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

Divya Narayanan,Donna Welch,Garrick Wallstrom,Mark Abelson,John Rodriguez,Paul Arrigg,Matthew Chapin

doi:10.1186/s12886-020-01683-8

Abstract

BackgroundTo 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.MethodsA 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.ResultsThere 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.ConclusionWhile 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.

Highlights

To prevent irreversible vision loss in age-related macular degeneration (AMD), it is critical to detect retinal dysfunction before permanent structural loss occurs
Novel tests developed for the current study: Normal vs non-advanced AMD groups As described in the methods, we developed a battery of visual function tests to identify endpoints that can differentiate the non-advanced AMD group with good visual acuity from age-matched normal controls
In the current study we evaluated a group of nonadvanced AMD subjects with good visual acuity and age-matched normal controls using a battery of visual function endpoints

Summary

Introduction

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. Age-related macular degeneration (AMD) is the leading cause of visual impairment in developed countries [1, 2]. While the actual cause of the disease remains unclear, several risk factors have been identified. Genetic studies have identified several genetic factors linked to AMD. Several studies have found a strong association between complement factor H polymorphism (Y402H) and higher risk of AMD [6, 7]. Several modifiable risk factors such as smoking and diet have been identified [8]

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