Another limitation of our study was the small cohort of patients; a larger cohort would allow us to obtain more robust results and divide GA into different groups based on FAF patterns. GA, the late-stage of AMD, is increasing exponentially with population aging4 and is becoming a larger public health problem.5 GA is characterized by loss of the retinal pigment epithelium (RPE) in the parafoveal area (pericentric macula).68 With disease progression, atrophic areas grow and coalesce leading to foveal RPE atrophy and moderate to severe vision loss.9 Patients with foveal-sparing (FS) GA may have good central vision but have many difficulties reading or recognizing faces due to parafoveal scotomata and because they cannot fit into the non-atrophic foveal area.9,10 The progression of GA results in a deterioration of visual function and a reduction in quality of life.
Age and gender variations in age-related macular degeneration prevalence in populations of european ancestry: a meta-analysis. HHS Vulnerability Disclosure, Help PMC legacy view 1Ophthalmology Department, Retina Research Center, Austin, Texas, USA, 2Optometry Department, University of Valencia, Valencia, Spain, 3Ophthalmology Department, Qvision, Hospital Vithas Virgen Del Mar, Almeria, Spain, 4Ophthalmology Department, La Fe University Hospital, Valencia, Spain, 5Surgery Department, University of Valencia, Valencia, Spain, 6Ophthalmology Department, Oftalvist, IMED Hospital, Valencia, Spain. There was a notable difference in age between groups, as healthy patients who met the requirements and completed all tests, were younger than patients with GA. The new PMC design is here! Association Between Visual Function Tests and NEI VFQ-25 in GA Patients. Augood CA, Vingerling JR, de Jong PTVM, et al. In patients with multiple hypo-autofluorescent areas, all areas of more than 0.5 mm2 were summed. http://creativecommons.org/licenses/by-nc/3.0/. Multimodal imaging with fundus autofluorescence (FAF) and spectral-domain optical coherence tomography (SD-OCT) have proven to be useful in monitoring GA.5,8,30 The combination of multimodal imaging with psychophysical tests and quality of life questionnaires may allow for a more comprehensive evaluation of the progression of GA.31,32 Nonetheless, there is no consensus on the anatomic and functional evaluation of GA that takes into account the patientreported outcome (PRO). Bandello F, Sacconi R, Querques L, Corbelli E, Cicinelli MV, Querques G. Recent advances in the management of dry age-related macular degeneration: a review. Statistical analysis was performed using IBM SPSS software version 24 (IBM-SPSS Inc, USA). Most of the clinical tests correlated highly with NEI VFQ-25 scores, but reading speed and atrophy area explained the majority of the variation in the GA patient-reported outcome. Association Between Visual Function Tests and NEI VFQ-25 in CG and GA Patients.
To comprehensively evaluate visual function in eyes with geographic atrophy (GA) as compared to normal eyes. Patient Baseline Demographics and Ocular Characteristics. MB]#F+Q.w^EnAE+52n#+WeQ6W|k&C @xAx}.p_Ct/G|p) ]dqa%\vs#j Mh>mx+!PMh%P?xaxaS$3E3(YokMiaxaxo@axaxa5($D@* fK (O_z4xaxaxaxao^BORS$(!9p:GAFiMBQ+nGB{C8+{39o__C'C=Q'gRA=x:~0=hP/9:|v.3FcsV `.r$OOg?__L 0JgP9Br\rm 9lF8 1og'|)I4~(p/]A&TZZA'qgZ\5?nZ4
In the GA group, moderate and strong correlations were found between the NEI VFQ-25 composite score, near and distance activities score with the atrophy area, maximum reading speed, maximum CS, fixation, and macular sensitivity (Table 4). Reading speed tests results explained most of the variance in the NEI VFQ-25 composite score and near activities score, accounting for more than 48% (p 0.01) of the variance in each of these scores (Table 7).
Abbreviations: GA, geographic atrophy; CG, control Group. When all patients were analyzed together as a group, all visual function tests showed correlation except central subfield thickness (CST) and CPS; results are illustrated in Table 6. The https:// ensures that you are connecting to the Visual function abnormalities and prognosis in eyes with age-related geographic atrophy of the macula and good visual acuity, Changes in retinal sensitivity in geographic atrophy progression as measured by microperimetry, Use of fundus perimetry (microperimetry) to quantify macular sensitivity. Best corrected visual acuity (BCVA) and low luminance visual acuity (LLVA) were measured with the Early Treatment Diabetic Retinopathy Study (ETDRS) chart illuminated with a negatoscope that provided the standardized illumination of the optotypes (equipped with two 20 watt daylight fluorescent bulbs) at 4 meters and at 1 meter only if unable to read at least 19 letters at 4 meters, in which case +0.75 diopter lens was added and the test performed at 1 meter. CPS is defined as the minimum character that one can read with fast speed. Notes: *p0.01 (MannWhitney U-test). Sunness JS, Gonzalez-Baron J, Applegate CA, et al. In contrast to the study by Hazel et al, CS results did not reach significance in our regression analysis in the near activities score. In conclusion, advanced AMD with GA causes a dramatic decrease of visual function and quality of life as a result of disease progression. Table 5 shows the only correlation found in the CG between NVA and distance activities score. On the right, the black points correspond to no sensitivity and the red points correspond to decreased sensitivity on the macular sensitivity map.
Interestingly, a recent study demonstrated that visual rehabilitation via microperimetry may be effective in improving fixation stability, reading speed, and visual acuity after one week of training, but no improvement in retinal sensitivity was noted after training.50 Some studies reveal detail on changes in retinal sensitivity in the pathogenesis of GA.
No relevant financial or commercial relationship exists for any author. Visual function and subjective quality of life compared in subjects with acquired macular disease.
Macular integrity and fixation stability were evaluated with the Macular Integrity Assessment (MAIA, CenterVue, Padova, Italy). Ramrez Estudillo JA, Len Higuera MI, Rojas Jurez S, Ordaz Vera ML, Pablo Santana Y, Celis Suazo B.
In our study, there were 6 questions about reading whereas the VCM1 has 15 reading questions. Age was not included as a factor in the analysis due to the fact that it did not correlate with any of the variables. Federal government websites often end in .gov or .mil.
The highest positive correlation was found between the maximum reading speed and the composite score r = 0.787 (p0.01), and the negative highest correlation was between the atrophy area and the composite score r = 0.689 (p0.01). p0.01 (Pearson Chi Square). the european eye study (EUREYE). Only significant relationships are shown. Given the lack of treatment options to prevent GA, it is especially important to monitor closely for progression of GA and comprehensively evaluate visual function.38 The ultimate goal will be early intervention once an effective treatment is established. In clinical practice, some psychological aspects and daily life difficulties have been neglected.33 There are very few studies centered on PRO measures to assess the influence of visual impairment on vision-related function and vision-related quality of life in patients with advanced AMD.34,35 The 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) test is the most often used in clinical trials, and is considered the gold standard to evaluate the impact of vision loss on quality of life in patients with AMD.5,32,36 Recently, the NEI VFQ-25 has been recognized as a valid and reliable measure of the impact of GA on visual function and vision-related quality of life.34 In addition to the NEI VFQ-25 test, the functional reading Independence (FRI) index is a new psychometric instrument for assessment of functional reading developed specifically for GA patients. GA lesion size was calculated using high-resolution (1536 x 1536 pixels) FAF and 30 x 30 degree field of images centered on the fovea. Our results demonstrated that a reading letter size between 20/125 and 20/160 may be optimal for all patients healthy eyes as well as those with geographic atrophy regardless of area of involvement. The measurement of reading speed was done with the Radner Reading Test measured as logarithm of the reading acuity determination (logRAD), formed of short sentence optotypes (14 words) with standardized word length, word location, lexical and syntactical difficulty. ==`, z~\/H Qan {q.~5Wyvw-Ym sf9n5US*'G+'LHO ''>d44jR! nS3H {T36O]3
Development of the 25-item national eye institute visual function questionnaire, Functional reading independence (FRI) index: a new patient-reported outcome measure for patients with geographic atrophy, Preventing the growth of geographic atrophy: an important therapeutic target in age-related macular degeneration, The effect of non-neovascular age-related macular degeneration on face recognition performance.
Reading speed and contrast sensitivity results are presented in Figures 1 and and2.2. Abbreviations: Max, maximum; GA, geographic atrophy. The current study did not divide GA into central and non-central atrophy groups. government site. There were strong and moderate correlations in CG and GA groups together, for NEI VFQ-25 composite score, near and distance activities score with all visual function tests, except for the CST and CPS (Table 6). They had better VA likely because 75% of the patients had foveal-sparing GA in our study. /Length1 625364 The GA areas were defined as areas of decreased autofluorescence (hypo-autofluorescence) and were measured using the Spectralis software version 5. )gq'>: FE:.gPkYW@~AhE U>AWiS;1R~X]bH!Oepk i=%Sh>IB+cD"MzOI{ # ;^] =u'3_ awr: bkW]zJz] OD6/0|A-^@!P/4 @;a=p?`` 4Q
Yehoshua Z, de Amorim Garcia Filho CA, Nunes RP, et al. The .gov means its official. OI The composite score in the GA group was 46.7 (mean VA letter score 71, 20/40). The results of the CSF were not significant in the regression analysis; however we have demonstrated a strong correlation between the CSF and near activities in the GA group (Table 4). It was tested at 32 centimeters and started with the larger letter size. Preliminary analysis showed that both variables were not normally distributed as assessed by ShapiroWilk test and p-value 0.05. In a previous trial, significant correlations between visual function tests and the vision-related quality of life test, vision core measure (VCM1), were identified in subjects with acquired macular disease.48 Recently, The Phase 2 MAHALO study reported correlations between NEI VFQ composite score and near and distance activities score, maximum binocular reading speed, and FRI index score in patients with GA.34 The highest correlation found was between the composite score and reading speed.
The patient should be able to distinguish the direction of the sinusoidal waves and the answers were recorded as a curve; the CSF curve of each patient was obtained. Learn more Furthermore, it has been suggested that these visual function measures be monitored more closely in patients with GA.17 As GA progresses, changes become evident in several visual functions before deterioration in BCVA occurs. There is a lack of correlation between CST and the NEI VFQ-25 in both groups likely due to fovea sparing of GA until very advanced and due to generalized variability in CST.
All participants underwent the psychophysical tests of visual function during the study visit. Sixty-three eyes from 63 patients 50 years old were recruited for this observational study; 31 were identified as normal macular health eyes and 32 with GA. Sadda SR, Chakravarthy U, Birch DG, Staurenghi G, Henry EC, Brittain C. Clinical endpoints for the study of geographic atrophy secondary to age-related macular degeneration. Error bars represent 95% confidence interval. The comparison of the results of the visual function tests between groups are shown in Table 2 and the NEI VFQ-25 scores in Table 3. Careers, Correspondence: Gowtham Jonna Tel +1512 454 5851, Email g_jonna@hotmail.com. Although the GA group showed an important reduction in the reading speed measurements compared with CG, both were able to read a similar size of letter with maximum speed.
Compared with NEI VFQ-25 composite scores in other studies such as: The Los Angeles Latino Eye Study 59.5 in late AMD (12 patients with GA, 17 patients with neovascular AMD), 79.4 for patients with early AMD and 80.7 for those without AMD,35 MARINA 69.3 (53.5 letters 20/80) and ANCHOR 69.9 (46.6 letters 20/125) in neovascular AMD,51 and last and uniquely GA patients the Phase 2 MAHALO study 61.7 (48 letters, 20/125),34 the composite score in our GA group was lower. Though variable, the mean enlargement rate of GA from the largest clinical trials to date is approximately 2 mm2 per year but there remains no currently approved, efficacious treatment option.29 For this reason, it is very important to continue to refine the tools for monitoring GA progression. endobj sharing sensitive information, make sure youre on a federal The decreased visual function is reflected in a poor quality of life in patients with GA. Reading speed, contrast sensitivity, fixation, and macular sensitivity are strongly associated with vision-related quality of life. /Filter /FlateDecode Only the sentences read in 20 seconds at most were recorded as valid. ]cQ`Lqli ydP~'y9F?0>7460~ Z,e@Q%~HB?CB>U5/0x`5P. Moderate and strong correlations in the GA group were found between maximum reading speed (r = 0.787) (p0.01), CS spatial frequency 3 cpd (r = 0.441) (p0.05), CS spatial frequency 6 cpd (r = 0.524) (p0.01), fixation P1 (r = 0.379) (p0.05), macular sensitivity (r = 0.484) (p0.05) and atrophic area (r = 0.689) (p0.01), and the VFQ-25 composite score. Reductions in maximum reading rate, LLVA, and CS, and worse LLD, are considered significant predictors of subsequent vision loss. The evaluation of macular function and retinal sensitivity,9,11,20-23 the measurement of extrafoveal fixation, PRL,2427 and fixation stability28 by microperimetry are useful to simultaneously analyze anatomic and visual function in patients with GA. Microperimetric assessment of visual function has been significantly correlated to the progression of GA lesion area over two years.20 This study illustrated a decrease of macular sensitivity and fixation stability in eyes with GA as compared to healthy eyes (p0.01) (Table 2). It is sometimes associated with depression due to the progressive loss of vision. Both CS and LLD are reliable measurements that detect abnormal visual function and help to determine the risk of VA loss in GA patients.17,48,49. The test is made up of circular sheets on a grey background with sinusoidal waves in 5 frequency levels and 8 contrast levels. Anatomic function was evaluated with spectral-domain optical coherence tomography (SD-OCT) and fundus autofluorescence (FAF). >> For each participant, standardized protocol refraction was performed first followed by BCVA and then LLVA.
In macular diseases such as AMD with GA, it is critical to correlate the anatomic findings with visual function.11 Though visual acuity has been used as the primary metric to assess visual function, it has been demonstrated that it is inadequate to comprehensively assess visual impairment10 and thus, underrepresents functional deficits.12 Other measures such as the contrast sensitivity function (CSF),1316 reading speed,1619 and low luminance visual acuity (LLVA), have been introduced to predict future VA loss.9,17,19 Several studies have also demonstrated the importance of microperimetry,9,11,20-23 measurement of extrafoveal fixation/preferred retinal locus (PRL),2427 and fixation stability in the assessment of retinal sensitivity and macular function.28. /Type /Stream 93JsFsbeCB~ZPy!,Ft 5g-n4))t 75cRK8]s{.7%mWcas/zzMPUoPUuo$5 !W>t)R",i: rI-Hf%8fEZzvr bk"Wv+CUY;3Ao2u/n_PUh0}Y7+ O`EcXD*k;RYU=UI]P}~jn!2wKAN2+f |*K,7cb.R"|ON hGH$KU DFsJWwWz1j;srDtTvOiT#&^t{s;i&m#1TW,%s"E"u'].st!>l%-#-%P. Error bars represent 95% confidence interval. This study was approved by the Committee of the Sanitary Research Institute La Fe.
Difficulties in reading tasks are the most common complaints in patients with GA due to the critical importance of reading in varied daily activities. The control group composite score was 89.6 (20/16), which is comparable to other studies.35,52. Abbreviations: GA, geographic atrophy; CG, control group. Finally, all patients completed the NEI VFQ-25 Version 2000. Abbreviations: CG, control group; GA, geographic atrophy; NVA, near visual acuity; BCVA, best corrected visual acuity; LLVA, low luminance visual acuity; LLD, low luminance deficit; CPS, critical point size; CS, contrast sensitivity; BCEA, bivariate contour ellipse area; CST, central subfield thickness; Max, maximum; SD-OCT, spectral-domain optical coherence tomography. about navigating our updated article layout.
Surprisingly, there was no correlation identified for CPS.
Schmitz-Valckenberg S, Bltmann S, Dreyhaupt J, Bindewald A, Holz FG, Rohrschneider K. Fundus autofluorescence and fundus perimetry in the junctional zone of geographic atrophy in patients with age-related macular degeneration, The preferred retinal locus in macular disease, Functional and cortical adaptations to central vision loss, Preferred retinal loci relationship to macular scotomas in a low-vision population, Concept of a functional retinal locus in age-related macular degeneration. Patients with foveal-sparing GA may have scotomata encircling the fovea or in the parafoveal area but with fovea-involving GA, central scotomata may lead to eccentric fixation and PRL. The In addition to reading speed, macular sensitivity showed an important relationship with composite and distance activities scores; if we add macular sensitivity to the model, it would explain an additional 4.8% of the variation (p 0.05) in the composite score and 8.3% of the variation (p 0.05) in the distance activities score.