Abstract
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.
Highlights
Age-related macular degeneration (AMD) represents the leading cause of blindness in the elderly in the industrialized world and a major public health concern [1]
Several studies have reported that anatomic parameters such as CNV area and diameter do not adequately explain changes in distance visual acuity in neovascular AMD (nAMD) [23, 26]
The majority of those studies did not include a multitude of morphologic parameters graded on the basis of the Early Treatment of Diabetic Retinopathy Study (ETDRS) grid subfields using latest image acquisition devices such as standard deviation (SD)-Optical Coherence Tomography (OCT) and OCT-A and did not evaluate different measures of visual function
Summary
Age-related macular degeneration (AMD) represents the leading cause of blindness in the elderly in the industrialized world and a major public health concern [1]. Despite typically mild visual impairment in the early stages, the progression of the disease results. Contrast Sensitivity in Bilateral nAMD in a severe central visual loss, which causes disability especially when both eyes are involved [3, 4]. Progressive AMD is either represented by macular neovascularization (MNV) or an advanced stage of dry AMD mainly characterized by geographic atrophy (GA) of the outer retina and the retinal pigment epithelium (RPE) which might initially spare the fovea [5, 6]. Eyes with neovascular AMD (nAMD) sometimes show GA zones at diagnosis or develop GA as well as subretinal scarring of MNV over the long-term [7]. Subretinal fibrosis and GA, both leading to defects in the outer retina, account for the principal causes of vision loss in nAMD [8]
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