Effects Of Age-related Macular Degeneration Research Articles

Assessment of vision-related quality of life and depression in patients with age-related macular degeneration.

To evaluate the effect of age-related macular degeneration (AMD) on vision-related quality of life (VRQOL) and depression levels. This cross-sectional study included 143 patients who are being followed up with a diagnosis of AMD. The Turkish versions of the National Eye Institute Visual Functioning Questionnaire-25 (NEI VFQ-25) and Geriatric Depression Scale-15 (GDS-15) were directed to the patients. The questionnaire results were analyzed based on the severity, treatment procedures for AMD, and sociodemographic characteristics of patients. The subscale scores obtained from the NEI VFQ-25 ranged from 47.54 for "near activities" to 84.02 for "color vision." Of the patients, 59.4% (85/143) were compatible with depression according to the GDS-15 questionnaire. There was no significant difference in the NEI VFQ-25 subscale scores between the gender groups (P > 0.05), whereas females were statistically significantly more depressive than males (P < 0.05). There were no significant differences between the injection (anti-vascular endothelial growth factors [anti-VEGF]) group and the non-injection group in terms of subscales of the NEI VFQ-25 questionnaire (P > 0.05). The depression ratio in the non-injected group was statistically significantly higher (P < 0.05). According to the present study, the association between depression and AMD is a fact that should be highlighted. Patients with depression had lower scores on the quality of life (QOL) test. Previous intravitreal injection did not affect NEI VFQ-25 scores. Female patients with AMD had higher rates of depression and lower visual acuity levels.

The effects of age-related macular degeneration on work productivity: A meta-analysis.

Age-related macular degeneration (AMD) is one of the leading causes of vision loss and blindness in older adults. Given the aging population in developed countries and the increased participation of older adults in the labour market, this paper aims to understand the impact of AMD on workplace productivity. Economic studies, comparative studies, observational studies, cohort studies, case series, randomized control trials, clinical trials, multicenter studies from MEDLINE, EMBASE, and CINHAL, as well as grey literature, were systematically searched to obtain all relevant literature. Duplicate records were removed, and two independent reviewers screened records for relevance. After screening, a risk of bias assessment was carried out. Data were extracted and a meta-analysis was performed using STATA 15.0. Fixed-effect and random-effect models were computed based on heterogeneity. Seven studies consisting of 3,060,864 subjects from 5 different countries were included in this systematic review. Mean wages lost due to impaired work productivity ranged from $1,395 to $55,180. The mean unemployment rate attributed to AMD ranged from 5.50% to 77.00%. Meta-analysis results indicated a significant unemployment rate (SMD = 0.44, CI: [0.27, 0.62]). Patients with AMD experience impaired work productivity as demonstrated by the wages lost and significantly higher rates of unemployment.

Measurement of the Inner Macular Layers for Monitoring of Glaucoma: Confounding Effects of Age-Related Macular Degeneration

To investigate the confounding effect of nonexudative age-related macular degeneration (AMD), specifically drusen and outer retinal atrophy, on the architecture and automated segmentation of the inner retinal layers as measured with OCT. Observational cross-sectional study. Two hundred sixty-three consecutive eyes with nonexudative AMD were identified through a retrospective chart review. Exclusion criteria were a diagnosis of glaucoma or glaucoma suspect, other retinal pathology affecting the macula, axial length > 26.5 mm or spherical equivalent less than -6 diopters, any other optic nerve or neurologic disorders, or poor image quality. Drusen were automatically segmented on macular OCT B-scans with a publicly available and validated deep learning approach. Automated segmentation of the inner plexiform layer (IPL)/inner nuclear layer (INL) boundary was carried out with the device's proprietary software. Quality of segmentation of the IPL/INL boundary as a function of drusen size and presence of inner retinal layer displacement in the area of macular pathology (drusen or atrophy). One hundred twenty-five eyes (65 patients) met the inclusion criteria. Drusen size varied between 16 and 272 μm (mean, 118 μm). Automated segmentation had a 22% chance of failure if the drusen height was between 145 and 185 μm and was most likely to fail with drusen heights above 185 μm. When drusen height was normalized by total retinal thickness, segmentation failed 36% of the time when the drusen to total retinal thickness ratio was 0.45 or above. Images were likely to show displacement of inner retinal layers with drusen heights above 176 μm and a normalized drusen height ratio of 0.5 or higher. Eighty-seven percent of images with outer retinal atrophy displayed incorrect segmentation. Outer retinal diseases can alter the retinal topography and affect the segmentation accuracy of the inner retinal layers. Large drusen may cause segmentation error and compression of the inner macular layers. Geographic atrophy confounds automated segmentation in a high proportion of eyes. Clinicians should be cognizant of the effects of outer retinal disease on the inner retinal layer measurements when interpreting the results of macular OCT imaging in patients with glaucoma.

The effect of age-related macular degeneration on cognitive test performance

The reliable assessment of cognitive functioning is critical to the study of brain-behaviour relationships. Yet conditions that are synchronous which ageing, including visual decline, are easily overlooked when interpreting cognitive test scores. The purpose of this study was to demonstrate the negative consequences of visual impairments on cognitive tests performance. Moderate to severe levels of age-related macular degeneration were simulated, with a set of goggles, in a sample of twenty-four normally sighted participants while they completed two cognitive tasks: a vision-dependent reaction time task and a vision-independent verbal fluency test. Performance on the reaction time task significantly decreased (p < 0.001) in the simulated age-related macular degeneration condition, by as much as 25 percentile ranks. In contrast, performance on the verbal fluency test were not statistically different between the simulated and normal vision conditions (p = 0.78). The findings highlight the importance of considering visual functioning when assessing cognitive function. When vision is not accounted for, low test scores may inaccurately indicate poor cognition. Such false attributions may have significant ramification for diagnosis and research on cognitive functioning.

Autofluorescent Organelles Within the Retinal Pigment Epithelium in Human Donor Eyes With and Without Age-Related Macular Degeneration.

PurposeHuman retinal pigment epithelium (RPE) cells contain lipofuscin, melanolipofuscin, and melanosome organelles that impact clinical autofluorescence (AF) imaging. Here, we quantified the effect of age-related macular degeneration (AMD) on granule count and histologic AF of RPE cell bodies.MethodsSeven AMD-affected human RPE-Bruch's membrane flatmounts (early and intermediate = 3, late dry = 1, and neovascular = 3) were imaged at fovea, perifovea, and near periphery using structured illumination and confocal AF microscopy (excitation 488 nm) and compared to RPE-flatmounts with unremarkable macula (n = 7, >80 years). Subsequently, granules were marked with computer assistance, and classified by their AF properties. The AF/cell was calculated from confocal images. The total number of granules and AF/cell was analyzed implementing a mixed effect analysis of covariance (ANCOVA).ResultsA total of 152 AMD-affected RPE cells were analyzed (fovea = 22, perifovea = 60, and near-periphery = 70). AMD-affected RPE cells showed increased variability in size and a significantly increased granule load independent of the retinal location (fovea: P = 0.02, perifovea: P = 0.04, and near periphery: P < 0.01). The lipofuscin fraction of total organelles decreased and the melanolipofuscin fraction increased in AMD, at all locations (especially the fovea). AF was significantly lower in AMD-affected cells (fovea: <0.01, perifovea: <0.01, and near periphery: 0.02).ConclusionsIn AMD RPE, lipofuscin was proportionately lowest in the fovea, a location also known to be affected by accumulation of soft drusen and preservation of cone-mediated visual acuity. Enlarged RPE cell bodies displayed increased net granule count but diminished total AF. Future studies should also assess the impact on AF imaging of RPE apical processes containing melanosomes.

OCULAR SURFACE TEMPERATURE DIFFERENCES IN RETINAL VASCULAR DISEASES.

To define the effect of age-related macular degeneration (AMD) and diabetic retinopathy (DR) on the ocular thermographic profile. This retrospective cross-sectional study included subjects diagnosed with DR or AMD between January and April 2019. Individuals without ocular disease served as controls. A thermal imaging camera was used for ocular surface temperature (OST) acquisition. The mean temperatures of the medial cantus, lateral cantus, and cornea were calculated. Thermographic images were obtained from 133 subjects (260 eyes, 97 DR and 163 AMD) and 48 controls (55 eyes). Ocular surface temperature was higher among patients with AMD and lowest among patients with DR (P < 0.001). A subgroup analysis revealed that eyes with diabetic macular edema had significantly higher OSTs than DR eyes without diabetic macular edema. Moreover, the OST in eyes with diabetic macular edema was similar to the measurements of the AMD group. There were no differences in OSTs between neovascular and nonneovascular AMD eyes. Although AMD and DR are considered posterior segment conditions, their effect on OST implies that the entire globe is involved. Although both conditions result from similar multifactorial pathophysiologic changes, the differences in OST between DR and AMD might be due to dissimilarity in the balance of pathologic processes involved in each condition. Further research is required to better understand the pathophysiology of these diseases and their effect on OST as well as to determine the effect of vasculature, circulation, and tissue metabolism on ocular temperature.

The Effect of Age-Related Macular Degeneration on Polarization Pattern Perception.

PurposeThe purpose of this study was to determine if a battery of polarization-modulated stimuli, quantified as a single metric, is effective in identifying macular disease in the presence/absence of cataract or pseudophakia.MethodsUsing a modified liquid crystal display, polarization pattern perception (PPP) for a formulated battery of geometric and logMAR stimuli was evaluated in participants that had either no eye pathology (healthy participants) or were grouped according to the presence of cataract, pseudophakia, and/or age-related macular degeneration (AMD). PPP was quantified as response frequencies to individual stimuli, and as a novel monocular polarization sensitivity score (Ps) based on perception of the stimulus battery set.ResultsStimulus response frequencies were pattern-dependent and, compared with healthy participants, reduced for cataract and AMD groups but not for subjects with pseudophakia. Compared with healthy eyes (n = 47, median Ps = 17), Ps was significantly reduced by AMD (n = 59, median Ps = 1, P < 0.001) and, to a lesser extent, by cataracts (n = 80, median Ps = 6, P < 0.001). There was no significant difference between Ps for healthy and pseudophakic eyes (n = 47, median Ps = 13, P = 0.323). There was no significant correlation between Ps and logMAR visual acuity.ConclusionsIn the absence of significant cataract, or in pseudophakia, a set of polarization-modulated visual stimuli, quantified as the Ps score, distinguishes AMD from healthy maculae.Translational RelevancePerception of polarization-modulated stimuli, previously shown to be macula-dependent in a laboratory setting, is effective as a test of macular function in health and disease in a clinic setting.

The effects of age-related macular degeneration on quality of life in a Brazilian population

BackgroundTo evaluate the impact of age-related macular degeneration (AMD) on the quality of life (QoL) in a Brazilian population using The National Eye Institute-Visual Function Questionnaire-25 (NEI-VFQ-25).MethodsThis observational study included 462 participants from the Departments of Ophthalmology of the University of Campinas and Conderg-Divinolândia. The NEI-VFQ-25 questionnaire and Rasch analysis were used to assess the vision-related quality of life (VRQoL). Patients with macular neovascularization were interviewed at enrollment and after three loading doses of intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment.ResultsOne hundred thirty-three patients were excluded because they had another ophthalmic disease, for a total of 349 patients included in the study (177 in the AMD group, 172 in the control group; 56.4% were women; mean ± standard deviation age, 70.6 ± 9.5 years). Most NEI-VFQ-25 subscale scores were significantly lower in the AMD group compared with the control group. The Rasch-calibrated NEI-VFQ-25 median score in the visual-functioning component was 56.41 for the AMD group and 61.53 for the control group, a difference of ± 4.00 (P = 0.0001). Separate analyses of the sociodemographic and ocular characteristics showed that the NEI-VFQ-25 scores were affected mostly by family income, educational level, descent, diet (vegetables/fruits), physical activity, and visual acuity (VA). The longitudinal component assessed a different group of 48 patients with exudative disease treated with anti-VEGF drugs. The mean logarithm of the minimum angle of resolution change in VA in treated eyes was a 0.16 decrease (P = 0.01). The mean change in the optical coherence tomography macular thickness was a 36.74-μm decrease (P = 0.012) from baseline to 4 months. The mean NEI-VFQ-25 scores improved significantly from baseline to follow-up at 4 months in almost all subscales.ConclusionsIn a Brazilian community, patients with AMD had a worse VRQoL than controls. The AMD severity and bilaterality were associated with decreased NEI-VFQ-25 scores. Higher family income, educational level, descent, and lifestyle significantly improved several subscales of the NEI-VFQ-25 questionnaire. Treated patients with exudative AMD had improvements in the VA, macular thickness, and most NEI-VFQ-25 subscale scores.

Our Experience of Nutraceutical Effects in Age-Related Macular Degeneration

Purpose: to assess the possibilities of ophthalmonutraceuticals using in age-related macular degeneration (AND) patients.Patients Methods. The study included 35 patients (68.3 ± 6.3 years old; 15 men, 20 women) with AMD (AREDS-2 and AREDS-3 categories). As an ophthalmic nutraceutical, a biological active supplement was used, included vitamins C and E, zinc, lutein, zeaxantine, cooper, selenium (Retinorm; 3 capsules per day with meals). The observation period was 12 months (6 courses of therapy). There were the main control points: examination at study entry and examination at study completion. All those observed patients were underwent standard ophthalmological examination; fundus state photo registration (Nidek); OCT (Opto-Vue). The significance of a possible increase in the proportion of AREDS-3–4 AMD category patients was assessed using the Pearson γ2 test. An additional criterion was the maximum corrected visual acuity (MCVA) stabilization. The mean and its standard deviation (M ± s) were calculated, the significance of differences was assessed using the Wilcoxon’s t-test.Results. The study was completed in 33 patients. In 2 eyes a transition of AMD from the AREDS-2 to AREDS-3 category was recorded (an increase in the number and size of druses, with the appearance of large druses). The increase in the proportion of patients with the AREDS-3 AMD category was statistically insignificant (γ2 = 0.267; p = 0.606). In no case was there a transition to the AREDS-4 category. In the vast majority of those who completed the study (31 eyes; 93.9 %), the manifestations of AMD were stable, which, taking in account the chosen criterion, allows us to consider nutraceutical support to be affective. MCVA during the observation period also remained stable with a slight, but statistically insignificant tendency to its increase (from 0.72 ± 0.07 to 0.75 ± 0.09; t = 37.5, p &gt; 0.05). One patient was excluded from the study after 6 months of observation due to development of an allergic skin reaction (presumably to the components of a nutraceutical). In the vast majority of patients (97.1%), no significant side effects of therapy were observed, the nutraceutical regimen was comfortable. One more patient was excluded from the study (after 3 months) due to his failure to appear for next follow-up examination.Conclusion. The use of Retinorm ophthalmonutraceutical can stabilize the manifestations of AMD (AREDS-2–3) in 93.9 % of patients with follow-up periods of up to 12 months. Repeated courses of therapy in 97.1 % of patients are not accompanied by significant side effects, and the regimen for taking ophthalmonutraceuticals is characterized by patients as comfortable.

The Effect of Age-Related Macular Degeneration on Components of Face Perception.

PurposePatients with age-related macular degeneration (AMD) experience difficulty with discriminating between faces. We aimed to use a new clinical test to quantify the impact of AMD on face perception and to determine the specific aspects that are affected.MethodsThe Caledonian face test uses an adaptive procedure to measure face discrimination thresholds: the minimum difference required between faces for reliable discrimination. Discrimination thresholds were measured for full-faces, external features (head-shape and hairline), internal features (nose, mouth, eyes, and eyebrows) and shapes (non-face task). Participants were 20 patients with dry AMD (logMAR VA = 0.14 to 0.62), 20 patients with wet AMD (0.10 to 0.60), and 20 age-matched control subjects (−0.18 to +0.06).ResultsRelative to controls, full-face discrimination thresholds were, on average, 1.76 and 1.73 times poorer in participants with dry and wet AMD, respectively. AMD also reduced sensitivity to face features, but discrimination of the internal, relative to external, features was disproportionately impaired. Both distance VA and contrast sensitivity were significant independent predictors of full-face discrimination thresholds (R2 = 0.66). Sensitivity to full-faces declined by a factor of approximately 1.19 per 0.1 logMAR reduction in VA.ConclusionsBoth dry and wet AMD significantly reduce sensitivity to full-faces and their component parts to similar extents. Distance VA and contrast sensitivity are closely associated with face discrimination sensitivity. These results quantify the extent of sensitivity impairment in patients with AMD and predict particular difficulty in everyday tasks that rely on internal feature information, including recognition of familiar faces and facial expressions.

Visual searching capabilities in Age-Related Macular Degeneration (AMD) subjects

A decrease in visual perception with age was observed due to a decline in neurocognitive and visual functions. Previous studies showed that aging affects visual processes and contextual perceptual phenomena. The aim of our study was to explore the effect of age as well as the effect of Age-Related Macular Degeneration (AMD) on the visual searching task. Three groups of twenty-one subjects were recruited: AMD subjects (mean age 72.29 ± 4.83 years); healthy elderly (72.55 ± 4.95); and young healthy volunteers (28.38 ± 2.77). Visual perception functions were evaluated with a modified barrage test developed by Metrisquare. Our results showed that AMD patients and elderly do not differ in terms of time, omissions and errors. However both were slower to perform the visual perception tests when compared with young adults. Regarding the number of errors and omissions, we only found significant differences between the young and the AMD subjects, the later making more omissions and errors respect to young healthy volunteers. Despite AMD patients made more errors likely because to their poor fixation capability, we could conclude that AMD patients, as well as healthy elderly subjects, could compensate their altered visual strategies by taking more time to perform the visual searching tasks, probably due to cortical plasticity. Highlights AMD patients and healthy elderly subjects do not differ in terms of time, omissions and errors. AMD patients, as well as healthy elderly subjects could compensate their visual difficulties by taking more time to perform the visual searching tasks when compared to young healthy volunteers. It is probably due to cortical plasticity. Note, however that AMD patients could make more errors when compared to young healthy volunteers, probably due to their poor fixation capability. The number of omissions and errors not different in healthy young and in elderly subjects.

Effects of Crude Fucus distichus Subspecies evanescens Fucoidan Extract on Retinal Pigment Epithelium Cells-Implications for Use in Age-Related Macular Degeneration.

Fucoidan extracts may have beneficial effects in age-related macular degeneration (AMD). Over-the-counter fucoidan preparations are generally undefined, crude extracts. In this study, we investigated the effect of a crude fucoidan extract from Fucus distichus subspecies evanescens (Fe) on the retinal pigment epithelium (RPE). Fe extract was investigated for chemical composition and molar mass. It was tested in primary RPE and RPE cell line ARPE19. Oxidative stress was induced with tert-butyl hydroperoxide, cell viability evaluated with MTT assay, VEGF secretion assessed in ELISA. Phagocytosis was evaluated in a fluorescence microscopic assay. Wound healing ability was tested in a scratch assay. Additionally, the inhibition of elastase and complement system by Fe extract was studied. The Fe extract contained about 61.9% fucose and high amounts of uronic acids (26.2%). The sulfate content was not as high as expected (6.9%). It was not toxic and not protective against oxidative stress. However, Fe extract was able to reduce VEGF secretion in ARPE19. Phagocytosis was also reduced. Concerning wound healing, a delay could be observed in higher concentrations. While some beneficial effects could be found, it seems to interfere with RPE function, which may reduce its beneficial effects in AMD treatment.

Bionic System Restores Sight

Trials reverse effects of age-related macular degeneration

Effects of Age-Related Macular Degeneration on Driving Performance.

PurposeTo explore differences in driving performance of older adults with age-related macular degeneration (AMD) and age-matched controls, and to identify the visual determinants of driving performance in this population.MethodsParticipants included 33 older drivers with AMD (mean age [M] = 76.6 ± 6.1 years; better eye Age-Related Eye Disease Study grades: early [61%] and intermediate [39%]) and 50 age-matched controls (M = 74.6 ± 5.0 years). Visual tests included visual acuity, contrast sensitivity, visual fields, and motion sensitivity. On-road driving performance was assessed in a dual-brake vehicle by an occupational therapist (masked to drivers' visual status). Outcome measures included driving safety ratings (scale of 1–10, where higher values represented safer driving), types of driving behavior errors, locations at which errors were made, and number of critical errors (CE) requiring an instructor intervention.ResultsDrivers with AMD were rated as less safe than controls (4.8 vs. 6.2; P = 0.012); safety ratings were associated with AMD severity (early: 5.5 versus intermediate: 3.7), even after adjusting for age. Drivers with AMD had higher CE rates than controls (1.42 vs. 0.36, respectively; rate ratio 3.05, 95% confidence interval 1.47–6.36, P = 0.003) and exhibited more observation, lane keeping, and gap selection errors and made more errors at traffic light–controlled intersections (P < 0.05). Only motion sensitivity was significantly associated with driving safety in the AMD drivers (P = 0.005).ConclusionsDrivers with early and intermediate AMD can exhibit impairments in their driving performance, particularly during complex driving situations; motion sensitivity was most strongly associated with driving performance. These findings have important implications for assessing the driving ability of older drivers with visual impairment.

Effects of Age-Related Macular Degeneration on Postural Sway.

Purpose: To compare the impact of unilateral vs. bilateral age-related macular degeneration (AMD) on postural sway, and the influence of different visual conditions. The hypothesis of our study was that the impact of AMD will be different between unilateral and bilateral AMD subjects compared to age-matched healthy elderly.Methods: Postural stability was measured with a platform (TechnoConcept®) in 10 elderly unilateral AMD subjects (mean age: 71.1 ± 4.6 years), 10 elderly bilateral AMD subjects (mean age: 70.8 ± 6.1 years), and 10 healthy age-matched control subjects (mean age: 69.8 ± 6.3 years). Four visual conditions were tested: both eyes viewing condition (BEV), dominant eye viewing (DEV), non-dominant eye viewing (NDEV), and eyes closed (EC). We analyzed the surface area, the length, the mean speed, the anteroposterior (AP), and mediolateral (ML) displacement of the center of pressure (CoP).Results: Bilateral AMD subjects had a surface area (p < 0.05) and AP displacement of the CoP (p < 0.01) higher than healthy elderly. Unilateral AMD subjects had more AP displacement of the CoP (p < 0.05) than healthy elderly.Conclusions: We suggest that ADM subjects could have poor postural adaptive mechanisms leading to increase their postural instability. Further studies will aim to improve knowledge on such issue and to develop reeducation techniques in these patients.

Age-Related Macular Degeneration Is Associated with Less Physical Activity among US Adults: Cross-Sectional Study.

BackgroundWe have a limited understanding of the effects of age-related macular degeneration (AMD) on physical activity (PA), and we have no prevalence estimates of the daily movement patterns among Americans with AMD. Therefore, we examined the association between AMD and PA and provided estimates of the daily movement patterns of Americans with AMD.MethodsData from the 2005-2006 National Health and Nutrition Examination Survey were used, including 1,656 adults (40-85 yrs). Retinal imaging was performed to classify individuals as no AMD, early AMD, or late AMD. Participants wore an ActiGraph 7164 accelerometer for 7 days to measure PA behavior.Results93.2% of participants with late AMD were in the least desirable group (not sufficiently active and having a negative light intensity-sedentary behavior balance). After adjustments (including age), participants with late AMD, as compared to those with no AMD, engaged in 50% less moderate-to-vigorous physical activity (MVPA) (RR = 0.50; 95% CI: 0.28-0.90). When visual acuity was entered into the model along with the other covariates, the association between late AMD and MVPA was no longer significant (RR = 0.54; 95% CI: 0.29-1.01), suggesting that visual acuity may partially mediate this relationship.ConclusionsIndividuals with late AMD engage in very little moderate-to-vigorous physical activity. Visually acuity, in part, explains the relationship between late AMD and PA.

Effects of age-related macular degeneration and ambient light on curb negotiation.

To determine how age-related macular degeneration (AMD) and changes in ambient light affect the ability to negotiate a curb while walking. Ten older adults with AMD and 11 normal-sighted control subjects performed a curb negotiation task under normal light (∼600 lux), dim light (∼0.7 lux), and following a sudden reduction (∼600 to 0.7 lux) of light. In this task, subjects walked and stepped up or down a simulated sidewalk curb. Movement kinematics and ground reaction forces were measured during curb ascent and descent. Habitual visual acuity, contrast sensitivity, and visual fields were also assessed. Apart from slower gait speed in those with AMD, there were no differences between groups during curb ascent for any other measure. During curb descent, older adults with AMD frequently used shuffling steps in the approach phase to locate the curb edge and showed prolonged double support duration stepping over the curb compared with control subjects. However, reduced lighting, particularly a sudden reduction, led to several significant changes in movement characteristics in both groups. For instance, toe clearance stepping up the curb was greater, and landing force stepping down was reduced. In addition, slower gait speed and greater double support duration were evident in curb ascent and descent. In AMD subjects, contrast sensitivity, visual acuity, and visual field threshold were associated with several kinematic measures in the three light conditions during curb negotiation. Minor AMD-specific changes in movement are seen during curb negotiation. However, attenuated lighting greatly impacts curb ascent and descent, regardless of eye disease, which manifests as a cautious walking strategy and may increase the risk of falling. Environmental enhancements that reduce the deleterious effects of poor lighting are required to improve mobility and quality of life of older adults, particularly those with AMD.

Space representation in age-related macular degeneration.

To investigate the effect of age-related macular degeneration (AMD) on memory for spatial representations in realistic environments. Participants were 19 patients with AMD and 13 age-matched observers. In a short-term spatial memory task, observers were first presented with one view of a scene (the prime view), and their task was to change the viewpoint forward or backward to match the prime view. Memory performance was measured as the number of snapshots between the selected view and the prime view. When selecting a match to the prime view, both people with AMD and those in the control group showed systematic biases toward the middle view of the range of snapshots. People with AMD exhibited a stronger middle bias after presentation of close and far prime views while navigating accurately after a middle prime view. No relation was found between visual acuity, visual field defect, or lesion size and the memory performance. Memory tasks using indoor scenes can be accomplished when central vision is impoverished, as with AMD. Stronger center bias for a scene location suggests that people with AMD rely more on their memory of a canonical view.

Psychosocial effects of age-related macular degeneration

Background: Age-related macular degeneration (AMD) affects approximately 10% of persons aged 65–74 years and 30% of those aged 75 and older and is the major cause of blindness in old age. AMD is progressive and irreversible.<Aim: To review the psychosocial effects of AMD.Method: OVID data bases (MEDLINE, psycINFO and CINAHL) from 1966 to 2004 were reviewed.Results: AMD is associated with functional impairment, high rates of depression, anxiety and emotional distress and increased mortality. Risk factors for depression are not well-defined, except for the degree of functional impairment and impending or actual loss of vision in the second eye. Behavioral and self-management programs may be effective in managing depression associated with AMD, but few studies have been performed, and none using drugs or multimodal therapy.Conclusion: AMD will become even more prevalent as the population ages. Identification of risk factors for psychological consequences and of effective interventions remain to be recognized.

Multivitamin-multimineral supplements and eye disease: age-related macular degeneration and cataract

The prevalence and effects of age-related macular degeneration (AMD) and cataract are increasing dramatically as the proportion of elderly in our population continues to rise. A multivitamin-multimineral supplement with a combination of vitamin C, vitamin E, β-carotene, and zinc (with cupric oxide) is recommended for AMD but not cataract. Weak support exists for multivitamins or other vitamin supplements from observational studies of cataract. The results of observational studies suggest that a healthy lifestyle with a diet containing foods rich in antioxidants, particularly lutein and zeaxanthin, as well as n−3 fatty acids, appears beneficial for AMD and possibly cataract. The Age-Related Eye Disease Study II will evaluate some of these additional nutrients as dietary supplements in a randomized trial.