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A Novel Smartphone-Based Color Test for Detection of Color Vision Defects in Age Related Macular Degeneration. J Ophthalmol 2022; 2022:9744065. [PMID: 35399161 PMCID: PMC8991385 DOI: 10.1155/2022/9744065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/14/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose To evaluate the efficacy of the smartphone-based K-color test to detect color defects in patients with Age-related Macular Degeneration (AMD). Methods 88 patients (n = 135 eyes) with AMD and 28 controls (n = 53 eyes) underwent color testing with the Hardy–Rand–Rittler (H-R-R), the K-color test, and the Ishihara test. The K-color test presents randomized colored shapes in decreasing steps of intensity, providing also a record system for result tele-transmission. Sensitivity, specificity, and reliability were examined to investigate the validity of the novel test. 26 participants with AMD also completed a questionnaire regarding the feasibility of the test. Results Linear mixed-effects models indicated a significant difference (p < 0.001) between AMD and normal eyes. The areas under the curve (AUC) were estimated to be 0.897 [95% CI: 0.841–0.952], 0.943 [95% CI: 0.901–0.984], and 0.931 [95% CI: 0.886–0.977] for the red, green, and blue color, respectively. Based on the H-R-R, the sensitivity of the test was 0.79, 0.90, and 0.95 for the red, green, and blue colors, respectively, and specificity was 0.88 for all colors. The new test recognized more abnormal cases than the Ishihara (sensitivity of 0.98 and 1.0 and specificity of 0.48 and 0.38 for red and green colors, respectively). Test-retest reliability was found to be high for the red [ICC = 0.996 (0.990–0.999)], green [ICC = 0.974 (0.929–0.990)], and blue [ICC = 0.992 (0.981–0.997)] colors. The majority of the asked participants stated that they could easily perform the test. Conclusion The K-color test was found to be sensitive and specific in detecting color defects in AMD patients. The K-color test may serve as a useful tool both for patients and their physicians.
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Lovie-Kitchin J, Feigl B. Assessment of age‐related maculopathy using subjective vision tests. Clin Exp Optom 2021; 88:292-303. [PMID: 16255688 DOI: 10.1111/j.1444-0938.2005.tb06713.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2005] [Revised: 08/29/2005] [Accepted: 09/06/2005] [Indexed: 11/30/2022] Open
Abstract
This paper reviews non-standard, clinical vision tests that may be used to detect the earliest visual loss in age-related maculopathy (ARM), before fundus changes are detected. We recommend a clinical test battery for all patients aged 60 years and older, comprising low luminance/low contrast (SKILL) VA or low contrast VA, desaturated D-15 colour vision assessment, flicker perimetry, glare recovery and dark adaptation if possible, together with conventional assessments of case history, ophthalmoscopy and high contrast visual acuity (VA) for the detection and diagnosis of ARM. Reading rate is also discussed as a potential indicator of early visual loss. For monitoring the progressive visual loss in age-related macular degeneration (AMD) and determining the requirements for optometric vision rehabilitation, we recommend more conventional clinical vision tests of distance and near visual acuity, reading rate, the effects of varying illumination and a functional central visual field assessment.
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Affiliation(s)
- Jan Lovie-Kitchin
- Queensland University of Technology, Faculty of Health, Victoria Park Road, Kelvin Grove, QLD, 4059, Australia.
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Affiliation(s)
- Brian Brown
- Department of Optometry, Queensland Institute of Technology, Brisbane, Australia
| | - Jan Lovie‐kitchin
- Department of Optometry, Queensland Institute of Technology, Brisbane, Australia
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Lovie‐kitchin JE. High contrast and low contrast visual acuity in age related macular degeneration. Clin Exp Optom 2021. [DOI: 10.1111/j.1444-0938.1989.tb06526.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- J. E. Lovie‐kitchin
- Centre for Eye Research, Department of Optometry, Queensland University of Technology
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Lott LA, Schneck ME, Haegerstrom-Portnoy G, Hewlett S, Stepien-Bernabe N, Gauer BM, Zaidi A, Fu AD, Brabyn JA. Simple Vision Function Tests that Distinguish Eyes with Early to Intermediate Age-related Macular Degeneration. Ophthalmic Epidemiol 2021; 28:93-104. [PMID: 32781860 PMCID: PMC7878586 DOI: 10.1080/09286586.2020.1793371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 06/18/2020] [Accepted: 06/30/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To present and compare baseline vision findings in eyes with early age-related macular degeneration (E-AMD), intermediate AMD (I-AMD), and age-similar participants with normal aging changes to the retina (No-AMD). METHODS Two hundred and thirty-seven eyes of 125 individuals (66.4% female, mean age 75.3 years) were tested monocularly using several simple, rapid psychophysical tests: high contrast visual acuity, low contrast visual acuity at reduced luminance, contrast sensitivity, shape discrimination hyperacuity, colour vision, reading rate, and glare recovery. Retinal status was determined using colour fundus photographs that were graded according to the Beckman Initiative for Macular Research Classification Committee scale. Logistic regression analyses with generalized estimating equations were used to assess the association between each vision variable and AMD category, while taking into account the correlation between the two eyes. RESULTS Three vision measures (contrast sensitivity [CS], shape discrimination hyperacuity [SDH], and colour discrimination [DesatCCS]) were significantly and independently associated with intermediate AMD. Relative Risk Ratios (RRR), 95% Confidence Intervals (in parentheses), beta coefficients, and significance (p) for the I-AMD vs. No-AMD model are: CS: RRR = 6.5 (1.91-22.0), beta = 1.87, p < .01; SDH: RRR = 2.34 (1.24-4.44), beta = 0.85, p < .001; DesatCCS: RRR = 1.43 (1.22-1.68), beta = 0.36, p < .001. Performance on these measures was significantly poorer for participants with I-AMD vs. No-AMD. CONCLUSIONS Simple screening tests distinguish eyes with intermediate AMD from eyes with less severe AMD or normal aging changes. This suggests that these vision measures may be significant predictors of which participants will go on to develop advanced AMD.
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Affiliation(s)
- Lori A Lott
- Smith-Kettlewell Eye Research Institute, 2318 Fillmore St. San Francisco, CA 94115
| | - Marilyn E Schneck
- Smith-Kettlewell Eye Research Institute, 2318 Fillmore St. San Francisco, CA 94115
| | - Gunilla Haegerstrom-Portnoy
- Smith-Kettlewell Eye Research Institute, 2318 Fillmore St. San Francisco, CA 94115
- School of Optometry, University of California Berkeley, Berkeley, CA 94720
| | - Susan Hewlett
- Smith-Kettlewell Eye Research Institute, 2318 Fillmore St. San Francisco, CA 94115
- School of Optometry, University of California Berkeley, Berkeley, CA 94720
| | | | - Bonnie M. Gauer
- Bonnie M. Gauer, OD, MS, LLC, 320 Medical Loop, Roseburg, OR 97471
| | - Ali Zaidi
- Pacific Eye Associates, 2100 Webster St. #214, San Francisco, CA 94115
| | - Arthur D. Fu
- West Coast Retina Medical Group, 1445 Bush St., San Francisco, CA 94109
| | - John A. Brabyn
- Smith-Kettlewell Eye Research Institute, 2318 Fillmore St. San Francisco, CA 94115
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Ittiara S, Hariprasad AS, Messner LV, Tresley DJ, Leong D, Schechet SA. Use of the King-Devick Variable Color Contrast Sensitivity Chart to differentiate stages of age-related macular degeneration. BMJ Open Ophthalmol 2020; 5:e000451. [PMID: 32426523 PMCID: PMC7228553 DOI: 10.1136/bmjophth-2020-000451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/20/2020] [Accepted: 04/27/2020] [Indexed: 11/17/2022] Open
Abstract
Objective This study aimed to determine which colour contrast sensitivity differences exist in early to advanced age-related macular degeneration (AMD) and examine the potential utility of the King-Devick Variable Color Contrast Sensitivity Chart in detecting AMD severity. Methods and analysis A total of 85 participants (144 total eyes) were recruited from multiple clinical practices and enrolled in the study. The control group consisted of 57 healthy eyes. The non-exudative AMD (NE-AMD) group consisted of 45 eyes. The exudative AMD (E-AMD) group consisted of 42 eyes. In a single study visit, monocular best-corrected visual acuity (BCVA) at 40 cm with 100% black contrast was determined for each eye. Using the BCVA line, the number of letters correctly identified (out of 10) was recorded for various colour presentations (red, green, blue and yellow) and at decreasing contrast levels (100%, 75%, 50% and 25%). Results Our results show worse visual performance under various colour contrast settings in E-AMD patients compared with healthy controls and NE-AMD. Colour contrast performance using blue and yellow differentiated more advanced stages of disease in E-AMD from earlier NE-AMD disease. Blue and black colour contrast performance more accurately identified the E-AMD group from healthy controls and the NE-AMD group. Conclusion The findings of this study demonstrate that colour contrast, particularly with black, blue and yellow, is impaired in E-AMD suggesting the potential for colour contrast measures to serve as an adjunctive clinical tool in identifying subtle altered visual function as well as the potential for detecting disease severity.
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Abstract
PURPOSE To assess the effect of intermediate age-related macular degeneration (AMD) on foveal cone-contrast thresholds. METHODS We measured L-M and S-cone-contrast thresholds in subjects with intermediate AMD (n = 10) and age-matched control subjects (n = 10). Monocular, foveal 3-degree Gaussian blobs (600-millisecond raised cosine) were presented at 16 cone ratios throughout L-, M-, and S-cone space, and threshold contours were modeled with probability summation between two independent detection mechanisms. The role that preretinal absorption plays in aging was also evaluated by simulation with FG15 and neutral-density filters. RESULTS Aging results in loss of neural sensitivity, not explained by lens changes. On average, intermediate AMD was associated with reduced sensitivity in both color and luminance channels (p < 0.05) that appeared to indicate greater involvement of S-cones. When data were normalized to age-expected values, the changes to cone sensitivity were shown to be consistent (∼200% loss) across L-M, M-L, and S-cone mechanisms. In comparison, the luminance (L + M) mechanism showed relative sparing (155% loss, p < 0.05). CONCLUSIONS Eyes with the same phenotype of intermediate AMD can have varying degrees of color threshold loss. Functional markers enhance the clinical definition of disease expression in AMD.
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Abstract
PURPOSE Pathologic changes of retinal photoreceptors associated with early age-related macular degeneration (AMD) have been well established, but the disease is usually asymptomatic at the early stage, and traditional suprathreshold clinical tests often fail to reveal functional deficiencies. The aim of this study is to demonstrate subtle changes of one suprathreshold visual function in early AMD eyes. METHODS The quality of preattentively discriminable texture stimuli was systematically degraded through random deletion of texture checks. The task of the subject was to make a forced choice decision on whether two equally degraded patches contained samples of the same or different types of textures. Tolerance to texture stimulus degradation was measured in young and elderly normal controls and in patients with early AMD. RESULTS Subjects were trained to perform the texture discrimination task until they made few errors in discriminating intact textures. Texture discrimination deteriorated with increasing stimulus degradation in all subjects. There was no significant difference between performance of young and elderly normal controls. Early AMD eyes showed significantly less tolerance to stimulus degradation than age-similar normal controls at a range of degradation levels. After controlling for visual acuity, normal subjects still performed significantly better than early AMD eyes at approximately 22% check deletion. There was no significant difference between better eyes of early AMD patients and fellow eyes of late AMD eyes. Performance on the degraded texture task was not correlated with visual acuity. A mild blur of the stimulus had little effect on discrimination of degraded textures. CONCLUSIONS Early AMD may not directly affect suprathreshold visual functions when the stimuli are intact and contain redundant information but may manifest itself as a reduction of tolerance to stimulus degradation in the form of localized information loss. The performance of patients with early AMD may be compromised when the visual stimulus contains less redundant information.
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Feigl B, Brown B, Lovie-Kitchin J, Swann P. Cone-mediated multifocal electroretinogram in early age-related maculopathy and its relationships with subjective macular function tests. Curr Eye Res 2009; 29:327-36. [PMID: 15590480 DOI: 10.1080/02713680490516198] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To investigate the multifocal electroretinogram (mfERG) and subjective function in early age-related maculopathy (ARM). METHODS Seventeen subjects with early ARM with visual acuity (VA) of 6/12 or better and 20 age-matched control subjects were examined. We assessed mfERGs, high and low contrast distance VA, near VA, low luminance VA, contrast sensitivity, saturated and desaturated Panel D-15 and visual fields (mean sensitivity). The mfERG responses were analysed by comparing central-overall (method 1) and superior-inferior (method 2) ratios. RESULTS The mfERG did not discriminate between the groups whereas colour vision (tritan deficiency), contrast sensitivity, and high contrast and low contrast VA showed significantly reduced responses for the early ARM group compared with the control group (p < or = 0.01). The mfERG first-order kernel responses correlated significantly with the desaturated D-15 in both methods (r = -0.5, p < or = 0.05). Fundus grading was not correlated with the mfERG measures. CONCLUSIONS Although the mfERG correlated significantly with the desaturated D-15 in early ARM, suggesting it operates at a sensitive level, it failed to discriminate between the control and ARM groups. In our sample, the subjective function measures were more sensitive than the mfERG measures.
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Affiliation(s)
- Beatrix Feigl
- Department of Ophthalmology, University of Graz, Austria.
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Neelam K, Nolan J, Chakravarthy U, Beatty S. Psychophysical Function in Age-related Maculopathy. Surv Ophthalmol 2009; 54:167-210. [DOI: 10.1016/j.survophthal.2008.12.003] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Feigl B. Age-related maculopathy – Linking aetiology and pathophysiological changes to the ischaemia hypothesis. Prog Retin Eye Res 2009; 28:63-86. [PMID: 19070679 DOI: 10.1016/j.preteyeres.2008.11.004] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Beatrix Feigl
- Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, 4059 QLD, Australia.
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Feigl B, Brown B, Lovie-Kitchin J, Swann P. Functional loss in early age-related maculopathy: the ischaemia postreceptoral hypothesis. Eye (Lond) 2006; 21:689-96. [PMID: 16680100 DOI: 10.1038/sj.eye.6702389] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
We review proposed models and psychophysical and electrophysiological tests performed in many studies for early age-related maculopathy (ARM). We suggest that ischaemia is the trigger for impaired retinal pigment epithelium function causing imbalance of secretion of vascular growth factors, reduced disc degradation capability and reduced metabolic activity and possible inflammatory response. This results in increased deposition of cell debris, such as drusen and thickens Bruch's membrane causing even more ischaemia of the overlying neurosensory retina. The photoreceptors are more resistant to ischaemia given their proximity to the choroid. Furthermore, being 'upstream' from the inner retinal layers, they act as an oxygen sink depriving retinal layers further from the choroid. Postreceptoral cell layers and especially parts of the inner nuclear layer that are located in the watershed zone between two sources of blood supply are preferentially vulnerable to ischaemia. Based on psychophysical and electrophysiological findings we propose that most of the function impairment in early ARM starts postreceptorally.
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Affiliation(s)
- B Feigl
- Institute of Health and Biomedical Innovation, School of Optometry, Queensland University of Technology, Brisbane, Queensland, Australia.
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Abstract
Late age-related maculopathy (ARM) is responsible for the majority of blind registrations in the Western world among persons over 50 years of age. It has devastating effects on quality of life and independence and is becoming a major public health concern. Current treatment options are limited and most aim to slow progression rather than restore vision; therefore, early detection to identify those patients most suitable for these interventions is essential. In this work, we review the literature encompassing the investigation of visual function in ARM in order to highlight those visual function parameters which are affected very early in the disease process. We pay particular attention to measures of acuity, contrast sensitivity (CS), cone function, electrophysiology, visual adaptation, central visual field sensitivity and metamorphopsia. We also consider the impact of bilateral late ARM on visual function as well as the relationship between measures of vision function and self-reported visual functioning. Much interest has centred on the identification of functional changes which may predict progression to neovascular disease; therefore, we outline the longitudinal studies, which to date have reported dark-adaptation time, short-wavelength cone sensitivity, colour-match area effect, dark-adapted foveal sensitivity, foveal flicker sensitivity, slow recovery from glare and slower foveal electroretinogram implicit time as functional risk factors for the development of neovascular disease. Despite progress in this area, we emphasise the need for longitudinal studies designed in light of developments in disease classification and retinal imaging, which would ensure the correct classification of cases and controls, and provide increased understanding of the natural course and progression of the disease and further elucidate the structure-function relationships in this devastating disorder.
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Affiliation(s)
- R E Hogg
- Ophthalmology and Vision Science, Queen's University and Royal Victoria Hospitals, Belfast BT12 6BA, UK
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Feigl B, Brown B, Lovie-Kitchin J, Swann P. Monitoring retinal function in early age-related maculopathy: visual performance after 1 year. Eye (Lond) 2004; 19:1169-77. [PMID: 15389263 DOI: 10.1038/sj.eye.6701711] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To monitor visual performance in early age-related maculopathy (ARM). METHODS We measured monocular visual function-high-contrast visual acuity (HC-VA), central visual fields (mean sensitivity, MS), colour vision (desaturated Panel D-15), Pelli-Robson (P-R), and cone- and rod-mediated multifocal electroretinograms (mfERG) in 13 ARM subjects and 13 age-matched control subjects with normal fundi at baseline and after 1 year. All had visual acuity of 6/12 or better. The mfERG data were compared to templates derived from the control group at baseline. We analysed the mfERG results by averaging the central and peripheral fields and the superior and inferior fields (CP and SI methods) and by calculating the local responses. RESULTS The mean rod-mediated responses were significantly delayed in the ARM group for the CP (P=0.04) and the SI methods (P=0.03) at baseline compared to the control group. This did not change significantly after 1 year, whereas the mean cone-mediated responses were within the normal range at both times. Although the local analysis revealed lower amplitudes for the cone- and rod-mediated responses at baseline this was not found after 1 year and only the local rod-mediated latencies were delayed at both times (P<0.01). HC-VA, desaturated Panel D-15 and P-R were significantly worse in the ARM group (P< or =0.01) at baseline but did not show further significant deterioration. Progressive fundus changes were found in only two subjects (18%). CONCLUSION Although there was significant impairment of retinal function in early ARM at baseline no further deterioration was evident after 1 year.
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Affiliation(s)
- B Feigl
- Department of Ophthalmology, University of Graz, Austria.
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Swann PG, Lovie-Kitchin JE. Age-related maculopathy. II: The nature of the central visual field loss. Ophthalmic Physiol Opt 1991. [DOI: 10.1111/j.1475-1313.1991.tb00196.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Scott R, Cunningham GT, Puddle JM, Klinger JD, Jacobs RJ. Ocular side effects of phenothiazines. Clin Exp Optom 1991. [DOI: 10.1111/j.1444-0938.1991.tb04601.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Rolene Scott
- *Department of Optometry, University of Auckland
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Swann PG, Lovie-Kitchin JE. Age-related maculopathy. I: A review of its morphology and effects on visual function. Ophthalmic Physiol Opt 1990; 10:149-58. [PMID: 2196510 DOI: 10.1111/j.1475-1313.1990.tb00969.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Age-related maculopathy (ARM) is a leading cause of permanent vision loss in elderly people. ARM therefore constitutes an important public health problem which will increase in magnitude as the number of aged people in the general population becomes greater. The consequences of this condition are exacerbated by the fact that treatment, especially of the atrophic form of the disease, is ineffective. While laser photocoagulation may be helpful in the exudative form of ARM, there is often an inexorable progression towards severe vision loss in these patients. Therefore considerable attention needs to be paid to the aetiology of ARM, the potential for its prevention or delayed onset and its recognition through functional disturbances. This is the first of three papers dealing with ARM and its effects on visual function. We review its morphology and the visual disturbances that may ensue. The second and third papers will discuss the nature and detection of the central visual field loss due to ARM.
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Affiliation(s)
- P G Swann
- Department of Optometry, Queensland University of Technology, Brisbane, Australia
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