An exploratory study to evaluate visual function endpoints in non-advanced age-related macular degeneration

Abstract

Background To prevent irreversible vision loss in age-related macular degeneration (AMD), it is critical to detect retinal dysfunction before permanent structural loss occurs. In the current study we evaluated a series of visual function tests to identify potential endpoints to detect visual dysfunction in non-advanced AMD. Methods A series of visual function tests were performed on 23 non-advanced AMD subjects (AREDS grade 1–4 on simplified scale) and 34 age-matched normals (AREDS grade 0). Tests included some commonly used endpoints such as ETDRS visual acuity (VA), low luminance (LL) 2.0ND ETDRS VA, MNREAD as well as newly developed tests such as the Ora-VCF™ test, Ora-tablet reading test, color sensitivity etc. Differences between the two groups were compared for each test. Test-retest repeatability and reproducibility was assessed on a subset of subjects and percent agreement was calculated. Results There was no difference in standard ETDRS VA between non-advanced AMD (0.06 ± 0.02 logMAR) and normal groups (0.04 ± 0.02 logMAR) (p = 0.57). LL 2.0 ETDRS VA and MNREAD showed no difference between the groups (p > 0.05). Ora-VCF™ test was significantly worse in the non-advanced AMD group compared to normals (0.67 ± 0.07 in AMD; 0.45 ± 0.04 in normals, p = 0.005). Non-advanced AMD subjects also had significantly worse reading performance using the Ora-tablet with LL 2.0ND (114.55 ± 11.22 wpm in AMD; 145.17 ± 9.55 wpm in normals p = 0.049). No significant difference between the groups was noted using other tests. Repeatability was 82% for Ora-VCF™ test and 92% for Ora-tablet LL 2.0ND reading. Reproducibility was 89% for both Ora-VCF™ test and Ora-tablet LL 2.0ND reading. Conclusion While there was no significant difference between non-advanced AMD and normal groups using some current common endpoints such as ETDRS VA, LL 2.0 ETDRS VA or MNREAD, Ora-VCF™ test and Ora-tablet LL 2.0ND reading tests were able to identify significant visual dysfunction in non-advanced AMD subjects. These tests show promise as endpoints for AMD studies.

Repeatability and Discriminatory Power of Chart-Based Visual Function Tests in Individuals With Age-Related Macular Degeneration

“…Though higher than AUC values presented here, both studies demonstrated greatest discrimination with CS, followed by LLVA, MAT, BCVA, and IReST in decreasing order. Narayanan et al also explored the discriminatory power of BCVA, LLVA, and CS between individuals with no AMD and those with nonadvanced AMD (AREDS grade, 1-4 on a simplified scale). Again, best discrimination was achieved with CS, with BCVA and LLVA failing to offer any discriminatory power.…”

“…This report focuses on a subset of the chosen VF end points that are chart based and arguably the simplest and least burdensome to capture, namely BCVA, low-luminance visual acuity (LLVA), Moorfields Acuity Test (MAT), Pelli-Robson Contrast Sensitivity (CS), and International Reading Speed Test (IReST) . Under single-center, cross-sectional settings, all 5 chart-based tests have previously demonstrated a statistically significant reduction in visual function in participants with iAMD compared with age-similar healthy individuals . Whether this holds in large, multicenter investigations and whether they can track change over time remains to be seen.…”

“…18,19 Under singlecenter, cross-sectional settings, all 5 chart-based tests have previously demonstrated a statistically significant reduction in visual function in participants with iAMD compared with age-similar healthy individuals. [20][21][22][23][24] Whether this holds in large, multicenter investigations and whether they can track change over time remains to be seen. Here, using MACUSTAR cross-sectional data, we report on the repeatability and discriminatory power of these simple chart-based assessments of VF, and consider the feasibility of deploying these tests in future multicenter clinical trials.…”

Microperimetry to predict disease progression in eyes at high risk of age‐related macular degeneration disease: The PREVISION study

“…In the most advanced stage, the patient's vision can be threatened by the progression of geographic atrophy involving the centre of the macula or the presence of macular neovascularization. Prior to stage 4, visual acuity is often not affected and cannot be used as a marker of disease progression (Narayanan et al, 2020). However, other functional tests can be performed, such as colour vision, low luminance visual acuity or contrast sensibility (Cocce et al, 2018; Pondorfer et al, 2020), but the lack of standards and reproducibility between centres limits the use of these tests in clinical practice (Hernández‐Andrés et al, 2020; Patel et al, 2009).…”

Analysis of the Clinical Efficacy of Minocycline in the Treatment of Diabetic Retinopathy

“…And then treated control group with rosuvastatin calcium tablets (5 mg, orally, once a day) and calcium dobesilate capsules (0.5 g, orally, three times a day); As well as receiving the same drugs as control group and observation group also received minocycline (100 mg; orally; every 12 h). The treatment cycle is 60 d. The change in visual acuity score relative to the baseline in the Early Treatment Diabetic Retinopathy Study (ETDRS) letters of the two groups after treatment [13] , is divided into the markedly effective, the effective and the ineffective. The markedly effective: After treatment, the visual acuity is improved more than 2 lines by visual inspection; Effective: The visual acuity is improved more than 1 line; Invalid: The visual acuity, microangioma and fundus oozing blood remain unchanged or even sharpened.…”