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Hunter AML, Anderson RS, Redmond T, Garway-Heath DF, Mulholland PJ. Investigating the Spatiotemporal Summation of Perimetric Stimuli in Dry Age-Related Macular Degeneration. Transl Vis Sci Technol 2023; 12:37. [PMID: 38019498 PMCID: PMC10691387 DOI: 10.1167/tvst.12.11.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 09/26/2023] [Indexed: 11/30/2023] Open
Abstract
Purpose To measure achromatic spatial, temporal, and spatiotemporal summation in dry age-related macular degeneration (AMD) compared to healthy controls under conditions of photopic gaze-contingent perimetry. Methods Twenty participants with dry AMD (mean age, 74.6 years) and 20 healthy controls (mean age, 67.8 years) performed custom, gaze-contingent perimetry tests. An area-modulation test generated localized estimates of Ricco's area (RA) at 2.5° and 5° eccentricities along the 0°, 90°, 180°, and 270° meridians. Contrast thresholds were measured at the same test locations for stimuli of six durations (3.7-190.4 ms) with a Goldmann III stimulus (GIII, 0.43°) and RA-scaled stimuli. The upper limit (critical duration) of complete temporal summation (using the GIII stimulus) and spatiotemporal summation (using the RA stimuli) was estimated using iterative two-phase regression analysis. Results Median (interquartile range [IQR]) RA estimates were significantly larger in AMD participants (2.5°: 0.21 [0.09-0.41] deg2; 5°: 0.32 [0.15-0.65 deg2]) compared to healthy controls (2.5°: 0.08 [0.05-0.13] deg2; 5°: 0.15 [0.08-0.22] deg2) at all test locations (all P < 0.05). No significant difference in median critical duration was found in AMD participants with the GIII stimulus (19.6 [9.9-30.4] ms) and RA-scaled stimuli (22.9 [13.9-40.3] ms) compared to healthy controls (GIII: 17.0 [11.3-24.0] ms; RA-scaled: 22.4 [14.3-33.1] ms) at all test locations (all P > 0.05). Conclusions Spatial summation is altered in dry AMD, without commensurate changes in temporal summation. Translational Relevance The sensitivity of perimetry to AMD may be improved by utilizing stimuli that probe alterations in spatial summation in the disease.
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Affiliation(s)
- Aoife M. L. Hunter
- Centre for Optometry and Vision Science, Biomedical Sciences Research Institute, Ulster University, Coleraine, UK
| | - Roger S. Anderson
- Centre for Optometry and Vision Science, Biomedical Sciences Research Institute, Ulster University, Coleraine, UK
- National Institute for Health Research Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Tony Redmond
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK
| | - David F. Garway-Heath
- National Institute for Health Research Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Pádraig J. Mulholland
- Centre for Optometry and Vision Science, Biomedical Sciences Research Institute, Ulster University, Coleraine, UK
- National Institute for Health Research Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
- School of Optometry and Vision Sciences, Cardiff University, Cardiff, UK
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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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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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Abstract
BACKGROUND It is of interest to examine paracentral functional deficits in early age-related maculopathy (ARM), as histopathological studies indicate that this is where the earliest changes occur. The purpose of this study is to detect the sensory functional deficits at chosen retinal areas around the fovea and at the fovea itself in patients with early age-related maculopathy and to determine the type of functional losses that are more pronounced in early ARM. METHODS Ten participants with early ARM and 10 age-matched controls took part. Crowded and uncrowded visual acuity and static and transient contrast sensitivity were measured in the same selected eye of each participant at eight predetermined retinal locations plus the fovea in patients with early ARM and controls. All measurements were made using computer-generated targets. RESULTS A significant difference between the controls and subjects with ARM was found in low spatial frequency static contrast sensitivity (p = 0.05) but not for transient contrast sensitivity (p = 0.586). Visual acuity (uncrowded VA and crowded VA) showed a borderline difference (p = 0.072 and p = 0.084, respectively). Compared to controls, there was no evidence of increased contour interaction effects in early ARM (p = 0.595). CONCLUSION The subjects with very early ARM showed significant loss of low spatial frequency static contrast sensitivity before the loss of high contrast VA, indicating that static contrast sensitivity may be one of the earliest functional losses in early ARM and this loss was found to extend across the central 10 degrees of the retina.
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Affiliation(s)
- Feng Qiu
- School of Optometry, University of Waterloo, Waterloo, Ontario, Canada
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Eisenbarth W, MacKeben M, Poggel DA, Strasburger H. Characteristics of dynamic processing in the visual field of patients with age-related maculopathy. Graefes Arch Clin Exp Ophthalmol 2007; 246:27-37. [PMID: 17882447 PMCID: PMC2082065 DOI: 10.1007/s00417-007-0641-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2006] [Revised: 04/28/2007] [Accepted: 05/07/2007] [Indexed: 11/30/2022] Open
Abstract
Purpose To investigate the characteristics of dynamic processing in the visual field of patients with age-related maculopathy (ARM) by measuring motion sensitivity, double-pulse resolution (DPR), and critical flicker fusion. Methods Fourteen subjects with ARM (18 eyes), 14 age-matched controls (19 eyes), and 7 young controls (8 eyes) served as subjects. Motion contrast thresholds were determined by a four-alternative forced-choice (4 afc) staircase procedure with a modification by Kernbach for presenting a plaid (size = 3.8°) moving within a stationary spatial and temporal Gaussian envelope in one of four directions. Measurements were performed on the horizontal meridian at 10°, 20°, 30°, 40°, and 60° eccentricity. DPR was defined as the minimal temporal gap detectable by the subject using a 9-fold interleaved adaptive procedure, with stimuli positioned on concentric rings at 5°, 10°, and 20° eccentricity on the principal and oblique meridians. Critical flicker fusion thresholds (CFF) and the Lanthony D-15 color vision test were applied foveally, and the subjects were free to use their fovea or whatever retinal area they needed to use instead, due to their retinal lesions caused by ARM. All measurements were performed under photopic conditions. Results Motion contrast sensitivity in subjects with ARM was pronouncedly reduced (0.23–0.66 log units, p < 0.01), not only in the macula but in a region up to 20° eccentricity. In the two control groups, motion contrast sensitivity systematically declined with retinal eccentricity (0.009–0.032 log units/degree) and with age (0.01 log units/year). Double-pulse thresholds in healthy subjects were approximately constant in the central visual field and increased outside a radius of 10° (1.73 ms/degree). DPR thresholds were elevated in subjects with ARM (by 23–32 ms, p < 0.01) up to 20° eccentricity, and their foveal CFFs were increased by 5.5 Hz or 14% (p < 0.01) as compared with age-matched controls. Conclusions Dynamic processing properties in subjects with ARM are severely impaired in the central visual field up to 20° eccentricity, which is clearly beyond the borders of the macula.
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Affiliation(s)
- Werner Eisenbarth
- Generation Research Program (GRP), Human Science Center, Ludwig-Maximilians University, Munich, Germany
- Academy of Applied Optometry (FFA), Marsplatz 8, 80335 Munich, Germany
| | - Manfred MacKeben
- The Smith-Kettlewell Eye Research Institute, San Francisco, CA USA
| | - Dorothe A. Poggel
- Generation Research Program (GRP), Human Science Center, Ludwig-Maximilians University, Munich, Germany
- Center for Innovative Visual Rehabilitation, Boston VA Medical Center, Boston, MA USA
| | - Hans Strasburger
- Generation Research Program (GRP), Human Science Center, Ludwig-Maximilians University, Munich, Germany
- Department of Medical Psychology, University of Göttingen, Göttingen, Germany
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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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Stavrou EP, Wood JM. Central visual field changes using flicker perimetry in type 2 diabetes mellitus. ACTA ACUST UNITED AC 2005; 83:574-80. [PMID: 16187995 DOI: 10.1111/j.1600-0420.2005.00527.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the efficacy of flicker perimetry compared with that of static perimetry in determining central visual field losses in participants with type 2 diabetes mellitus. METHODS Flicker and static perimetry were performed using the Medmont field analyser on 20 participants with type 2 diabetes mellitus and 24 age-matched control participants. RESULTS Flicker, but not static, perimetry demonstrated significant reductions in thresholds in those participants who had a recent diagnosis of diabetes or who had no or only minimal diabetic retinopathy compared to the control group at eccentricities close to fixation. CONCLUSION Flicker perimetry is recommended for the evaluation of visual field losses in participants with recent onset of diabetes and minimal diabetic retinopathy.
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Affiliation(s)
- Efty P Stavrou
- School of Optometry, Queensland University of Technology, Kelvin Grove, Queensland, Australia.
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Elsner AE, Burns SA, Weiter JJ. Cone photopigment in older subjects: decreased optical density in early age-related macular degeneration. JOURNAL OF THE OPTICAL SOCIETY OF AMERICA. A, OPTICS, IMAGE SCIENCE, AND VISION 2002; 19:215-222. [PMID: 11778727 PMCID: PMC2981061 DOI: 10.1364/josaa.19.000215] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
We measured changes to cone photoreceptors in patients with early age-related macular degeneration. The data of 53 patients were compared with normative data for color matching measurements of long- and middle-wavelength-sensitive cones in the central macula. A four-parameter model quantified cone photopigment optical density and kinetics. Cone photopigment optical density was on average less for the patients than for normal subjects and was uncorrelated with visual acuity. More light was needed to reduce the photopigment density by 50% in the steady state for patients. These results imply that cone photopigment optical density is reduced by factors other than slowed kinetics.
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Affiliation(s)
- Ann E Elsner
- Schepens Eye Research Institute and Harvard University, Boston, Massachusetts 02114, USA
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Vingrys AJ, Pesudovs K. Localized scotomata detected with temporal modulation perimetry in central serous chorioretinopathy. AUSTRALIAN AND NEW ZEALAND JOURNAL OF OPHTHALMOLOGY 1999; 27:109-16. [PMID: 10379709 DOI: 10.1046/j.1440-1606.1999.00158.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIM Flicker deficits have been reported in various maculopathies, including age-related macular degeneration. We test whether flicker losses exist in patients with central serous chorioretinopathy (CSC) and whether the size and flicker frequency of the target is important in detecting such losses. METHODS We examined four CSC patients with temporal modulation (flicker perception) perimetry using the Medmont auto-flicker module (Medmont Pty Ltd, Melbourne, Vic. Australia), as well as static perimetry and colour vision. One case was examined using sophisticated laboratory equipment to precisely measure their temporal contrast sensitivity function (temporal CSF or de Lange curve) using larger targets to consider the effect of target frequency and size. Two patients were followed longitudinally and tested after resolution of the maculopathy. We compared our patients with an age-matched control group of 11 people. RESULTS Temporal modulation perimetry detected larger and more localized defects in all cases of active CSC compared with static perimetry. There appeared to be size and frequency tuning to the deficit, with greatest loss being found at 16 Hz with small (0.5 degree) targets. The losses resolved in one case where the retina recovered in 4 weeks, but remained to a lesser degree in another case who suffered a 2 year long fluctuating course before the CSC subsided. CONCLUSIONS Temporal modulation perimetry detects a loss of flicker sensitivity in patients with CSC. Deeper and more clearly defined scotomata are found with a flickering stimulus compared with a steady state one. The greatest losses of flicker sensitivity are found with 16 Hz modulation and with small targets located directly over the lesion. The duration of the disease may be important for recovery of flicker sensitivity. Temporal modulation perimetry appears to be a valuable tool for the confirmation of functional loss due to CSC.
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Affiliation(s)
- A J Vingrys
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, Victoria, Australia.
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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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