Visual factors and mobility in persons with age-related macular degeneration

The objectives of this study were to determine the effects of reducing light level on mobility performance in persons with age-related macular degeneration (ARMD) and how performance relates to measures of visual sensory and perceptual function. ARMD results in the loss of central, high-acuity vision and is the leading cause of vision loss in veterans participating in the blind rehabilitation programs of the Department of Veterans Affairs. In 41 subjects with ARMD acuity, peak letter contrast sensitivity, visual field extent, glare disability, color confusion, spatio-temporal contrast sensitivity, motion sensitivity, scanning ability, and figure-ground discrimination were measured to determine their ability to predict mobility performance. Mobility performance was assessed under photopic (high illumination) and mesopic (low illumination) lighting conditions on a laboratory obstacle course and two real-world courses, an indoor hallway and an outdoor residential route. Reducing illumination resulted in significant increases in the time to complete each course and the number of mobility incidents (errors) that occurred. Two measures of overall performance, total time and total mobility incidents, were calculated for each course by summing time and incidents over the two illumination levels. Combinations of vision variables were able to account for 30 to 60% of the variance in the measures of overall performance. Log contrast sensitivity measured with the Pelli-Robson chart test and visual field extent were the most important predictors of performance. Other variables making significant contributions to prediction in multi-predictor models included: scanning ability, glare sensitivity, color confusion, and peak contrast sensitivity to drifting gratings.