scores are associated with objective measures of visual function in early and intermediate age-related macular degeneration (AMD). Methods Cross-sectional study of subjects with early AMD Age-Related Eye Disease Study (AREDS) stage 2, N = 33), intermediate AMD (AREDS stage 3, N = 47), and age-matched healthy controls (N = 21). Subjects were interviewed with the LLQ. Psychophysical tests performed included best-corrected visual acuity (BCVA), mesopic microperimetry, dark adaptometry (DA), low luminance visual acuity (LLVA), and cone contrast test (CCT). Low luminance deficit (LLD) was the difference in the number of letters read under photopic versus low luminance settings. The relationship between LLQ and visual function test scores was assessed with linear regression. Results Subjects with intermediate AMD had significantly lower LLQ composite scores (mean = 75.8 ± 16.7; median = 76, range [29, 97]) compared with early AMD (mean = 85.3 ± 13.3; median = 88, range [50, 100], P = 0.007) or controls (mean = 91.4 ± 6.5; median = 94, range [79, 99], P < 0.001) in the overall cohort. LLQ composite scores were associated with computerized BCVA (β = 0.516), computerized LLVA at two background luminance (1.3 cd/m2, β = 0.660; 0.5 cd/m2, β = 0.489) along with their respective computerized LLDs (β = −0.531 and −0.467), rod intercept (β = −0.312), and CCT green (β = 0.183) (all P < 0.05). Only the computerized LLVAs and computerized LLDs remained statistically significant after adjusting for AMD versus control status (P < 0.05). Among AMD subjects, LLQ composite scores were significantly associated with the computerized LLVAs (β = 0.622 and 0.441) and LLDs (β = −0.795 and −0.477) at both the 1.3 and 0.5 cd/m2 luminance levels, respectively, and these associations remained significant after adjusting for AMD severity (P < 0.05). Conclusions Among subjects with early and intermediate AMD, LLQ scores were significantly associated with computerized LLVA and LLD. LLQ is a useful patient-centered functional measure of visual impairment in early and intermediate AMD.
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Affiliation(s)
- Atalie C Thompson
- Duke University, Department of Ophthalmology, Durham, North Carolina, United States
| | - Ulrich F O Luhmann
- Roche Pharmaceutical Research and Early Development, Translational Medicine Ophthalmology, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Sandra S Stinnett
- Duke University, Department of Ophthalmology, Durham, North Carolina, United States
| | - Lejla Vajzovic
- Duke University, Department of Ophthalmology, Durham, North Carolina, United States
| | - Anupama Horne
- Duke University, Department of Ophthalmology, Durham, North Carolina, United States
| | - Cynthia A Toth
- Duke University, Department of Ophthalmology, Durham, North Carolina, United States
| | - Scott W Cousins
- Duke University, Department of Ophthalmology, Durham, North Carolina, United States
| | - Eleonora M Lad
- Duke University, Department of Ophthalmology, Durham, North Carolina, United States
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17
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Tan RS, Guymer RH, Luu CD. Repeatability of Retinal Sensitivity Measurements Using a Medmont Dark-Adapted Chromatic Perimeter in Healthy and Age-Related Macular Degeneration Cases. Transl Vis Sci Technol 2018; 7:3. [PMID: 29736324 PMCID: PMC5931259 DOI: 10.1167/tvst.7.3.3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 03/27/2018] [Indexed: 11/24/2022] Open
Abstract
Purpose To determine the intrasession and intersession test-retest repeatability of retinal sensitivity measurements using a dark-adapted chromatic perimeter (DACP). Methods For intrasession testing, retinal sensitivity within the central 24° for the 505-nm stimulus was measured after 20, 30, and 40 minutes of dark adaptation (DA) and for the 625-nm stimulus was measured after the first and second 505-nm tests. For intersession testing, retinal sensitivity for both stimuli was measured after 30 minutes of DA at baseline and 1 month. The point-wise sensitivity (PWS) difference and coefficient of repeatability (CoR) of each stimulus and group were determined. Results For intrasession testing, 10 age-related macular degeneration (AMD) and eight control subjects were recruited. The overall CoR for the 505-nm stimulus was 8.4 dB for control subjects and 9.1 dB for AMD cases, and for the 625-nm stimulus was 6.7 dB for control subjects and 9.5 dB for AMD cases. For intersession testing, seven AMD cases and 13 control subjects returned an overall CoR for the 505-nm stimulus of 8.2 dB for the control and 11.7 dB for the AMD group. For the 625-nm stimulus the CoR was 6.2 dB for the control group and 8.4 dB for the AMD group. Approximately 80% of all test points had a PWS difference of ±5 dB between the two intrasession or intersession measurements for both stimuli. Conclusions The CoR for the DACP is larger than that reported for scotopic perimeters; however, the majority of test points had a PWS difference of ±5 dB between tests. Translational Relevance The DACP offers an opportunity to measure static and dynamic rod function at multiple locations with an acceptable reproducibility level.
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Affiliation(s)
- Rose S Tan
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia.,Department of Surgery (Ophthalmology), The University of Melbourne, East Melbourne, Victoria, Australia.,Department of Ophthalmology, Trisakti University, Jakarta, Indonesia
| | - Robyn H Guymer
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia.,Department of Surgery (Ophthalmology), The University of Melbourne, East Melbourne, Victoria, Australia
| | - Chi D Luu
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia.,Department of Surgery (Ophthalmology), The University of Melbourne, East Melbourne, Victoria, Australia
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19
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Vottonen P. Anti-vascular endothelial growth factors treatment of wet age-related macular degeneration: from neurophysiology to cost-effectiveness. Acta Ophthalmol 2018; 96 Suppl A109:1-46. [PMID: 29468838 DOI: 10.1111/aos.13706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Pasi Vottonen
- Department of Ophthalmology; Kuopio University Hospital; University of Eastern Finland; Kuopio Finland
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20
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Moran R, Beatty S, Stack J, O’Halloran AM, Feeney J, Akuffo KO, Peto T, Kenny RA, Nolan JM. The Relationship Between Plasma Concentrations of Lutein and Zeaxanthin with Self-Reported and Actual Prevalence of AMD in an Irish Population-Based Sample. Curr Eye Res 2017; 43:383-390. [DOI: 10.1080/02713683.2017.1403633] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Rachel Moran
- Macular Pigment Research Group, Nutrition Research Centre Ireland, School of Health Science, Waterford Institute of Technology, Waterford, Ireland
| | - Stephen Beatty
- Macular Pigment Research Group, Nutrition Research Centre Ireland, School of Health Science, Waterford Institute of Technology, Waterford, Ireland
| | - Jim Stack
- Macular Pigment Research Group, Nutrition Research Centre Ireland, School of Health Science, Waterford Institute of Technology, Waterford, Ireland
| | - Aisling M. O’Halloran
- The Irish Longitudinal Study on Ageing, Department of Medical Gerontology, Trinity College, Dublin, Ireland
| | - Joanne Feeney
- The Irish Longitudinal Study on Ageing, Department of Medical Gerontology, Trinity College, Dublin, Ireland
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University, Belfast, United Kingdom
| | - Kwadwo O. Akuffo
- Macular Pigment Research Group, Nutrition Research Centre Ireland, School of Health Science, Waterford Institute of Technology, Waterford, Ireland
| | - Tunde Peto
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing, Department of Medical Gerontology, Trinity College, Dublin, Ireland
| | - John M. Nolan
- Macular Pigment Research Group, Nutrition Research Centre Ireland, School of Health Science, Waterford Institute of Technology, Waterford, Ireland
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21
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Ly A, Yapp M, Nivison-Smith L, Assaad N, Hennessy M, Kalloniatis M. Developing prognostic biomarkers in intermediate age-related macular degeneration: their clinical use in predicting progression. Clin Exp Optom 2017; 101:172-181. [PMID: 29136680 DOI: 10.1111/cxo.12624] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 08/08/2017] [Accepted: 08/08/2017] [Indexed: 12/27/2022] Open
Abstract
Age-related macular degeneration is a common, complex and blinding eye disease. When early and intermediate levels of severity are detected in one or both eyes, there is a wide-ranging 0.4 to 53 per cent risk of progression to advanced disease in five years. In order to maximise visual outcomes for their patients, practising eye-care professionals must be able to stratify patients according to their risk of progression, intervene (for example by recommending smoking cessation or nutritional supplements and Amsler grid self-monitoring in intermediate disease) and monitor accordingly. With the aid of ocular imaging, a range of under-recognised yet meaningful risk factors have been identified. The purpose of this review is to assist the eye-care practitioner in stratifying the risk of progression in intermediate age-related macular degeneration using the range of established and emerging precursory signs that herald loss of vision.
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Affiliation(s)
- Angelica Ly
- Centre for Eye Health, Sydney, New South Wales, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia
| | - Michael Yapp
- Centre for Eye Health, Sydney, New South Wales, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia
| | - Lisa Nivison-Smith
- Centre for Eye Health, Sydney, New South Wales, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia
| | - Nagi Assaad
- Centre for Eye Health, Sydney, New South Wales, Australia.,Department of Ophthalmology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Michael Hennessy
- Centre for Eye Health, Sydney, New South Wales, Australia.,Department of Ophthalmology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Michael Kalloniatis
- Centre for Eye Health, Sydney, New South Wales, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia
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22
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Decreased Visual Function Scores on a Low Luminance Questionnaire Is Associated with Impaired Dark Adaptation. Ophthalmology 2017; 124:1332-1339. [PMID: 28602520 DOI: 10.1016/j.ophtha.2017.05.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 05/04/2017] [Accepted: 05/08/2017] [Indexed: 12/27/2022] Open
Abstract
PURPOSE We investigate whether responses on a Low Luminance Questionnaire (LLQ) in patients with a range of age-related macular degeneration (AMD) severity are associated with their performance on focal dark adaptation (DA) testing and with choroidal thickness. DESIGN Cross-sectional, single-center, observational study. PARTICIPANTS A total of 113 participants older than 50 years of age with a range of AMD severity. METHODS Participants answered the LLQ on the same day they underwent DA testing using a focal dark adaptometer measuring rod intercept time (RIT). We performed univariable and multivariable analyses of the LLQ scores and age, RIT, AMD severity, subfoveal choroidal thickness [SFCT], phakic status, and best-corrected visual acuity. MAIN OUTCOME MEASURES The primary outcome of this study was the score on the 32-question LLQ. Each item in the LLQ is designated to 1 of 6 subscales describing functional problems in low luminance: driving, emotional distress, mobility, extreme lighting, peripheral vision, and general dim lighting. Scores were computed for each subscale, in addition to a weighted total mean score. RESULTS Responses from 113 participants (mean age, 76.2±9.3 years; 58.4% were female) and 113 study eyes were analyzed. Univariable analysis demonstrated that lower scores on all LLQ subscales were correlated with prolonged DA testing (longer RIT) and decreased choroidal thickness. All associations were statistically significant except for the association of choroidal thickness and "peripheral vision." The strongest association was the LLQ subscale of driving with RIT (r =-0.97, P < 0.001). Multivariable analysis for each of the LLQ subscale outcomes, adjusted for age, included RIT, with total LLQ score, "driving," "extreme lighting," and "mobility" also including choroidal thickness. In all multivariable analyses, RIT had a stronger association than choroidal thickness. CONCLUSIONS This cross-sectional analysis demonstrates associations of patient-reported functional deficits, as assessed on the LLQ, with both reduced DA and reduced choroidal thickness, in a population of older adults with varying degrees of AMD severity and good visual acuity in at least 1 eye. These analyses suggest that local functional measurements of DA testing (RIT) and choroidal thickness are associated with patient-reported functional deficits.
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The use of microperimetry in assessing visual function in age-related macular degeneration. Surv Ophthalmol 2017; 63:40-55. [PMID: 28579549 DOI: 10.1016/j.survophthal.2017.05.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 05/22/2017] [Accepted: 05/25/2017] [Indexed: 11/23/2022]
Abstract
Microperimetry is a novel technique for assessing visual function that appears particularly suitable for age-related macular degeneration (AMD). Compared with standard automated perimetry, microperimetry offers several unique features. It simultaneously images the fundus, incorporates an eye-tracking system to correct the stimulus location for fixation loss, and identifies any preferred retinal loci. We identified 52 articles that met the inclusion criteria for a systematic review of microperimetry in the assessment of visual function in AMD. We discuss microperimetry and AMD in relation to disease severity, structural imaging outcomes, other measures of visual function, and evaluation of the efficacy of surgical and/or medical therapies in clinical trials. The evidence for the use of microperimetry in the functional assessment of AMD is encouraging. Disruptions of the ellipsoid zone band and retinal pigment epithelium are clearly associated with reduced differential light sensitivity despite the maintenance of good visual acuity. Reduced differential light sensitivity is also associated with outer segment thinning and retinal pigment epithelium thickening in early AMD and with both a thickening and a thinning of the whole retina in choroidal neovascularization. Microperimetry, however, lacks the robust diffuse and focal loss age-corrected probability analyses associated with standard automated perimetry, and the technique is currently limited by this omission.
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24
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Aguilar C, Castet E. Evaluation of a gaze-controlled vision enhancement system for reading in visually impaired people. PLoS One 2017; 12:e0174910. [PMID: 28380004 PMCID: PMC5381883 DOI: 10.1371/journal.pone.0174910] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 03/17/2017] [Indexed: 11/23/2022] Open
Abstract
People with low vision, especially those with Central Field Loss (CFL), need magnification to read. The flexibility of Electronic Vision Enhancement Systems (EVES) offers several ways of magnifying text. Due to the restricted field of view of EVES, the need for magnification is conflicting with the need to navigate through text (panning). We have developed and implemented a real-time gaze-controlled system whose goal is to optimize the possibility of magnifying a portion of text while maintaining global viewing of the other portions of the text (condition 1). Two other conditions were implemented that mimicked commercially available advanced systems known as CCTV (closed-circuit television systems)—conditions 2 and 3. In these two conditions, magnification was uniformly applied to the whole text without any possibility to specifically select a region of interest. The three conditions were implemented on the same computer to remove differences that might have been induced by dissimilar equipment. A gaze-contingent artificial 10° scotoma (a mask continuously displayed in real time on the screen at the gaze location) was used in the three conditions in order to simulate macular degeneration. Ten healthy subjects with a gaze-contingent scotoma read aloud sentences from a French newspaper in nine experimental one-hour sessions. Reading speed was measured and constituted the main dependent variable to compare the three conditions. All subjects were able to use condition 1 and they found it slightly more comfortable to use than condition 2 (and similar to condition 3). Importantly, reading speed results did not show any significant difference between the three systems. In addition, learning curves were similar in the three conditions. This proof of concept study suggests that the principles underlying the gaze-controlled enhanced system might be further developed and fruitfully incorporated in different kinds of EVES for low vision reading.
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Affiliation(s)
| | - Eric Castet
- LPC, Aix Marseille Univ, CNRS, Marseille, France
- * E-mail:
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Taylor DJ, Hobby AE, Binns AM, Crabb DP. How does age-related macular degeneration affect real-world visual ability and quality of life? A systematic review. BMJ Open 2016; 6:e011504. [PMID: 27913556 PMCID: PMC5168634 DOI: 10.1136/bmjopen-2016-011504] [Citation(s) in RCA: 137] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 09/21/2016] [Accepted: 11/04/2016] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To review systematically the evidence of age-related macular degeneration (AMD) affecting real-world visual ability and quality of life (QoL). To explore trends in specific topics within this body of the literature. DESIGN Systematic review. METHODS A systematic literature search was carried out using MEDLINE, EMBASE, CINAHL, PsycINFO, PsychARTICLES and Health and Psychosocial Instruments for articles published up to January 2015 for studies including people diagnosed with AMD, assessing real-world visual ability or QoL as an outcome. Two researchers screened studies for eligibility. Details of eligible studies including study design, characteristics of study population and outcomes measured were recorded in a data extraction table. All included studies underwent quality appraisal using the Mixed Methods Appraisal Tool 2011 Version (MMAT). RESULTS From 5284 studies, 123 were eligible for inclusion. A range of approaches were identified, including performance-based methods, quantitative and qualitative patient-reported outcome measures (PROMs). AMD negatively affects tasks including mobility, face recognition, perception of scenes, computer use, meal preparation, shopping, cleaning, watching TV, reading, driving and, in some cases, self-care. There is evidence for higher rates of depression among people with AMD than among community dwelling elderly. A number of adaptation strategies have been associated with AMD of varying duration. Much of the research fails to report the type of AMD studied (59% of included studies) or the duration of disease in participants (74%). Of those that do report type studied, the breakdown is as follows: wet AMD 20%, dry AMD 4% and both types 17%. CONCLUSIONS There are many publications highlighting the negative effects of AMD in various domains of life. Future research should focus on delivering some of this research knowledge into patient management and clinical trials and differentiating between the types of AMD.
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Affiliation(s)
- Deanna J Taylor
- Division of Optometry and Visual Science, School of Health Sciences, City, University of London, London, UK
| | - Angharad E Hobby
- Division of Optometry and Visual Science, School of Health Sciences, City, University of London, London, UK
| | - Alison M Binns
- Division of Optometry and Visual Science, School of Health Sciences, City, University of London, London, UK
| | - David P Crabb
- Division of Optometry and Visual Science, School of Health Sciences, City, University of London, London, UK
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Maynard ML, Zele AJ, Feigl B. Mesopic Pelli-Robson contrast sensitivity and MP-1 microperimetry in healthy ageing and age-related macular degeneration. Acta Ophthalmol 2016; 94:e772-e778. [PMID: 27225020 DOI: 10.1111/aos.13112] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 04/04/2016] [Indexed: 01/31/2023]
Abstract
PURPOSE To determine whether decreasing illumination of the Pelli-Robson contrast sensitivity (CS) chart and MP-1 microperimeter to low mesopic conditions is more sensitive to vision changes occurring with healthy ageing and in early and intermediate age-related macular degeneration (AMD) and whether these mesopic tests can differentiate visual function between healthy older participants with and without AMD risk genotypes. METHODS Retinal sensitivity was measured in 98 healthy participants (19-85 years) and 21 AMD (AREDS Grade 2/3) patients (73.9 ± 6.5 years) using the Pelli-Robson CS chart and MP-1 microperimeter under low mesopic and standard illumination. The effect of ageing and AMD on retinal sensitivity was estimated using regression analysis. Healthy older participants (>50 years; n = 24) were genotyped for AMD risk genes CFH and/or ARMS2 and retinal sensitivity was compared between genotypes. RESULTS With healthy ageing, photopic and mesopic Pelli-Robson CS showed a similar decline (-0.004 log CS/year). In AMD, photopic CS showed a similar decline to healthy ageing (-0.004 log CS/year) while mesopic CS was significantly reduced (-0.007 log CS/year). Both standard and low mesopic microperimetry showed a significant decline (-0.51 and -0.73% contrast/year) with healthy ageing and greater decline (-0.73 and -0.99% contrast/year) with AMD onset. Pelli-Robson CS and microperimetry sensitivity did not differ between AMD risk genotypes in healthy participants. CONCLUSIONS Mesopic Pelli-Robson CS detects functional deficits before photopic CS in early and intermediate AMD that can be differentiated from ageing. This test can be easily administered in clinical practice and may provide a means for early detection of retinal dysfunction.
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Affiliation(s)
- Michelle L. Maynard
- Medical Retina and Visual Science Laboratories Institute of Health and Biomedical Innovation Queensland University of Technology (QUT) Brisbane QLD Australia
- School of Biomedical Sciences Queensland University of Technology (QUT) Brisbane QLD Australia
| | - Andrew J. Zele
- Medical Retina and Visual Science Laboratories Institute of Health and Biomedical Innovation Queensland University of Technology (QUT) Brisbane QLD Australia
- School of Optometry and Vision Science Queensland University of Technology (QUT) Brisbane QLD Australia
| | - Beatrix Feigl
- Medical Retina and Visual Science Laboratories Institute of Health and Biomedical Innovation Queensland University of Technology (QUT) Brisbane QLD Australia
- School of Biomedical Sciences Queensland University of Technology (QUT) Brisbane QLD Australia
- Queensland Eye Institute South Brisbane QLD Australia
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Ku JY, Milling AF, Pitrelli Vazquez N, Knox PC. Performance, usability and comparison of two versions of a new macular vision test: the handheld Radial Shape Discrimination test. PeerJ 2016; 4:e2650. [PMID: 27833815 PMCID: PMC5101616 DOI: 10.7717/peerj.2650] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 10/03/2016] [Indexed: 01/27/2023] Open
Abstract
Background Central vision, critical for everyday tasks such as reading and driving, is impacted by age-related changes in the eye and by diseases such as age-related macular degeneration. The detection of changes in macular function is therefore important. The Radial Shape Discrimination (RSD) test measures the threshold at which distortions in a radial frequency pattern can be detected and there is evidence that it is more sensitive to macular pathology than visual acuity (VA). It also provides a more quantitative measure of macular function than the commonly available Amsler grid. Recently, handheld versions of the test (hRSD) in which stimuli are presented on mobile devices (e.g., Apple iPod Touch, iPhone) have been developed. We investigated the characteristics of the hRSD test in healthy participants. Methods Data were collected using both three-alternative forced choice (3AFC) and 4AFC versions of the hRSD test, presented on an Apple iPod Touch. For the 3AFC version, data from a single test session were available for 186 (72 male; mean ± SD age 42 ± 17y; range 16–90y) healthy participants. Test-retest data were available for subgroups of participants (intra-session: N = 74; tests approximately 2 months apart: N = 30; tests 39 months apart: N = 15). The 3AFC and 4AFC versions were directly compared in 106 participants who also completed a usability questionnaire. Distance and near VA and Pelli Robson Contrast Sensitivity (CS) data were collected and undilated fundoscopy performed on the majority of participants. Results Mean (±SD) 3AFC hRSD threshold was −0.77 ± 0.14 logMAR, and was statistically significantly correlated with age (Pearson r = 0.35; p < 0.001). The linear regression of hRSD threshold on age had a slope of +0.0026 compared to +0.0051 for near VA (which also correlated with age: r = 0.51; p < 0.001). There were no statistically significant differences in hRSD thresholds for any of the test-retest subgroups. We also observed no statistically significant difference between 3AFC (−0.82 ± 0.11 logMAR) and 4AFC (−0.80 ± 0.12 logMAR) hRSD thresholds (t = 1.85, p = 0.067) and participants reported excellent test usability with no strong preference expressed between the 3AFC and 4AFC versions of the test. Discussion The 3AFC hRSD thresholds we report are consistent with a number of previous studies, as is its greater stability in ageing compared to VA. We have also shown that in the absence of pathology, thresholds are stable over short and long timescales. The 4AFC thresholds we have reported provide a baseline for future investigations, and we have confirmed that 3AFC and 4AFC thresholds are similar, providing a basis of comparisons between studies using the different versions. As the hRSD test is easy to use and relatively inexpensive, clinical studies are now required to establish its ability to detect and monitor macular pathologies.
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Affiliation(s)
- Jae Y Ku
- Eye & Vision Science, University of Liverpool , Liverpool , United Kingdom
| | - Ashli F Milling
- Directorate of Orthoptics and Vision Science, University of Liverpool , Liverpool , United Kingdom
| | | | - Paul C Knox
- Eye & Vision Science, University of Liverpool , Liverpool , United Kingdom
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Baraas RC, Gjelle JVB, Finstad EB, Jacobsen SB, Gilson SJ. The relationship between perifoveal achromatic, L- and M-cone acuity and retinal structure as assessed with multimodal high resolution imaging. Vision Res 2016; 132:45-52. [PMID: 27353223 DOI: 10.1016/j.visres.2016.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 06/14/2016] [Accepted: 06/16/2016] [Indexed: 11/27/2022]
Abstract
The relationships between perifoveal measures of achromatic-, L- and M-cone acuity and retinal structure were investigated in healthy young males. Thirty-two males, aged 20-39years, with normal foveal logMAR letter acuity and no observed ocular abnormalities participated in the study. Achromatic and isolated L- and M-cone spatial acuity was measured in the dominant eye with a Sloan E letter of 90% achromatic decrement contrast or 23% increment cone contrast, respectively. Separately, the central part of the same eye was imaged with high-resolution spectral-domain optical coherence tomography (SD-OCT) and adaptive optics ophthalmoscopy (AOO). Thickness measures and cone density in the fovea and parafoveal region were not correlated with perifoveal structural measures. A significant correlation was observed between thicker retinal pigment epithelium (RPE) complex, higher cone density and better L-cone logMAR at 5deg eccentricity, but not for achromatic or M-cone logMAR. The results imply that single letter perifoveal L-cone acuity, rather than achromatic acuity, may provide a useful measure for assessing the structure-function relationship and detecting early changes in the perifoveal cone mosaic.
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Affiliation(s)
- Rigmor C Baraas
- National Centre for Optics, Vision and Eye Care, Department of Optometry and Visual Science, Faculty of Health Sciences, University College of Southeast Norway, Kongsberg, Norway.
| | - Jon V B Gjelle
- National Centre for Optics, Vision and Eye Care, Department of Optometry and Visual Science, Faculty of Health Sciences, University College of Southeast Norway, Kongsberg, Norway
| | - Elisabeth Bratlie Finstad
- National Centre for Optics, Vision and Eye Care, Department of Optometry and Visual Science, Faculty of Health Sciences, University College of Southeast Norway, Kongsberg, Norway
| | - Siri Bjørnetun Jacobsen
- National Centre for Optics, Vision and Eye Care, Department of Optometry and Visual Science, Faculty of Health Sciences, University College of Southeast Norway, Kongsberg, Norway
| | - Stuart J Gilson
- National Centre for Optics, Vision and Eye Care, Department of Optometry and Visual Science, Faculty of Health Sciences, University College of Southeast Norway, Kongsberg, Norway
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Chandramohan A, Stinnett SS, Petrowski JT, Schuman SG, Toth CA, Cousins SW, Lad EM. VISUAL FUNCTION MEASURES IN EARLY AND INTERMEDIATE AGE-RELATED MACULAR DEGENERATION. Retina 2016; 36:1021-31. [PMID: 26925551 PMCID: PMC4844847 DOI: 10.1097/iae.0000000000001002] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The objectives of this study were to evaluate 1) the feasibility of performing computerized tests of low luminance visual acuity (LLVA), cone-specific contrast (Cone Contrast Test [CCT]), contrast sensitivity, and microperimetry and 2) the test-retest repeatability of these outcomes in dry age-related macular degeneration (AMD). METHODS This prospective study enrolled 30 subjects at a single site (8 controls, 8 early AMD, and 12 intermediate AMD). Subjects underwent LLVA, contrast sensitivity, CCT, and microperimetry with eye tracking. Low luminance deficit was defined as best-corrected visual acuity minus LLVA in EDTRS letters. Follow-up testing was administered at approximately 1 month. RESULTS There was high test-retest repeatability at one month for all visual function metrics (intraclass correlations >0.7) except log contrast sensitivity (intraclass correlations 0.6). Compared with controls, patients with intermediate AMD showed significant deficits on best-corrected visual acuity, LLVA, low luminance deficit, percent-reduced threshold on microperimetry, and red CCT (P < 0.05), but not on contrast sensitivity, green and blue CCT. CONCLUSION This pilot study supports the feasibility and reliability of using LLVA, microperimetry, and CCT in early dry AMD. Our data suggest these measures can be used as alternative future clinical trial endpoints. A larger, prospective natural history study of alternative visual function measures in dry AMD is warranted.
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Affiliation(s)
- Arthika Chandramohan
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
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Wong CW, Yanagi Y, Lee WK, Ogura Y, Yeo I, Wong TY, Cheung CMG. Age-related macular degeneration and polypoidal choroidal vasculopathy in Asians. Prog Retin Eye Res 2016; 53:107-139. [PMID: 27094371 DOI: 10.1016/j.preteyeres.2016.04.002] [Citation(s) in RCA: 245] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 03/31/2016] [Accepted: 04/11/2016] [Indexed: 12/12/2022]
Abstract
Age-related macular degeneration (AMD) is the leading cause of irreversible blindness in elderly people globally. It is estimated that there will be more Asians with AMD than the rest of the world combined by 2050. In Asian populations, polypoidal choroidal vasculopathy (PCV) is a common subtype of exudative AMD, while choroidal neovascularization secondary to AMD (CNV-AMD) is the typical subtype in Western populations. The two subtypes share many common clinical features and risk factors, but also have different epidemiological and clinical characteristics, natural history and treatment outcomes that point to distinct pathophysiological processes. Recent research in the fields of genetics, proteomics and imaging has provided further clarification of differences between PCV and CNV-AMD. Importantly, these differences have manifested as disparity in response to intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) treatment between PCV and CNV-AMD, emphasizing the need for accurate diagnosis of PCV and in distinguishing PCV from CNV-AMD, particularly in Asian patients. Current clinical trials of intravitreal anti-VEGF therapy and photodynamic therapy will provide clearer perspectives of evidence-based management of PCV and may lead to paradigm shifts in therapeutic strategies away from those currently employed in the treatment of CNV-AMD. Further research is needed to clarify the relative contribution of specific pathways in inflammation, complement activation, extracellular matrix dysregulation, lipid metabolism and angiogenesis to the pathogenesis of PCV. Findings from this research, together with improved diagnostic technology and new therapeutics, will facilitate more optimal management of Asian AMD.
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Affiliation(s)
- Chee Wai Wong
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore
| | - Yasuo Yanagi
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore
| | - Won-Ki Lee
- Department of Ophthalmology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Yuichiro Ogura
- Department of Ophthalmology, Nagoya City University, Nagoya, Japan
| | - Ian Yeo
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore
| | - Tien Yin Wong
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore.
| | - Chui Ming Gemmy Cheung
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore
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Shah N, Dakin SC, Dobinson S, Tufail A, Egan CA, Anderson RS. Visual acuity loss in patients with age-related macular degeneration measured using a novel high-pass letter chart. Br J Ophthalmol 2016; 100:1346-52. [PMID: 26846435 DOI: 10.1136/bjophthalmol-2015-307375] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 12/21/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS Conventional Logarithm of the Minimum Angle of Resolution (logMAR) acuity is the current gold standard for assessing visual function in age-related macular degeneration (AMD). However, visual acuity (VA) often remains 'normal' when measured with these charts, even with advanced retinal changes. We wished to investigate how VA measurements with the Moorfields Acuity Chart (MAC), which employs high-pass filtered letters, compares to conventional letter charts in subjects with AMD. METHODS Monocular best-corrected VA measurements and test-retest variability (TRV) were compared for conventional and MAC charts in 38 normal observers (mean age 52.1 years) and 80 patients (mean age 80.6 years) with varying degrees of acuity loss owing to AMD. Methods of Bland-Altman and ordinary least-squares regression were employed for data analysis. RESULTS A proportional bias was confirmed between conventional and MAC measurements (r(2)=0.133, p=0.001) such that MAC acuity was -0.45 logMAR 'worse' at the 0.00 logMAR acuity level, but only -0.26 logMAR 'worse' at the 1.00 logMAR level. The mean bias was much smaller in the normal subject group (-0.16 logMAR). Similar TRV (ranging from ±0.09 to ±0.12 logMAR) was found for both charts in both subject groups. CONCLUSIONS VA measurements with the MAC chart appear to be more sensitive to functional loss in AMD compared with conventional letter charts, with similar TRV. Simulations indicate this may be because the high-pass filtered letters are more vulnerable to undersampling as a result of retinal cell loss in the disease process.
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Affiliation(s)
- Nilpa Shah
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Steven C Dakin
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK Department of Optometry & Vision Science, University of Auckland, Auckland, New Zealand
| | - Sarah Dobinson
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Adnan Tufail
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Catherine A Egan
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Roger S Anderson
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK Vision Science Research Group, School of Biomedical Sciences, University of Ulster at Coleraine, N Ireland, UK
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Dow CT, Harley CB. Evaluation of an oral telomerase activator for early age-related macular degeneration - a pilot study. Clin Ophthalmol 2016; 10:243-9. [PMID: 26869760 PMCID: PMC4734847 DOI: 10.2147/opth.s100042] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Purpose Telomere attrition and corresponding cellular senescence of the retinal pigment epithelium contribute to the changes of age-related macular degeneration. Activation of the enzyme telomerase can add telomeric DNA to retinal pigment epithelium chromosomal ends and has been proposed as a treatment for age-related macular degeneration. We report the use of a small molecule, oral telomerase activator (TA)-65 in early macular degeneration. This study, focusing on early macular degeneration, provides a model for the use of TAs in age-related disease. Method Thirty-eight (38) patients were randomly assigned to a 1-year, double-blinded, placebo-controlled interventional study with arms for oral TA-65 or placebo. Macular functions via micro-perimetry were the primary measured outcomes. Results The macular function in the arm receiving the TA-65 showed significant improvement relative to the placebo control. The improvement was manifest at 6 months and was maintained at 1 year: macular threshold sensitivity (measured as average dB [logarithmic decibel scale of light attenuation]) improved 0.97 dB compared to placebo (P-value 0.02) and percent reduced thresholds lessened 8.2% compared to the placebo arm (P-value 0.04). Conclusion The oral TA significantly improved the macular function of treatment subjects compared to controls. Although this study was a pilot and a larger study is being planned, it is noteworthy in that it is, to our knowledge, the first randomized placebo-controlled study of a TA supplement.
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Affiliation(s)
- Coad Thomas Dow
- McPherson Eye Research Institute, University of Wisconsin-Madison, Madison, WI, USA; Chippewa Valley Eye Clinic, Eau Claire, Wisconsin, WI, USA
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Wu Z, Guymer RH, Finger RP. Low luminance deficit and night vision symptoms in intermediate age-related macular degeneration. Br J Ophthalmol 2015; 100:395-8. [PMID: 26250520 DOI: 10.1136/bjophthalmol-2015-306621] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 07/17/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS To determine the relationship between self-reported visual difficulties under low luminance conditions (night vision symptoms) and visual function measures in intermediate age-related macular degeneration (AMD). METHODS One hundred participants with bilateral intermediate AMD were examined in a prospective cross-sectional study with visual function measures including best-corrected visual acuity (BCVA), low luminance visual acuity (LLVA) and microperimetry in both eyes. A 10-item Night Vision Questionnaire (NVQ-10) was then used to determine the degree of self-reported night vision symptoms experienced by each participant. For analyses, low luminance deficit (LLD) was derived as the difference between LLVA and BCVA, and microperimetric mean sensitivity (MS; all points) and central sensitivity (CS; points within the central 1°) were determined. Rasch analysis was used to estimate the person measure of night vision symptoms, and its relationship with visual function parameters was determined. RESULTS NVQ-10 person measures were significantly associated with LLD (β coefficient=0.067, 95% CI 0.005 to 0.130, p=0.034), but not BCVA, LLVA, microperimetric MS or CS (p≥0.090). Participants with the highest degree of self-reported night vision symptoms (fourth quartile of person measure) had significantly worse LLD than those with the least difficulty (first quartile of person measure; p=0.019). CONCLUSIONS In individuals with bilateral intermediate AMD, LLD was associated with self-reported night vision symptoms, suggesting that this measure may better capture the visual difficulties experienced by these individuals under low luminance conditions than the conventional measure of photopic visual acuity.
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Affiliation(s)
- Zhichao Wu
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Victoria, Australia
| | - Robyn H Guymer
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Victoria, Australia
| | - Robert P Finger
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Victoria, Australia
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Winther C, Frisén L. New rarebit vision test captures macular deficits hidden to acuity tests. Acta Ophthalmol 2015; 93:481-485. [PMID: 25604486 DOI: 10.1111/aos.12659] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 12/05/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE Evaluation of a new personal-computer-based vision test aimed for rapid and accurate assessment of macular conditions such as age-related macular degeneration (AMD). METHODS The new test depends on segmented digits defined by rarebits, that is, receptive field-size bright dots briefly presented against a dark background. Digit size was fixed at 40 × 50 min of arc. Digit positions were varied at random within a 4.6 × 3.5-degree test field. There were no fixation demands. The number of rarebits per digit segment could be varied between 3 (the minimum needed for veridical perception) and 128, in 11 preset steps. The test task was to find the smallest rarebit number required to recognize the test digits. Thirty-seven patients with various stages of AMD and 25 control subjects participated in the evaluation, which also included a standard acuity test. RESULTS Analysis of receiver operating characteristics indicated significantly better discrimination by the rarebit test. Rarebit numbers >16 appeared to reliably indicate the presence of oedema. CONCLUSION The rarebit test appeared well suited for fine grading of vision in AMD. The simple set-up and the lack of fixation demands made for practicable examinations of short durations. The test is available for free on the Internet.
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Affiliation(s)
- Christina Winther
- Department of Clinical Neuroscience and Rehabilitation; Institute of Neuroscience and Physiology; The Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Lars Frisén
- Department of Clinical Neuroscience and Rehabilitation; Institute of Neuroscience and Physiology; The Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
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Wu Z, Guymer RH, Jung CJ, Goh JK, Ayton LN, Luu CD, Lawson DJ, Turpin A, McKendrick AM. Measurement of Retinal Sensitivity on Tablet Devices in Age-Related Macular Degeneration. Transl Vis Sci Technol 2015; 4:13. [PMID: 26175959 DOI: 10.1167/tvst.4.3.13] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 03/16/2015] [Indexed: 11/24/2022] Open
Abstract
PURPOSE We compared measurements of central retinal sensitivity on a portable, low-cost tablet device to the established method of microperimetry in age-related macular degeneration (AMD). METHODS A customized test designed to measure central retinal sensitivity (within the central 1° radius) on a tablet device was developed using an open-source platform called PsyPad. A total of 30 participants with AMD were included in this study, and all participants performed a practice test on PsyPad, followed by four tests of one eye and one test of the other eye. Participants then underwent standardized microperimetry examinations in both eyes. RESULTS The average test duration on PsyPad was 53.9 ± 7.5 seconds, and no significant learning effect was observed over the examinations performed (P = 1.000). The coefficient of repeatability of central retinal sensitivity between the first two examinations on PsyPad was ±1.76 dB. The mean central retinal sensitivity was not significantly different between PsyPad (25.7 ± 0.4 dB) and microperimetry (26.1 ± 0.4 dB, P = 0.094), and the 95% limits of agreement between the two measures were between -4.12 and 4.92 dB. CONCLUSIONS The measurements of central retinal sensitivity can be performed effectively using a tablet device, displaying reasonably good agreement with those obtained using the established method of microperimetry. TRANSLATIONAL RELEVANCE These findings highlight the potential of tablet devices as low-cost and portable tools for developing and performing visual function measures that can be easily and widely implemented.
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Affiliation(s)
- Zhichao Wu
- Centre for Eye Research Australia University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Robyn H Guymer
- Centre for Eye Research Australia University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Chang J Jung
- Centre for Eye Research Australia University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Jonathan K Goh
- Centre for Eye Research Australia University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Lauren N Ayton
- Centre for Eye Research Australia University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Chi D Luu
- Centre for Eye Research Australia University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - David J Lawson
- Department of Computing and Information Systems, University of Melbourne, Melbourne, Australia
| | - Andrew Turpin
- Department of Computing and Information Systems, University of Melbourne, Melbourne, Australia
| | - Allison M McKendrick
- Department of Optometry and Vision Sciences, University of Melbourne, Melbourne, Australia
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Self-Testing of Vision in Age-Related Macula Degeneration: A Longitudinal Pilot Study Using a Smartphone-Based Rarebit Test. J Ophthalmol 2015; 2015:285463. [PMID: 26124958 PMCID: PMC4466471 DOI: 10.1155/2015/285463] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 05/08/2015] [Accepted: 05/18/2015] [Indexed: 11/17/2022] Open
Abstract
Purpose. There is a need for efficient self-tests of vision in patients with neovascular age-related macula degeneration. A new tablet/smartphone application aiming to meet this need is described and its performance is assessed in a longitudinal pilot study. Materials and Methods. The new MultiBit Test (MBT) employs segmented digits defined by rarebits, that is, receptive field-size bright dots briefly presented against a dark background. The number of rarebits per digit segment was varied in a cyclic fashion, in preset steps. There were no fixation demands. Twenty-eight patients with neovascular AMD of varying severity were monitored for an average of 30 weeks. Test scores were evaluated on an individual basis, by contrasting observed trends with the clinical status recorded at independently scheduled clinical examinations. Results. Serial plots of MBT results revealed gradual improvement after successful antineovascular treatment. Recurrences were signalled by gradual deteriorations of results. Test results remained stable during clinically stable time intervals. MBT results agreed well with clinical assessments whereas an acuity test performed at chance level. The MBT was well accepted by all subjects. Conclusions. The MBT appears to have a good potential for effective self-testing of vision in AMD and merits large-scale studies. Exploration of MBT performance with other forms of macula conditions may be worthwhile.
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Thibaut M, Tran THC, Delerue C, Boucart M. Misidentifying a tennis racket as keys: object identification in people with age-related macular degeneration. Ophthalmic Physiol Opt 2015; 35:336-44. [PMID: 25847590 DOI: 10.1111/opo.12201] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 01/05/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE Previous studies showed that people with age-related macular degeneration (AMD) can categorise a pre-defined target object or scene with high accuracy (above 80%). In these studies participants were asked to detect the target (e.g. an animal) in serial visual presentation. People with AMD must rely on peripheral vision which is more adapted to the low resolution required for detection than for the higher resolution required to identify a specific exemplar. We investigated the ability of people with central vision loss to identify photographs of objects and scenes. METHODS Photographs of isolated objects, natural scenes and objects in scenes were centrally displayed for 2 s each. Participants were asked to name the stimuli. We measured accuracy and naming times in 20 patients with AMD, 15 age-matched and 12 young controls. RESULTS Accuracy was lower (by about 30%) and naming times were longer (by about 300 ms) in people with AMD than in age-matched controls in the three categories of images. Correct identification occurred in 62-66% of the stimuli for patients. More than 20% of the misidentifications resulted from a structural and/or semantic similarity between the object and the name (e.g. spectacles for dog plates or dolphin for shark). Accuracy and naming times did not differ significantly between young and older normally sighted participants indicating that the deficits resulted from pathology rather than to normal ageing. CONCLUSIONS These results show that, in contrast to performance for categorisation of a single pre-defined target, people with central vision loss are impaired at identifying various objects and scenes. The decrease in accuracy and the increase in response times in patients with AMD indicate that peripheral vision might be sufficient for object and scene categorisation but not for precise scene or object identification.
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Affiliation(s)
- Miguel Thibaut
- Laboratoire Neurosciences Fonctionnelles et Pathologies, Le Centre National de la Recherche Scientifique, Université Lille Nord de France, Lille, France
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Wu Z, Luu CD, Ayton LN, Goh JK, Lucci LM, Hubbard WC, Hageman JL, Hageman GS, Guymer RH. Fundus autofluorescence characteristics of nascent geographic atrophy in age-related macular degeneration. Invest Ophthalmol Vis Sci 2015; 56:1546-52. [PMID: 25678689 DOI: 10.1167/iovs.14-16211] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
PURPOSE We examined the fundus autofluorescence (FAF) characteristics of nascent geographic atrophy (nGA), pathological features preceding the development of drusen-associated atrophy in eyes with age-related macular degeneration (AMD) that can be visualized using high-resolution optical coherence tomography (OCT). METHODS Spectral-domain OCT (SD-OCT) and FAF imaging were performed longitudinally in 221 eyes with intermediate AMD (having at least drusen >125 μm), and seven areas that developed drusen-associated atrophy in five eyes were examined and categorized with respect to FAF characteristics. These categories then were used to characterize 49 areas of nGA or drusen-associated atrophy on SD-OCT identified in a cross-sectional study with 230 participants with bilateral intermediate AMD. RESULTS Sequential imaging revealed that FAF characteristics in the atrophic areas could be grouped into three categories: predominantly hyperautofluorescent (hyperAF), presence of both hyper- and hypoautofluorescence (mixed AF), or predominantly hypoautofluorescent (hypoAF). In the cross-sectional study, the FAF characteristics were significantly dependent on the type of atrophic area (P = 0.002), where areas of nGA appeared most commonly as being mixed AF (63%), while areas of drusen-associated atrophy most commonly as hypoAF (86%). CONCLUSIONS Fundus autofluorescence imaging revealed that areas of nGA were most commonly characterized by both hyper- and hypoautofluorescent changes, which differs from areas of drusen-associated atrophy that most often appeared hypoautofluorescent. These findings provide important insights into the FAF characteristics of areas undergoing atrophic changes in eyes still considered to be in the early stages of AMD by current methods, and thus assist in the characterization of disease severity in these early stages.
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Affiliation(s)
- Zhichao Wu
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Victoria, Australia
| | - Chi D Luu
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Victoria, Australia
| | - Lauren N Ayton
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Victoria, Australia
| | - Jonathan K Goh
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Victoria, Australia
| | - Lucia M Lucci
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, Center for Translational Medicine, University of Utah, Salt Lake City, Utah, United States
| | - William C Hubbard
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, Center for Translational Medicine, University of Utah, Salt Lake City, Utah, United States
| | - Jill L Hageman
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, Center for Translational Medicine, University of Utah, Salt Lake City, Utah, United States
| | - Gregory S Hageman
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, Center for Translational Medicine, University of Utah, Salt Lake City, Utah, United States
| | - Robyn H Guymer
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Victoria, Australia
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Measuring Visual Function Using the MultiQuity System: Comparison with an Established Device. J Ophthalmol 2015; 2014:180317. [PMID: 25580278 PMCID: PMC4280651 DOI: 10.1155/2014/180317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 11/15/2014] [Indexed: 11/26/2022] Open
Abstract
Purpose. To compare measures of visual acuity (VA) and contrast sensitivity (CS) from the Thompson Xpert 2000 and MultiQuity (MiQ) devices. Methods. Corrected distance VA (CDVA) and CS were measured in the right eye of 73 subjects, on an established system (Thompson Xpert) and a novel system (MiQ 720). Regression was used to convert MiQ scores into the Thompson scale. Agreement between the converted MiQ and Thompson scores was investigated using standard agreement indices. Test-retest variability for both devices was also investigated, for a separate sample of 24 subjects. Results. For CDVA, agreement was strong between the MiQ and Thomson devices (accuracy = 0.993, precision = 0.889, CCC = 0.883). For CS, agreement was also strong (accuracy = 0.996, precision = 0.911, CCC = 0.907). Agreement was unaffected by demographic variables or by presence/absence of ocular pathology. Test-retest agreement indices for both devices were excellent: in the range 0.88–0.96 for CDVA and in the range 0.90–0.98 for CS. Conclusion. MiQ measurements exhibit strong agreement with corresponding Thomson measurements, and test-retest results are good for both devices. Agreement between the two devices is unaffected by age or ocular pathology.
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Alexander MS, Lajoie K, Neima DR, Strath RA, Robinovitch SN, Marigold DS. Effect of ambient light and age-related macular degeneration on precision walking. Optom Vis Sci 2014; 91:990-9. [PMID: 24987813 DOI: 10.1097/opx.0000000000000316] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To determine how age-related macular degeneration (AMD) and changes in ambient light affect the control of foot placement while walking. METHODS Ten older adults with AMD and 11 normal-sighted controls performed a precision walking task under normal (∼600 lx), dim (∼0.7 lx), and after a sudden reduction (∼600 to 0.7 lx) of light. The precision walking task involved subjects walking and stepping to the center of a series of irregularly spaced, low-contrast targets. Habitual visual acuity and contrast sensitivity and visual field function were also assessed. RESULTS There were no differences between groups when performing the walking task in normal light (p > 0.05). In reduced lighting, older adults with AMD were less accurate and more variable when stepping across the targets compared to controls (p < 0.05). A sudden reduction of light proved the most challenging for this population. In the AMD group, contrast sensitivity and visual acuity were not significantly correlated with walking performance. Visual field thresholds in the AMD group were only associated with greater foot placement error and variability in the dim light walking condition (r = -0.69 to -0.87, p < 0.05). CONCLUSIONS While walking performance is similar between groups in normal light, poor ambient lighting results in decreased foot placement accuracy in older adults with AMD. Improper foot placement while walking can lead to a fall and possible injury. Thus, to improve the mobility of those with AMD, strategies to enhance the environment in reduced lighting situations are necessary.
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Affiliation(s)
- M Scott Alexander
- *MSc †PhD ‡MD, FRCSC §OD, PhD, FAAO Department of Biomedical Physiology and Kinesiology (MSA, KL, RAS, SNR, DSM), School of Engineering Science (SNR), Simon Fraser University, Burnaby; and Private Practice, New Westminster (DRN), British Columbia, Canada
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Herbik A, Geringswald F, Thieme H, Pollmann S, Hoffmann MB. Prediction of higher visual function in macular degeneration with multifocal electroretinogram and multifocal visual evoked potential. Ophthalmic Physiol Opt 2014; 34:540-51. [PMID: 25160891 DOI: 10.1111/opo.12152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 07/17/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Visual search can be guided by past experience of regularities in our visual environment. This search guidance by contextual memory cues is impaired by foveal vision loss. Here we compared retinal and cortical visually evoked responses in their predictive value for contextual cueing impairment and visual acuity. METHODS Multifocal electroretinograms to flash stimulation (mfERGs; 103 locations; 55.8° diameter) and visual evoked potentials to pattern-reversal stimulation (mfVEPs; 60 locations; 48.6° diameter) were recorded monocularly in participants with age-related macular degeneration (n = 14 and 16, respectively). Response magnitudes were calculated as the respective signal-to-noise ratios for each eccentricity. Visual acuities (logMAR, range: 0.0-1.2) and contextual cueing effects on visual search (reaction time gain, range: -0.14-0.15) were correlated with the signal-to-noise ratios. A step-wise regression analysis was applied separately to the mfERG- and mfVEP-dataset to determine the eccentricity range and the processing stage that is critical for these visual functions. RESULTS Central mfERGs (1.0-3.2°) were the sole predictor of contextual cueing of visual search (p = 0.006), but they were not significant predictors of visual acuity. In contrast, central mfVEPs (1.3-3.2°) were the sole predictor of visual acuity (p < 0.001), but they were not significant predictors of contextual cueing. CONCLUSIONS Contextual cueing is more dependent on parafoveal mfERG magnitude while visual acuity is more dependent on parafoveal mfVEP magnitude. The relation of contextual cueing to parafoveal mfERG magnitudes indicates the predictive value of retinal bipolar cell activity for this advanced level of visual function.
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Affiliation(s)
- Anne Herbik
- Department of Ophthalmology, Otto-von-Guericke University, Magdeburg, Germany
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42
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Visual-Function Tests for Self-monitoring of Age-Related Macular Degeneration. Optom Vis Sci 2014; 91:956-65. [DOI: 10.1097/opx.0000000000000324] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Ramos de Carvalho JE, Willig A, Chung R, Peiretti E, Mura M. Current surgical treatment of age-related macular degeneration. EXPERT REVIEW OF OPHTHALMOLOGY 2014. [DOI: 10.1586/17469899.2014.920692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Detection of early age-related macular degeneration using novel functional parameters of the focal cone electroretinogram. PLoS One 2014; 9:e96742. [PMID: 24796326 PMCID: PMC4010489 DOI: 10.1371/journal.pone.0096742] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 04/10/2014] [Indexed: 11/19/2022] Open
Abstract
The focal cone electroretinogram is a sensitive marker for macular disease, but have we unlocked its full potential? Typically assessment of waveform parameters is subjective and focuses on a small number of locations (e.g. the a-wave). This study evaluated the discriminatory and diagnostic potential of 4 conventional and 15 novel, objectively determined, parameters in patients with early Age-related Macular Degeneration. Focal cone electroretinograms were recorded in 54 participants with early Age-related Macular Degeneration (72.9±8.2 years) and 54 healthy controls (69±7.7 years). Conventional a and b wave amplitudes and implicit times were measured and compared to novel parameters derived from both the 1st and 2nd derivatives and the frequency-domain power spectrum of the electroretinogram.Statistically significant differences between groups were shown for all conventional parameters, the majority of 1st and 2nd derivative parameters and the power spectrum at 25 and 30 Hz. Receiver operating characteristics showed that both conventional and 1st and 2nd derivative implicit times had provided the best diagnostic potential. A regression model showed a small improvement over any individual parameter investigated. The non-conventional parameters enhanced the objective evaluation of the focal electroretinogram, especially when the amplitude was low. Furthermore, the novel parameters described here allow the implicit time of the electroretinogram to be probed at points other than the peaks of the a and b waves. Consequently these novel analysis techniques could prove valuable in future electrophysiological investigation, detection and monitoring of Age-related Macular Degeneration.
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Akuffo KO, Beatty S, Stack J, Dennison J, O’Regan S, Meagher KA, Peto T, Nolan J. Central Retinal Enrichment Supplementation Trials (CREST): design and methodology of the CREST randomized controlled trials. Ophthalmic Epidemiol 2014; 21:111-23. [PMID: 24621122 PMCID: PMC4002658 DOI: 10.3109/09286586.2014.888085] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 07/25/2013] [Accepted: 09/03/2013] [Indexed: 01/25/2023]
Abstract
PURPOSE The Central Retinal Enrichment Supplementation Trials (CREST) aim to investigate the potential impact of macular pigment (MP) enrichment, following supplementation with a formulation containing 10 mg lutein (L), 2 mg zeaxanthin (Z) and 10 mg meso-zeaxanthin (MZ), on visual function in normal subjects (Trial 1) and in subjects with early age-related macular degeneration (AMD; Trial 2). METHODS CREST is a single center, double-blind, randomized clinical trial. Trial 1 (12-month follow-up) subjects are randomly assigned to a formulation containing 10 mg L, 10 mg MZ and 2 mg Z (n = 60) or placebo (n = 60). Trial 2 (24-month follow-up) subjects are randomly assigned to a formulation containing 10 mg L, 10 mg MZ, 2 mg Z plus 500 mg vitamin C, 400 IU vitamin E, 25 mg zinc and 2 mg copper (Intervention A; n = 75) or 10 mg L and 2 mg Z plus 500 mg vitamin C, 400 IU vitamin E, 25 mg zinc and 2 mg copper (Intervention B; n = 75). Contrast sensitivity (CS) at 6 cycles per degree represents the primary outcome measure in each trial. Secondary outcomes include: CS at other spatial frequencies, MP, best-corrected visual acuity, glare disability, photostress recovery, light scatter, cognitive function, foveal architecture, serum carotenoid concentrations, and subjective visual function. For Trial 2, AMD morphology, reading speed and reading acuity are also being recorded. CONCLUSIONS CREST is the first study to investigate the impact of supplementation with all three macular carotenoids in the context of a large, double-blind, randomized clinical trial.
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Affiliation(s)
- Kwadwo Owusu Akuffo
- Macular Pigment Research Group, Department of Chemical and Life Sciences, Waterford Institute of TechnologyWaterfordIreland
| | - Stephen Beatty
- Macular Pigment Research Group, Department of Chemical and Life Sciences, Waterford Institute of TechnologyWaterfordIreland
| | - Jim Stack
- Macular Pigment Research Group, Department of Chemical and Life Sciences, Waterford Institute of TechnologyWaterfordIreland
| | - Jessica Dennison
- Macular Pigment Research Group, Department of Chemical and Life Sciences, Waterford Institute of TechnologyWaterfordIreland
| | - Sarah O’Regan
- Macular Pigment Research Group, Department of Chemical and Life Sciences, Waterford Institute of TechnologyWaterfordIreland
| | - Katherine A. Meagher
- Macular Pigment Research Group, Department of Chemical and Life Sciences, Waterford Institute of TechnologyWaterfordIreland
| | - Tunde Peto
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of OphthalmologyLondonUK
| | - John Nolan
- Macular Pigment Research Group, Department of Chemical and Life Sciences, Waterford Institute of TechnologyWaterfordIreland
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Low-luminance visual acuity and microperimetry in age-related macular degeneration. Ophthalmology 2014; 121:1612-9. [PMID: 24661863 DOI: 10.1016/j.ophtha.2014.02.005] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 02/03/2014] [Accepted: 02/07/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To compare the effectiveness of low-luminance visual acuity (LLVA) and microperimetry as functional measures in early stages of age-related macular degeneration (AMD). DESIGN Prospective cross-sectional study. PARTICIPANTS One hundred seventy-nine participants with a clinical spectrum of non-neovascular AMD and 26 control participants. METHODS Best-corrected visual acuity (BVCA), LLVA, and microperimetric retinal sensitivity were measured on 1 eye of all participants. Low-luminance deficit (LLD) was calculated as the difference between LLVA and BCVA. The functional parameters were compared between 6 clinical severity groups (from controls to non-foveal geographic atrophy [GA]), and the relationships and magnitude of these parameters were determined and compared. MAIN OUTCOME MEASURES Visual acuity parameters (BCVA, LLVA, and LLD) and central retinal sensitivity. RESULTS Best-corrected visual acuity, LLVA, and central retinal sensitivity were reduced significantly for all AMD clinical severity groups when compared with control participants (P ≤ 0.002), except for those with drusen between 63 and 125 μm (P ≥ 0.107). However, LLD was not significantly different from control participants in all groups (P ≥ 0.073), except in the non-foveal GA group (P = 0.008). A significant positive relationship between central retinal sensitivity and LLD (R = 0.613; P < 0.001), but not BCVA, suggests that there is a trend for LLVA to detect a greater extent of functional deficit than BCVA in eyes with increasingly poorer retinal sensitivity. However, the results of the linear regression models estimated central retinal sensitivity to be 6.1, 3.7, and 5.1 standard deviations (SDs) less than normal by the time BCVA, LLVA, and LLD, respectively, were 2 SDs less than normal. CONCLUSIONS In early stages of AMD, LLVA did not detect a greater extent of functional deficit than BCVA when compared with control participants. Although there was a trend for LLVA to be more effective at detecting foveal deficits than BCVA in eyes with increasingly poorer retinal sensitivity, both visual acuity measures were much less sensitive compared with microperimetry.
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Thibaut M, Tran THC, Szaffarczyk S, Boucart M. The contribution of central and peripheral vision in scene categorization: a study on people with central vision loss. Vision Res 2014; 98:46-53. [PMID: 24657253 DOI: 10.1016/j.visres.2014.03.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 03/05/2014] [Accepted: 03/08/2014] [Indexed: 11/24/2022]
Abstract
Studies in normally sighted people suggest that scene recognition is based on global physical properties and can be accomplished by the low resolution of peripheral vision. We examine the contribution of peripheral and central vision in scene gist recognition in patients with central vision loss and age-matched controls. Twenty-one patients with neovascular age related macular degeneration (AMD), with a visual acuity lower than 20/50, and 15 age-matched normally sighted controls participated in a natural/urban scene categorization task. The stimuli were colored photographs of natural scenes presented randomly at one of five spatial locations of a computer screen: centre, top left, top right, bottom left and bottom right at 12° eccentricity. Sensitivity (d') and response times were recorded. Normally sighted people exhibited higher sensitivity and shorter response times when the scene was presented centrally than for peripheral pictures. Sensitivity was lower and response times were longer for people with AMD than for controls at all spatial location. In contrast to controls patients were not better for central than for peripheral pictures. The results of normally sighted controls indicate that scene categorization can be accomplished by the low resolution of peripheral vision but central vision remains more efficient than peripheral vision for scene gist recognition. People with central vision loss likely categorized scenes on the basis of low frequency information both in normal peripheral vision and in low acuity central vision.
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Affiliation(s)
- Miguel Thibaut
- Laboratoire Neurosciences et Pathologies Fonctionnelles, Université Lille Nord de France, CNRS, France
| | - Thi Ha Chau Tran
- Laboratoire Neurosciences et Pathologies Fonctionnelles, Université Lille Nord de France, CNRS, France; Service d'Ophtalmologie, Hôpital Saint Vincent de Paul, Lille, France
| | - Sebastien Szaffarczyk
- Laboratoire Neurosciences et Pathologies Fonctionnelles, Université Lille Nord de France, CNRS, France
| | - Muriel Boucart
- Laboratoire Neurosciences et Pathologies Fonctionnelles, Université Lille Nord de France, CNRS, France.
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Saksens NT, Fleckenstein M, Schmitz-Valckenberg S, Holz FG, den Hollander AI, Keunen JE, Boon CJ, Hoyng CB. Macular dystrophies mimicking age-related macular degeneration. Prog Retin Eye Res 2014; 39:23-57. [PMID: 24291520 DOI: 10.1016/j.preteyeres.2013.11.001] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 11/15/2013] [Accepted: 11/18/2013] [Indexed: 01/30/2023]
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Niamprem P, Rujivipat S, Tiyaboonchai W. Development and characterization of lutein-loaded SNEDDS for enhanced absorption in Caco-2 cells. Pharm Dev Technol 2013; 19:735-42. [PMID: 23985012 DOI: 10.3109/10837450.2013.829092] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A self-nanoemulsifying drug delivery system (SNEDDS) has been developed for enhanced oral bioavailability of lutein. Its permeation enhancement has been evaluated using monolayers of Caco-2 cells. SNEDDS is composed of a mixture of Lexol® and Emulmetik® 900, Labrasol®, and Tween 80 as oil, surfactant and co-surfactant, respectively. Upon dilution of lutein-loaded SNEDDS with water, a nanoemulsion was obtained in <10 s with spherical droplets of 40-150 nm in diameter. The zeta potential was in the range of -19 to -32 mV. Increasing the ratio of surfactant to co-surfactant decreased the mean droplet size. Dissolution studies showed that lutein was released rapidly (<5 min) from SNEDDS into 0.1 N HCl and pH 6.8 phosphate buffer solution without any aggregation. In vitro studies using Caco-2 cells revealed that lutein-loaded SNEDDS showed shorter lag time and greater (2-fold) cellular accumulation compared with the lutein dispersion.
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Affiliation(s)
- Pattravee Niamprem
- Department of Pharmaceutical Technology, Faculty of Pharmaceutical Sciences, Naresuan University , Phitsanulok 65000 , Thailand
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50
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Aslam T, Mahmood S, Balaskas K, Patton N, Tanawade RG, Tan SZ, Roberts SA, Parkes J, Bishop PN. Repeatability of visual function measures in age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2013; 252:201-6. [PMID: 23884391 DOI: 10.1007/s00417-013-2421-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Revised: 07/02/2013] [Accepted: 07/03/2013] [Indexed: 10/26/2022] Open
Abstract
PURPOSE To assess repeatability of visual function measures in patients with early, intermediate or late age-related macular degeneration (AMD) without active neovascular disease in the study eye, but active neovascular AMD in the fellow eye. METHODS One hundred subjects from an ongoing trial were screened for this study in which their LogMAR acuity, contrast sensitivity and reading performance were assessed using standardised protocols by trained optometrists. The same measures were repeated one month later and repeatability of the visual functions assessed. RESULTS Data from 83 subjects satisfied inclusion criteria for analysis. Coefficient of repeatability was 14.9 letters for LogMAR visual acuity , 7.2 letters for Pelli Robson contrast sensitivity, 0.72 for LogMAR reading acuity, 110.4 words/ min for reading speed and 0.67 for LogMAR critical print size. Intraclass correlation coefficients allowed comparison between measures and were found to be 0.96 for LogMAR visual acuity, 0.93 for contrast sensitivity, 0.75 for LogMAR reading acuity, 0.79 for reading speed and 0.74 for LogMAR critical print size. Coefficients of variation were 9.4 %, 10.7 %, 48.4 %, 28.4 % and 31.8 % respectively. CONCLUSIONS We found coefficients of repeatability that concurred with previous studies demonstrating variability of visual functions in patients with AMD. In addition, we found intraclass correlation coefficients to be better with visual acuity and contrast sensitivity than with measures of reading performance.
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Affiliation(s)
- Tariq Aslam
- Manchester Royal Eye Hospital, Manchester Academic Health Science Centre, Manchester, UK
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