Detecting vision loss in intermediate age-related macular degeneration: A comparison of visual function tests

Pondorfer, Susanne G.; Heinemann, M.; Wintergerst, Maximilian W. M.; Pfau, Maximilian; Strömer, Annika; Holz, Frank G.; Finger, Robert P.

doi:10.1371/journal.pone.0231748

Cited by 26 publications

(44 citation statements)

References 50 publications

(73 reference statements)

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“…The measurement of standard visual acuity (VA) is the basis of any visual function examination despite it being insensitive to early disease, or unable to differentiate different disease stages in many retinal conditions 1–4 . It is well established that vision under low luminance conditions is reduced compared with standard VA 5–8 .…”

Section: Introductionmentioning

confidence: 99%

Low luminance visual acuity as a clinical measure and clinical trial outcome measure: a scoping review

Wood

Jolly

Buckley

et al. 2021

Ophthalmic Physiologic Optic

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Purpose The measurement of standard visual acuity (VA) is the most well‐known part of any ophthalmic examination to indicate visual function. Despite this, it is insensitive in detecting early disease changes. Therefore, other visual function tests have been developed including low luminance VA (LLVA) and low luminance deficit (LLD). This scoping literature review aims to summarise the current published applications of LLVA and LLD assessments to evaluate their utility as clinical markers and research outcome measures in a variety of ophthalmic conditions. Recent findings Sixty‐five peer‐reviewed publications were included. LLVA was pioneered for use in geographic atrophy, a subtype of age‐related macular degeneration, which remains the mainstay of its clinical application. However, other studies have reported additional useful applications in inherited retinal diseases including rare maculopathies and rod‐cone dystrophies. Although there are some variations in testing methodology, use of the standard Early Treatment Diabetic Retinopathy Study (ETDRS) chart with a 2.0 log unit neutral density filter is the most popular approach. The optimal testing luminance is still to be defined. Summary Overall, LLVA is an earlier clinical marker of change in central retinal function than standard VA. It has been shown to be a risk factor for disease progression and a better indicator of a patient’s level of everyday visual function. It is inexpensive and simple to implement using readily available standard ophthalmic equipment.

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Section: Introductionmentioning

confidence: 99%

Low luminance visual acuity as a clinical measure and clinical trial outcome measure: a scoping review

Wood

Jolly

Buckley

et al. 2021

Ophthalmic Physiologic Optic

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“…Whereas, LLVA has been shown to capture visual impairment in nAMD better than standard distance acuity ( 41 ), there is currently limited data correlating systematically LLVA and various morphologic characteristics. The Chroma and Spectri studies reported a weak negative correlation between LLVA and GA lesion size at baseline and week 48 in bilateral GA in dry AMD ( 42 ).…”

Section: Discussionmentioning

confidence: 99%

Strongest Correlation Between Contrast Sensitivity and Morphological Characteristics in Bilateral nAMD

et al. 2021

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In patients with neovascular age-related macular degeneration (nAMD) there is often an inconsistency between their subjective visual impairment and a still relatively preserved standard Early Treatment of Diabetic Retinopathy Study (ETDRS) best corrected visual acuity. Therefore, in order to better capture the specific functional defects in nAMD, other tests need to be evaluated. In a previous study, we reported contrast sensitivity of the better eye to best correlate with near distance and distance vision related quality of life in patients with bilateral nAMD. Here, we evaluated Pelli-Robson contrast sensitivity, ETDRS visual acuity, low luminance visual acuity and Radner maximum reading speed and correlated them with several morphologic parameters as measured on fundus autofluorescence imaging, optical coherence tomography and optical tomography angiography in 54 patients. A multiple regression analysis was performed which correlated each visual function parameter with the anatomic features. The results showed the strongest correlations between the total area of macular geographic atrophy as well as the percentage of geographic atrophy in the central 1 mm and contrast sensitivity. Further, the regression model selected the total area of macular geographic atrophy, the photoreceptor inner and outer segments interface disruption score, the presence of subretinal fibrosis in the central 1 mm and the central retinal thickness as the variables that explained 71% of the variation in contrast sensitivity when including all eyes. Hence, our results suggest that among the evaluated measures of vision, contrast sensitivity is best correlated with the morphologic impairment in bilateral nAMD. Thus, contrast sensitivity may complement ETDRS visual acuity in clinical trials and serve as a standard diagnostic tool in clinical practice.

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“…Dimitrov et al assessed a battery of visual function tests and concluded that contrast thresholds assessed using flickering targets could be used as optimal tests to assess visual function in AMD [ 21 ]. In a recently published study by Pondorfer et al [ 23 ], several visual function tests were found to be sensitive in differentiating normal from intermediate AMD subjects. While their general conclusion that contrast sensitivity and mesopic testing conditions are sensitive to elicit visual dysfunction in non-advanced AMD, are in general agreement with the results of our study, there are several differences in study methods between our study and Pondorfer et al’s.…”

Section: Discussionmentioning

confidence: 99%

“…Our goal was to develop functional tests that are capable of identifying subtle differences between these two groups and reliably capture underlying neuronal dysfunction in AMD at its earliest stage. While several previous studies have looked into sensitive visual function tests for early and intermediate stages of AMD [18,[21][22][23], our study is unique in that we focused on identifying tests that are sensitive but also relatively easy and simple to implement in clinical trial settings by focusing on cone-based tests. The test duration for each of the visual function tests described in this study is less than 5 min per eye.…”

Section: Introductionmentioning

confidence: 99%

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

Narayanan

Rodriguez

Wallstrom³

et al. 2020

BMC Ophthalmol

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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.

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Detecting vision loss in intermediate age-related macular degeneration: A comparison of visual function tests

Cited by 26 publications

References 50 publications

Low luminance visual acuity as a clinical measure and clinical trial outcome measure: a scoping review

Low luminance visual acuity as a clinical measure and clinical trial outcome measure: a scoping review

Strongest Correlation Between Contrast Sensitivity and Morphological Characteristics in Bilateral nAMD

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

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