Abstract
Age-related macular degeneration (AMD) affects various aspects of visual function compromising patients’ functional vision and quality of life. Compared to visual acuity, contrast sensitivity correlates better with vision-related quality of life and subjectively perceived visual impairment. It may also be affected earlier in the course of AMD than visual acuity. However, lengthy testing times, coarse sampling and resolution, and poor test–retest reliability of the existing contrast testing methods have limited its widespread adoption into routine clinical practice. Using active learning principles, the qCSF can efficiently measure contrast sensitivity across multiple spatial frequencies with both high sensitivity in detecting subtle changes in visual function and robust test–retest reliability, emerging as a promising visual function endpoint in AMD both in clinical practice and future clinical trials.
Highlights
Age-related macular degeneration (AMD) is currently the leading cause of visual impairment in subjects older than 50 years of age in developed countries and the thirdleading cause worldwide [1]
Even with relatively high visual acuity, it is not uncommon for patients with early or intermediate AMD to complain of subjective visual impairment and demonstrate reduced vision-related quality of life (VRQoL) scores [3,5,6,7]
A recent study looking at visual acuity (VA) differences between the two widely used charts in subjects entering clinical trials, reported a significant VA variability of 0.14 logMAR (6.7 letters) in both non-neovascular and neovascular AMD and progressively increased VA variability was observed with progressively worse VA [10]
Summary
Age-related macular degeneration (AMD) is currently the leading cause of visual impairment in subjects older than 50 years of age in developed countries and the thirdleading cause worldwide [1]. Given the anticipated aging of the global population, the prevalence of AMD is expected to increase from approximately 30–50 million people worldwide in 2017 [2] to 288 million by the year 2040 [1]. Severe reductions in visual acuity (VA) typically manifest late in the course of the disease, limiting the clinical utility of the traditional visual acuity test in early and intermediate stages of AMD [3,4,5]. Even with relatively high visual acuity, it is not uncommon for patients with early or intermediate AMD to complain of subjective visual impairment and demonstrate reduced vision-related quality of life (VRQoL) scores [3,5,6,7]
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