Suitability and repeatability of a photostress recovery test device, the macular degeneration detector (MDD-2), for diabetes and diabetic retinopathy assessment

Optical instrument for the study of time recovery from total disability glare vision

Disability glare is defined as the loss of contrast sensitivity of the retinal image due to intraocular straylight originated from the presence of an intense and broad bright light in the field of vision. This loss of vision can range between vision loss at high spatial frequencies or total temporal blindness. If the extreme case occurs, the recovery time is crucial in night driving conditions or those professional activities in which maximum visual acuity is required at any moment. The recovery time depends mainly on the intensity and glare angle of the light source, ocular straylight, and the photoreceptor response at the retina. The recovery time can also be affected by ocular pathologies, aging, or physiological factors that increase ocular straylight. The aim of this work is to develop a new optical instrument based on psychophysical methodology as well as to investigate the recovery time from total disability glare (photobleaching) as a function of the contrast of the visual target and the glare angle of the source in healthy volunteers. Results showed significant exponential correlation between recovery time and contrast of the visual target and linear correlation between contrast sensitivity and the glare angle. Those findings allowed to obtain an empirical expression to compute the recovery time required to restore contrast sensitivity baseline vision after photobleaching. Finally, a statistical dependence of recovery time with age was found for short glare angles that disappear as the glare angle increases.

Cone photoreceptor macular function and recovery after photostress in early non-exudative age-related macular degeneration

Purpose

To identify parameters from cone function and recovery after photostress that detect functional deficits in early non-exudative age-related macular degeneration (AMD) and to determine the repeatability of these parameters.

Methods

Cone-mediated visual function recovery after photostress was examined in three groups of subjects: young normal subjects (ages 20–29; N=8), older normal subjects (ages 50–90; N=9), and early non-exudative AMD subjects (ages 50–90; N=12). Eight AMD and four normal subjects were retested 1 year after the initial evaluation. Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity (VA) and parameters of cone function (baseline cone sensitivity and cone recovery half-life following photobleach) were measured and compared between AMD and normal subjects. Short-term repeatability was assessed for each subject’s initial evaluation. Long-term repeatability was assessed by comparing outcomes from the initial evaluation and 1-year follow-up.

Results

The mean baseline cone threshold was significantly worse in subjects with early AMD compared to older normal subjects (−1.80±0.04 vs −1.57±0.06 log cd/m²p=0.0027). Moreover, the baseline cone threshold parameter exhibited good short-term (intraclass correlation coefficient [ICC]=0.88) and long-term (ICC=0.85) repeatability in all subjects. The cone intercept parameter and ETDRS VA were not significantly different between AMD and older normal subject groups. Cone recovery half-life was significantly different between older normal and AMD subject groups (p=0.041). Neither ETDRS VA nor cone function parameters were significantly different for any group at the 1-year follow-up.

Conclusion

The baseline cone threshold shows potential as a novel parameter to assess visual dysfunction in early AMD. This outcome consistently detected deficits in AMD subjects, and differentiated them from age-matched controls with high test–retest repeatability.

Claimed Effects, Outcome Variables and Methods of Measurement for Health Claims on Foods Related to Vision Proposed Under Regulation (EC) 1924/2006

Adequate visual function has a strong impact on the quality of life of people. Several foods and food components have been hypothesized to play a role in the maintenance of normal visual function and in the prevention of eye diseases. Some of these foods/food components have been the object of a request of authorization for use of health claims under Articles 13(5) or 14 of the Regulation (EC) 1924/2006. Most of these requests have received a negative opinion from the European Food Safety Authority (EFSA) due to the choice of inappropriate outcome variables (OVs) and/or methods of measurement (MMs) applied in the studies used to substantiate the claims. This manuscript refers to the collection, collation and critical analysis of OVs and MMs related to vision. Guidance document and requests for authorization of health claims were used to collect OVs and MMs related to vision. A literature review was performed to critically analyse OVs and MMs, with the aim of defining their appropriateness in the context of a specific claimed effect related to vision. The results highlight the importance of adequate choices of OVs and MMs for an effective substantiation of claims related to visual function.

Macular pigment is associated with glare-affected visual function and central visual field loss in glaucoma

AIM

To evaluate the relationship between macular pigment optical density (MPOD) and glare disability in open-angle glaucoma.

METHODS

A cross-sectional analysis of baseline data (88 subjects; median age, 67 (range 36-84) years) collected during the Macular Pigment and Glaucoma Trial (ISRCTN registry number: 56985060). MPOD at 0.25°, 0.5° and 1° of retinal eccentricity was measured using customised heterochromatic flicker photometry. Mesopic contrast sensitivity with glare (mCSg), photostress recovery time (PRT) and self-reported glare symptoms were evaluated. Fourier-domain optical coherence tomography was used to analyse ganglion cell complex (GCC) and identify foveal involvement.

RESULTS

Low spatial frequency (f) mCSg was significantly correlated with MPOD at 0.25°(3 cycles per degree (cpd): r=0.25, p=0.04) and 0.5° (3 cpd: r=0.23, p=0.04) of retinal eccentricity. Those with foveal GCC loss exhibited lower MPOD, had worse low spatial fmCSg (1.5 cpd and 3 cpd, p=0.02 each) and prolonged PRT (p=0.02) in comparison with those without foveal involvement. The depth of central 10° field loss was related to MPOD at all eccentricities (p<0.01 for all). Those who reported glare symptoms had a significantly lower MPOD at all retinal eccentricities (0.25° and 1°: p=0.05 each; 0.5°: p=0.04), including those with foveal involvement (0.25°: p=0.05; 0.5°: p<0.01; 1°: p=0.01).

CONCLUSIONS

Macular pigment level may be an important consideration among those experiencing disability glare in glaucoma, including those with foveal involvement.

TRIAL REGISTRATION NUMBER

ISRCTN56985060, Post-results.