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Terheyden JH, Pondorfer SG, Behning C, Berger M, Carlton J, Rowen D, Bouchet C, Poor S, Luhmann UFO, Leal S, Holz FG, Butt T, Brazier JE, Finger RP. Disease-specific assessment of Vision Impairment in Low Luminance in age-related macular degeneration - a MACUSTAR study report. Br J Ophthalmol 2023; 107:1144-1150. [PMID: 35354561 PMCID: PMC10359508 DOI: 10.1136/bjophthalmol-2021-320848] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 03/07/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS To further validate the Vision Impairment in Low Luminance (VILL) questionnaire, which captures visual functioning and vision-related quality of life (VRQoL) under low luminance, low-contrast conditions relevant to age-related macular degeneration (AMD). METHODS The VILL was translated from German into English (UK), Danish, Dutch, French, Italian and Portuguese. Rasch analysis was used to assess psychometric characteristics of 716 participants (65% female, mean age 72±7 years, 82% intermediate AMD) from the baseline visit of the MACUSTAR study. In a subset of participants (n=301), test-retest reliability (intraclass correlation coefficient (ICC) and coefficient of repeatability (CoR)) and construct validity were assessed. RESULTS Four items were removed from the VILL with 37 items due to misfit. The resulting Vision Impairment in Low Luminance with 33 items (VILL-33) has three subscales with no disordered thresholds and no misfitting items. No differential item functioning and no multidimensionality were observed. Person reliability and person separation index were 0.91 and 3.27 for the Vision Impairment in Low Luminance Reading Subscale (VILL-R), 0.87 and 2.58 for the Vision Impairment in Low Luminance Mobility Subscale (VILL-M), and 0.78 and 1.90 for the Vision Impairment in Low Luminance Emotional Subscale (VILL-E). ICC and CoR were 0.92 and 1.9 for VILL-R, 0.93 and 1.8 for VILL-M and 0.82 and 5.0 for VILL-E. Reported VRQoL decreased with advanced AMD stage (p<0.0001) and was lower in the intermediate AMD group than in the no AMD group (p≤0.0053). CONCLUSION The VILL is a psychometrically sound patient-reported outcome instrument, and the results further support its reliability and validity across all AMD stages. We recommend the shortened version of the questionnaire with three subscales (VILL-33) for future use. TRIAL REGISTRATION NUMBER NCT03349801.
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Affiliation(s)
| | | | - Charlotte Behning
- Department of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Moritz Berger
- Department of Medical Biometry, Informatics and Epidemiology, University of Bonn, Bonn, Germany
| | - Jill Carlton
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Donna Rowen
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | | | - Ulrich F O Luhmann
- Roche Pharmaceutical Research and Early Development, Translational Medicine Ophthalmology, Roche Innovation Center Basel, Basel, Switzerland
| | | | - Frank G Holz
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Thomas Butt
- UCL Institute of Ophthalmology, University College London, London, UK
| | - John E Brazier
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Robert P Finger
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
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Longitudinal Evaluation of Visual Function Impairments in Early and Intermediate Age-Related Macular Degeneration Patients. OPHTHALMOLOGY SCIENCE 2022; 2:100173. [PMID: 36245764 PMCID: PMC9559970 DOI: 10.1016/j.xops.2022.100173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 04/07/2022] [Accepted: 05/16/2022] [Indexed: 11/24/2022]
Abstract
Purpose To evaluate visual function (VF) changes in early and intermediate age-related macular degeneration (eAMD and iAMD) over 24 months. Design Prospective, observational natural history study. Participants Participants were enrolled at the Duke Eye Center. Methods A total of 101 subjects (33 with eAMD, 47 with iAMD, and 21 normal controls) were recruited. Visual function (VF) tests included best-corrected visual acuity (BCVA), low- luminance visual acuity (LLVA), microperimetry (MP), cone contrast tests (CCTs), and dark adaptation (DA). Mixed-effect model repeated measures based on absolute values and change from baseline identified VF tests differentiating AMD from controls and revealing longitudinal VF decline when controlling for covariates (baseline value, age, coronary artery disease, dry eye, and phakic status). Nine AMD genetic risk variants, combinations of these (genetic burden score), reticular pseudodrusen (RPD), and hyperreflective foci (HRF) were tested as predictors of diagnosis and VF performance. Main Outcome Measures Longitudinal changes in VF metrics over 24 months. Results A total of 70 subjects completed the 2-year visit (22 with eAMD, 31 with iAMD, and 17 controls). Percent reduced threshold (PRT) on MP and CCT red significantly distinguished iAMD versus controls after 12 and 24 months, respectively. Cone contrast test red, PRT, and absolute threshold (AT) on MP showed significant longitudinal deterioration of VF in iAMD versus baseline at 12 months and onward, however, with a reduced rate of worsening. The DA data confirmed a preexisting functional deficit in iAMD at baseline and revealed an increasing proportion of poorly performing iAMD subjects in DA over the study period. None of the other VF measures showed consistent significant changes among the normal, early, and intermediate groups or over time. The genetic burden score was significantly associated with AMD diagnosis (relative risk for iAMD = 1.64, P < 0.01) and DA (r = 0.42, P = 0.00005). Reticular pseudodrusen and HRF showed moderate associations with DA and weak to moderate associations with MP variables. Conclusions In iAMD, MP variables, CCT red, and DA revealed slow and nonlinear functional decline over 24 months. A structure-function relationship in eAMD and iAMD stages was demonstrated among HRF, RPD, and DA, possibly modified by genetic risk factors. These structural and functional features represent potential end points for clinical trials in iAMD.
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Key Words
- AMD, age-related macular degeneration
- AREDS, Age-Related Eye Disease Study
- AT, absolute threshold
- BCVA, best-corrected visual acuity
- CCT, cone contrast test
- CFP, color fundus photography
- DA, dark adaptation
- Early AMD
- HRF, hyperreflective foci
- Intermediate AMD
- LLD, low-luminance deficit
- LLVA
- LLVA, low-luminance visual acuity
- MMRM, mixed-effect repeated measure
- MP, microperimetry
- Microperimetry
- PRT, percent reduced threshold
- RIT, rod intercept time
- RPD, reticular pseudodrusen
- RPE, retinal pigment epithelium
- SD, standard deviation
- SD-OCT, spectral domain OCT
- SNP, single nucleotide polymorphism
- VF, visual function
- Visual function
- dB, decibels
- eAMD, early AMD
- iAMD, intermediate AMD
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Pondorfer SG, Terheyden JH, Overhoff H, Stasch-Bouws J, Holz FG, Finger RP. Development of the Vision Impairment in Low Luminance Questionnaire. Transl Vis Sci Technol 2021; 10:5. [PMID: 33505772 PMCID: PMC7794270 DOI: 10.1167/tvst.10.1.5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 11/26/2020] [Indexed: 01/08/2023] Open
Abstract
Purpose The purpose of this study was to design and evaluate an instrument for assessing vision-related quality of life appropriate for the specific visual impairment characteristic for all stages of age-related macular degeneration (AMD), with a focus on the low luminance deficit in early/intermediate stages. Methods A standardized questionnaire was developed in three steps with participants with early, intermediate, and late AMD: (1) based on in-depth interviews (n = 19) and two focus group discussions (n = 5 each), content was developed followed by 2. (2) The questionnaire development using cognitive debriefing interviews (n = 3) and leading to a preliminary version of the questionnaire. (3) This version was then administered to 127 participants with early, intermediate, and late AMD. Psychometric properties, such as response category functioning (floor and ceiling effects) and targeting of item difficulty to patient ability of the pilot Vision Impairment in Low Luminance (VILL) questionnaire were evaluated using Rasch analysis. Results The preliminary VILL questionnaire consisted of 68 items with a 5-step response scale. Several items were removed based on floor/ceiling effects or misfit and a final pool of 37 items remained. The response scale was collapsed to four categories as one category was underutilized. The targeting of the instrument was good with minimal difference in person and item means (0.52 logits). Precision was also good with a person separation index of 3.55 and reliability of 0.93. There was evidence of multidimensionality (eigenvalue of the first contrast = 5.95) in the scale, which could be resolved by splitting the items into subscales including a reading, mobility, and emotional well-being subscale. Conclusions Individuals with AMD report difficulties with vision-related activities and functioning under visually challenging conditions at all stages of the disease. These aspects were considered when developing the 37-item VILL, which demonstrates promising psychometric characteristics. Further assessments of reliability and validity are warranted. Translational Relevance The VILL questionnaire is a new patient-reported outcome (PRO) measure developed for future use in AMD studies.
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Affiliation(s)
| | - Jan H Terheyden
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | | | | | - Frank G Holz
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Robert P Finger
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
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Hathibelagal AR, Mulani Y, Dave VP. Visual function deficits in eyes with resolved endophthalmitis. Sci Rep 2021; 11:2285. [PMID: 33504844 PMCID: PMC7840664 DOI: 10.1038/s41598-021-81530-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 01/05/2021] [Indexed: 12/19/2022] Open
Abstract
To evaluate the changes in functional vision in patients with resolved endophthalmitis. This was a cross-sectional study. The study included 20 patients with resolved endophthalmitis and best-corrected visual acuity of 20/100 or better. Visual acuity (VA), contrast threshold (CT), red/green (RG) and yellow/blue (YB) colour vision and 15 Hz flicker modulation threshold (FMT) were assessed using standard psychophysical techniques. The median age was 54 years. The median visual acuity was 0.27 (~ 20/40-Snellen Equivalent) ((interquartile range [IQR]), 0.30) logMAR). The median log contrast threshold (CT) was - 1.13 (IQR, 0.36) log units (normative value for age-matched CT: - 1.61 log units). The median red/green (RG) and yellow/blue (YB) thresholds were 11.52 (IQR, 26.19) and 9.45 (IQR, 16.20) CAD units respectively, which were at least 5 times higher than age-matched normative RG and YB thresholds. The median central cone- mediated FMT was 17.64% (IQR, 23.40%), which was much higher compared to age-matched FMT (5.48% [IQR, 3.47]). Linear regression revealed significant relationship between contrast thresholds and foveal thickness (y = 0.001x-1.47, R2 = 0.20, p = 0.048). Though endophthalmitis may resolve with a good visual acuity, deficits in visual functions like chromatic discrimination, cone-mediated flicker and contrast sensitivity persist.
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Affiliation(s)
- Amithavikram R Hathibelagal
- Brien Holden Institute of Optometry and Vision Sciences, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
| | - Yasmeen Mulani
- Brien Holden Institute of Optometry and Vision Sciences, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
| | - Vivek Pravin Dave
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India.
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Hathibelagal AR, Bharadwaj SR, Yadav AR, Subramanian A, Sadler JRE, Barbur JL. Age-related change in flicker thresholds with rod- and cone-enhanced stimuli. PLoS One 2020; 15:e0232784. [PMID: 32639956 PMCID: PMC7343165 DOI: 10.1371/journal.pone.0232784] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 04/21/2020] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Rod and cone photoreceptor-specific tests can be time-consuming. A new non-invasive test is described. The test is based on the measurement of flicker modulation thresholds with rod- and cone-enhanced visual stimuli, which requires only minimum adaptation time. Here, we investigated how the rod-and cone-mediated flicker thresholds vary with age. METHODS Monocular thresholds with rod and cone-enhanced stimuli were measured in 140 healthy adults, (age range: 18-75 years), foveally (0°) and at four parafoveal locations, at an eccentricity of 5° in each of the four quadrants using five, adaptive, interleaved staircases. Temporal frequencies, stimulus sizes, background luminance and spectral composition, were adjusted appropriately to achieve approximately 1 log unit separation in sensitivity between the rod- and cone-enhanced stimuli. Spectrally calibrated, 'neutral density' filters were used to enable adequate control of display luminance for rod enhanced stimuli. RESULTS The magnitude of central and parafoveal rod thresholds was significantly higher than the central and parafoveal cone thresholds, respectively (p < 0.001) in both the age groups. However, the rate of increase in central rod thresholds (y = 0.45x-12.79; linear regression equation) was not significantly steeper than the rate of increase in central (y = 0.29x-8.53) cone thresholds (p = 0.15). Centrally, cone thresholds showed a better correlation with rod central thresholds for the age > 45 years (Spearman correlation, ρ = 0.74, p < 0.001) compared to age ≤ 45 years (ρ = 0.41, p < 0.001). CONCLUSIONS Thresholds with rod- and cone-enhanced stimuli are largely invariant below 45 years of age and increase rapidly above this age. This age-wise normative database can be used as an effective functional-marker to assess photoreceptor sensitivities in retinal diseases.
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Affiliation(s)
- Amithavikram R. Hathibelagal
- Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, India
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Shrikant R. Bharadwaj
- Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, India
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Anil R. Yadav
- Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, India
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Ahalya Subramanian
- Centre for Applied Vision Research, School of Health Sciences, City, University of London, London, England, United Kingdom
| | - James R. E. Sadler
- Centre for Applied Vision Research, School of Health Sciences, City, University of London, London, England, United Kingdom
- Human Performance, QinetiQ, Hampshire, England, United Kingdom
| | - John L. Barbur
- Centre for Applied Vision Research, School of Health Sciences, City, University of London, London, England, United Kingdom
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Pondorfer SG, Heinemann M, Wintergerst MWM, Pfau M, Strömer AL, Holz FG, Finger RP. Detecting vision loss in intermediate age-related macular degeneration: A comparison of visual function tests. PLoS One 2020; 15:e0231748. [PMID: 32298375 PMCID: PMC7162506 DOI: 10.1371/journal.pone.0231748] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 03/31/2020] [Indexed: 11/18/2022] Open
Abstract
The purpose of the study was to evaluate the diagnostic accuracy of visual function tests in intermediate age-related macular degeneration (iAMD). A total of 62 subjects (38 patients with iAMD and 24 controls) were included and underwent several functional assessments: Best-corrected visual acuity (BCVA), low luminance visual acuity (LLVA), visual acuity (VA) measured with the Moorfields Vanishing Optotypes Acuity Charts (MAC), contrast sensitivity with the Pelli-Robson test, reading speed using the International Reading Speed texts (IReST) and mesopic and dark-adapted microperimetry (S-MAIA, CenterVue, Padova, Italy). Groups were compared using non-parametric Wilcoxon rank sum tests and ROC analyses. Linear regression was used to control for confounding. Results showed that all visual function test performances except the IReST were significantly reduced in iAMD patients compared to controls (p < 0.05). These effects did not alter after controlling for age and sex. Best discrimination between iAMD and controls yield the combination of LLVA and contrast sensitivity as well as MAC-VA and contrast sensitivity (ROC area under the curve 0.95 and 0.93, respectively). Our results suggest that LLVA, MAC-VA, contrast sensitivity and mesopic and dark-adapted microperimetry can capture visual impairment characteristic for iAMD. Best discrimination against iAMD is achieved with a combination of two tests.
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Affiliation(s)
| | | | | | - Maximilian Pfau
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | | | - Frank G. Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Robert P. Finger
- Department of Ophthalmology, University of Bonn, Bonn, Germany
- * E-mail:
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Welker SG, Pfau M, Heinemann M, Schmitz-Valckenberg S, Holz FG, Finger RP. Retest Reliability of Mesopic and Dark-Adapted Microperimetry in Patients With Intermediate Age-Related Macular Degeneration and Age-Matched Controls. Invest Ophthalmol Vis Sci 2018; 59:AMD152-AMD159. [PMID: 30372731 DOI: 10.1167/iovs.18-23878] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To determine the intrasession test-retest reliability of mesopic and dark-adapted fundus-controlled perimetry in patients with intermediate age-related macular degeneration (iAMD). Methods We conducted a cross-sectional study with 23 iAMD patients (67.3 ± 8.2 years; range, 50-85; 78% female) and 24 healthy controls (61.3 ± 5.2 years; range, 50-71; 50% female) using a modified MAIA microperimeter. All patients underwent duplicate mesopic (achromatic stimuli, 400-800 nm) and dark-adapted (red stimuli, 627 nm) microperimetry, using a grid of 33 stimuli over 14° of the central retina. Main outcome measure was the intrasession test-retest reliability for pointwise sensitivity (PWS). Results PWS test-retest reliability was good among mesopic and dark-adapted testing in both patients and controls (coefficient of repeatability of 4.4, 4.52, 3.96, and 4.56 dB, respectively). Mean mesopic sensitivity in patients was 2.62 dB lower than in controls (P < 0.01); mean dark-adapted sensitivity was 2.49 dB lower than in controls (P < 0.01). Conclusions The modified MAIA device allows for reliable mesopic and dark-adapted microperimetry in iAMD patients. We found that iAMD is associated with both reduced mesopic and dark-adapted retinal sensitivity.
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Affiliation(s)
| | - Maximilian Pfau
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | | | | | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Robert P Finger
- Department of Ophthalmology, University of Bonn, Bonn, Germany
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Robinson DG, Margrain TH, Dunn MJ, Bailey C, Binns AM. Low-Level Nighttime Light Therapy for Age-Related Macular Degeneration: A Randomized Clinical Trial. ACTA ACUST UNITED AC 2018; 59:4531-4541. [DOI: 10.1167/iovs.18-24284] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- D. Grant Robinson
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, United Kingdom
| | - Tom H. Margrain
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, United Kingdom
| | - Matt J. Dunn
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, United Kingdom
| | - Clare Bailey
- Bristol Eye Hospital, Lower Maudlin Street, Bristol, United Kingdom
| | - Alison M. Binns
- Division of Optometry and Visual Science, School of Health Sciences, City, University of London, United Kingdom
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Taylor DJ, Edwards LA, Binns AM, Crabb DP. Seeing it differently: self-reported description of vision loss in dry age-related macular degeneration. Ophthalmic Physiol Opt 2017; 38:98-105. [PMID: 29168192 DOI: 10.1111/opo.12419] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 09/19/2017] [Indexed: 01/01/2023]
Abstract
PURPOSE A realistic description of visual symptoms associated with dry age-related macular degeneration (AMD) is important for raising awareness of the condition and educating patients. This study aimed to develop a set of descriptors for dry AMD and examine the realism of images currently and frequently used to show visual symptoms of the condition. METHODS Volunteers with dry AMD with a range of disease severity were given an eye examination and were asked to describe visual symptoms of their condition in a conversational interview. Participants were also asked to comment on a photograph typically used to portray the visual symptoms of AMD. Interviews were audio recorded, transcribed and subjected to content analysis. RESULTS Twenty-nine participants were interviewed. Median (interquartile range [IQR]) age was 75 (70, 79) years. Median (IQR) binocular visual acuity (VA) and Pelli-Robson contrast sensitivity (CS) was 0.2 (0.18, 0.36) logMAR and 1.65 (1.50, 1.95) log CS respectively. Three, 17 and nine patients had early, intermediate and late (geographic atrophy, GA) AMD, respectively. The most frequently reported descriptor group was blur (n = 13) followed by missing (n = 10) and distortion (n = 7). We chose the most popular image used to portray the visual symptoms of dry AMD based on an internet search and showed this to 21 participants. Sixteen participants (76% [95% confidence interval 53-92%]), including three out of the seven people with geographic atrophy, unequivocally rejected the realism of the image. CONCLUSIONS People with dry AMD use a wide range of descriptors for their visual experience. Visual symptoms of dry AMD as portrayed by commonly shown images were not the experience of most people in this study.
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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
| | - Laura A Edwards
- 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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