Abstract
Purpose
To evaluate visual function variations in eyes with age-related macular degeneration (AMD) compared to normal eyes under different light/contrast conditions using a time-dependent visual acuity testing instrument, the Central Vision Analyzer (CVA).
Methods
Overall, 37 AMD eyes and 35 normal eyes were consecutively tested with the CVA after assessing best-corrected visual acuity (BCVA) using ETDRS charts. The CVA established visual thresholds for three mesopic environments (M1 (high contrast), M2 (medium contrast), and M3 (low contrast)) and three backlight-glare environments (G1 (high contrast, equivalent to ETDRS), G2 (medium contrast), and G3 (low contrast)) under timed conditions. Vision drop across environments was calculated, and repeatability of visual scores was determined.
Results
BCVA significantly reduced with decreasing contrast in all eyes. M1 scores for BCVA were greater than M2 and M3 (P<0.001); G1 scores were greater than G2 and G3 (P<0.01). BCVA dropped more in AMD eyes than in normal eyes between M1 and M2 (P=0.002) and between M1 and M3 (P=0.003). In AMD eyes, BCVA was better using ETDRS charts compared to G1 (P<0.001). The drop in visual function between ETDRS and G1 was greater in AMD eyes compared to normal eyes (P=0.004). Standard deviations of test–retest ranged from 0.100 to 0.139 logMAR.
Conclusion
The CVA allowed analysis of the visual complaints that AMD patients experience with different lighting/contrast time-dependent conditions. BCVA changed significantly under different lighting/contrast conditions in all eyes, however, AMD eyes were more affected by contrast reduction than normal eyes. In AMD eyes, timed conditions using the CVA led to worse BCVA compared to non-timed ETDRS charts.
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References
Khandhadia S, Cherry J, Lotery AJ . Age-related macular degeneration. Adv Exp Med Biol 2012; 724: 15–36.
Age-Related Eye Disease Study 2 Research Group. Lutein+zeaxanthin and omega-3 fatty acids for age-related macular degeneration: the Age-Related Eye Disease Study 2 (AREDS2) randomized clinical trial. JAMA 2013; 309 (19): 2005–2015.
Rosenfeld PJ, Brown DM, Heier JS, Boyer DS, Kaiser PK, Chung CY et al. Ranibizumab for neovascular age-related macular degeneration. N Engl J Med 2006; 355 (14): 1419–1431.
Lim LA, Frost NA, Powell RJ, Hewson P . Comparison of the ETDRS logMAR, ‘compact reduced logMar’ and Snellen charts in routine clinical practice. Eye (Lond) 2010; 24 (4): 673–677.
Mitchell J, Bradley C . Quality of life in age-related macular degeneration: a review of the literature. Health Qual Life Outcomes 2006; 4: 97.
Ferris FL 3rd, Kassoff A, Bresnick GH, Bailey I . New visual acuity charts for clinical research. Am J Ophthalmol 1982; 94 (1): 91–96.
Yavuz GA, Unver YB, Bekiroglu N, Presti P, Sinclair SH . Central field perimetry of discriminated targets: I. Results for normal individuals using high-contrast targets. Eye (Lond) 2009; 23 (11): 2082–2089.
Bradley A, Thomas T, Kalaher M, Hoerres M . Effects of spherical and astigmatic defocus on acuity and contrast sensitivity: a comparison of three clinical charts. Optom Vis Sci 1991; 68 (6): 418–426.
Pesudovs K, Hazel CA, Doran RM, Elliott DB . The usefulness of Vistech and FACT contrast sensitivity charts for cataract and refractive surgery outcomes research. Br J Ophthalmol 2004; 88 (1): 11–16.
Ruamviboonsuk P, Tiensuwan M, Kunawut C, Masayaanon P . Repeatability of an automated Landolt C test, compared with the early treatment of diabetic retinopathy study (ETDRS) chart testing. Am J Ophthalmol 2003; 136 (4): 662–669.
Gutstein W, Sinclair SH, North RV, Bekiroglu N . Screening athletes with Down syndrome for ocular disease. Optometry 2010; 81 (2): 94–99.
Gomez ML . Measuring the Quality of vision after cataract surgery. In “Cataract surgery and lens implantation”. Curr Opin Ophthalmol 2014; 25 (1): 3–11.
Barteselli G, Chhablani J, Gomez ML, Doede AL, Dustin L, Kozak I et al. Visual function assessment in simulated real-life situations in HIV-infected subjects. PLoS One 2014; 9 (5): e97023.
Vos JJ . On the cause of disability glare and its dependence on glare angle, age and ocular pigmentation. Clin Exp Optom 2003; 86 (6): 363–370.
Luo MR, Cui G, Rigg B . The development of the CIE 2000 colour-difference formula: CIEDE2000. Color Res Appl 2001; 26 (5): 340–350.
Peli E . Contrast in complex images. J Opt Soc Am A 1990; 7 (10): 2032–2040.
Bland JM, Altman DG . Measurement error. BMJ 1996; 312 (7047): 1654.
Falkenstein IA, Cochran DE, Azen SP, Dustin L, Tammewar AM, Kozak I et al. Comparison of visual acuity in macular degeneration patients measured with Snellen and early treatment diabetic retinopathy study charts. Ophthalmology 2008; 115 (2): 319–323.
Fletcher DC, Schuchard RA . Visual function in patients with choroidal neovascularization resulting from age-related macular degeneration: the importance of looking beyond visual acuity. Optom Vis Sci 2006; 83 (3): 178–189.
Bellmann C, Unnebrink K, Rubin GS, Miller D, Holz FG . Visual acuity and contrast sensitivity in patients with neovascular age-related macular degeneration. Results from the Radiation Therapy for Age-Related Macular Degeneration (RAD-) Study. Graefes Arch Clin Exp Ophthalmol 2003; 241 (12): 968–974.
Nguyen NX, Weismann M, Trauzettel-Klosinski S . Improvement of reading speed after providing of low vision aids in patients with age-related macular degeneration. Acta Ophthalmol 2009; 87 (8): 849–853.
Raasch TW, Bailey IL, Bullimore MA . Repeatability of visual acuity measurement. Optom Vis Sci 1998; 75 (5): 342–348.
Arditi A, Cagenello R . On the statistical reliability of letter-chart visual acuity measurements. Invest Ophthalmol Vis Sci 1993; 34 (1): 120–129.
Bailey IL, Lovie JE . New design principles for visual acuity letter charts. Am J Optom Physiol Opt 1976; 53 (11): 740–745.
Acknowledgements
This study was supported by NIH grants R01EY007366 and R01EY018589 (WRF), R01EY016323 (D-UB), and in part by an unrestricted fund from Research to Prevent Blindness to the Department of Ophthalmology, University of California, San Diego.
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Barteselli, G., Gomez, M., Doede, A. et al. Visual function assessment in simulated real-life situations in patients with age-related macular degeneration compared to normal subjects. Eye 28, 1231–1238 (2014). https://doi.org/10.1038/eye.2014.189
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DOI: https://doi.org/10.1038/eye.2014.189
