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Reference map of multimodal vision deficits in intermediate age-related macular degeneration: contrast sensitivity
Filippos Vingopoulos1,2, Raviv Katz1, Neal Sanjay Patel2
1Harvard Retinal Imaging Lab, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.
Purpose:
To provide a reference map of deficits in contrast sensitivity (CS) and low-contrast visual acuity (LCVA) across stages of non-exudative age-related macular degeneration (AMD) and evaluate functional consequences of optical coherence tomography structural biomarkers.
Method:
Prospective cross-sectional study of 509 eyes of 358 subjects: 317 dry AMD eyes (99 early, 177 intermediate, 41 advanced), 192 healthy control eyes. Reference limits defined from control eye measures of best-corrected visual acuity (BCVA), quantitative contrast sensitivity function (CSF) measures of LCVA, area under the logarithm CSF (AULCSF), CS at multiple frequencies. Risk scores defined by the sum of structural biomarkers in each eye were associated with visual outcomes across and within AMD stages using multiple linear regression analyses.
Results:
Compared with controls, AULCSF declined by 2.2 decibels (dB) in early AMD (eAMD), 3.7 dB in intermediate AMD (iAMD) and 8 dB in advanced AMD. Proportions iAMD eyes breaching reference limits: 50% for AULCSF, 36% for BCVA, 39% for LCVA. For eAMD and iAMD, risk scores were significantly correlated with AULCSF (p<0.02) and CS at low frequencies (1-3 cpd, p<0.005) but not BCVA and LCVA (p>0.05). High-risk eyes breached 1-3 cpd reference limits at higher rates (60-68%) than low-risk eyes (24-30%). AULCSF and LCVA deficits were presented on a novel map of multimodal vision loss.
Conclusion:
The functional consequences of AMD structural biomarkers were validated by structure-function analyses. We provide a reference map of multimodal vision deficits in AMD for CS and LCVA that could be useful to follow the progression of vision loss in AMD in routine clinical practice and as a clinical trial endpoint.
