Visual Performance, and it\u27s Response to Intervention, in Subjects with Age-Related Macular Degeneration.

Abstract Objectives: 1. To explore visual performance status through a range of psychophysical methods beyond corrected distance visual acuity (CDVA), in subjects with age-related macular degeneration (AMD). 2. To investigate the effects on these visual performance parameters in subjects with neovascular age-related macular degeneration (nv-AMD) and in subjects with early AMD undergoing anti-VEGF (vascular endothelial growth factor) therapy and macular carotenoid supplementation, respectively. 3. To understand the role of a supplement containing meso-zeaxanthin (MZ; the third, and currently least explored, macular carotenoid) on the augmentation of macular pigment (MP), on visual performance and on disease progression (graded according to the AREDS [Age-Related Eye Disease Study] criteria), in subjects with early AMD. 4. To explore the impact of macular carotenoid supplementation on vision in subjects presenting with atypical macular pigment optical density (MPOD) spatial profiles at baseline. Outcomes: This study has shown that CDVA is not the most appropriate measure of visual function and does not reflect retinal morphology in cases of early AMD or in cases of nv-AMD. Retinotopic ocular sensitivity (ROS), however, appears to be a more reflective measure of disease severity, where it correlates well with AMD-severity grade (in cases of early AMD) and also with mean foveal thickness (MFT; in cases of nv-AMD). In eyes with nv-AMD undergoing monthly intravitreal ranibizumab injections, there have been demonstrable improvements in a range of parameters of visual function, namely, contrast sensitivity (CS), glare disability (GD), and ROS but no significant change in CDVA, despite a reduction in MFT. MP can be augmented, and CS enhanced, in subjects with early AMD who receive supplemental macular carotenoids. Subjects with low baseline central MPOD had the greatest increases in MPOD and the greatest improvements in CS, when compared with subjects with medium or high baseline MPOD, suggesting that the 4 optimisation of CS (and putatively visual performance in general) is somewhat dependent on central MP levels. The literature review has concluded that supplementation with the macular carotenoids offers the best means of fortifying the antioxidant defenses of the macula, thus putatively reducing the risk of AMD and/or its progression, and of optimising visual performance. Conclusions: The findings of this work suggest the incorporation of tests, complimentary to CDVA, such as CS, GD, and particularly ROS, when attempting to understand disease severity in cases of AMD. In terms of monitoring change over time, the results of this study do seem to indicate that measures of ROS may be particularly useful in monitoring subjects with nv-AMD, while measures of CS and GD may be more apt in monitoring change in subjects with early AMD. Macular carotenoid supplementation can enhance visual performance in subjects with early AMD

Visual Performance in Patients with Neovascular Age Related Macular Degeneration Undergoing Treatment With Intravitreal Ranibizumab

Purpose. To assess visual function and its response to serial intravitreal ranibizumab (Lucentis, Genentech) in patients with neovascular age-related macular degeneration (nv-AMD). Methods. Forty-seven eyes of 47 patients with nv-AMD, and corrected distance visual acuity (CDVA) logMAR 0.7 or better, undergoing intravitreal injections of ranibizumab, were enrolled into this prospective study. Visual function was assessed using a range of psychophysical tests, while mean foveal thickness (MFT) was determined by optical coherence tomography (OCT). Results. Groupmean (±sd)MFT reduced significantly frombaseline (233±59)) to exit (205±40)) (p = 0.001). CDVA exhibited no change between baseline and exit visits (p = 0.48 and p = 0.31 resp.). Measures of visual function that did exhibit statistically significant improvements (p \u3c 0.05 for all) included reading acuity, reading speed, mesopic and photopic contrast sensitivity (CS), mesopic and photopic glare disability (GD), and retinotopic ocular sensitivity (ROS) at all eccentricities. Conclusion. Eyes with nv-AMD undergoing intravitreal ranibizumab injections exhibit improvements in many parameters of visual function. Outcome measures other than CDVA, such as CS, GD, and ROS, should not only be considered in the design of studies investigating nv-AMD, but also in treatment and retreatment strategies for patients with the condition

Clinical Study Visual Performance in Patients with Neovascular Age-Related Macular Degeneration Undergoing Treatment with Intravitreal Ranibizumab

properly cited. Purpose. To assess visual function and its response to serial intravitreal ranibizumab (Lucentis, Genentech) in patients with neovascular age-related macular degeneration (nv-AMD). Methods. Forty-seven eyes of 47 patients with nv-AMD, and corrected distance visual acuity (CDVA) logMAR 0.7 or better, undergoing intravitreal injections of ranibizumab, were enrolled into this prospective study. Visual function was assessed using a range of psychophysical tests, while mean foveal thickness (MFT) was determined by optical coherence tomography (OCT). Results. Group mean (±sd) MFT reduced significantly from baseline (233 (±59)) to exit (205 (±40)) ( = 0.001). CDVA exhibited no change between baseline and exit visits ( = 0.48 and = 0.31, resp.). Measures of visual function that did exhibit statistically significant improvements ( < 0.05 for all) included reading acuity, reading speed, mesopic and photopic contrast sensitivity (CS), mesopic and photopic glare disability (GD), and retinotopic ocular sensitivity (ROS) at all eccentricities. Conclusion. Eyes with nv-AMD undergoing intravitreal ranibizumab injections exhibit improvements in many parameters of visual function. Outcome measures other than CDVA, such as CS, GD, and ROS, should not only be considered in the design of studies investigating nv-AMD, but also in treatment and retreatment strategies for patients with the condition

Visual Function and Its Relationship with Severity of Early, and Activity of Neovascular, Age-Related Macular Degeneration

Abstract Purpose: To investigate the relationship between visual function and severity of early age-related macular degeneration (AMD) and activity of neovascular (nv-) AMD. Methods: The following data was collected from 66 eyes of 66 subjects with early AMD and 47 eyes of 47 subjects with active nv-AMD: corrected distance visual acuity (CDVA); contrast sensitivity (CS); glare disability (GD); and retinotopic ocular sensitivity (ROS) of the central 5° of the retina, by microperimetry. Fundus photographic grading of early AMD was performed in a masked fashion. Mean foveal thickness (MFT) was measured by spectral domain optical coherence tomography in patients with nv-AMD. Results: In subjects with early AMD, there was an inverse and statistically significant relationship between measures of ROS within the central 5° of retina (including fixation) and severity of early AMD (p=0.01). In eyes with active nv-AMD, an inverse and statistically significant relationship was observed between measures of MFT and measures of ROS at the central 5° of retina (r=-0.34; p=0.02). No other measures, including CDVA, were significantly related to severity of early AMD, or to MFT in nv-AMD. Conclusion: Although ROS was cross-sectionally associated with disease severity, and inversely related to MFT, an important determinant of need-to-treat in cases of nv-AMD, further research is required to determine the appropriateness of ROS for monitoring early and active neovascular forms of this disease

Visual Function and Its Relationship with Severity of Early, and Activity of Neovascular, Age-Related Macular Degeneration

Purpose: To investigate the relationship between visual function and severity of early age-related macular degeneration (AMD) and activity of neovascular (nv-) AMD. Methods: The following data was collected from 66 eyes of 66 subjects with early AMD and 47 eyes of 47 subjects with active nv-AMD: corrected distance visual acuity (CDVA); contrast sensitivity (CS); glare disability (GD); and retinotopic ocular sensitivity (ROS) of the central 5° of the retina, by microperimetry. Fundus photographic grading of early AMD was performed in a masked fashion. Mean foveal thickness (MFT) was measured by spectral domain optical coherence tomography in patients with nv-AMD. Results: In subjects with early AMD, there was an inverse and statistically significant relationship between measures of ROS within the central 5° of retina (including fixation) and severity of early AMD (p=0.01). In eyes with active nv-AMD, an inverse and statistically significant relationship was observed between measures of MFT and measures of ROS at the central 5° of retina (r=-0.34; p=0.02). No other measures, including CDVA, were significantly related to severity of early AMD, or to MFT in nv-AMD. Conclusion: Although ROS was cross-sectionally associated with disease severity, and inversely related to MFT, an important determinant of need-to-treat in cases of nv-AMD, further research is required to determine the appropriateness of ROS for monitoring early and active neovascular forms of this disease

Supplementation With Three Different Macular Carotenoid Formulations in Patients With Early Age-Related Macular Degeneration.

Purpose: To investigate the impact of three different macular carotenoid formulations on macular pigment optical density and visual performance in subjects with early age-related macular degeneration. Methods: Fifty-two subjects were supplemented and followed for 12 months, 17 of them were in intervention Group 1 (20 mg/day lutein and 2 mg/day zeaxanthin); 21 in Group 2 (10 mg/day meso-zeaxanthin, 10 mg/day lutein, and 2 mg/day zeaxanthin); and 14 in Group 3 (17 mg/day meso-zeaxanthin, 3 mg/day lutein, and 2 mg/day zeaxanthin). The macular pigment optical density was measured using customized heterochromatic flicker photometry, and visual function was assessed using corrected distance visual acuity and by letter contrast sensitivity. Results: A statistically significant increase in the macular pigment optical density was observed at all measured eccentricities in Group 2 (P # 0.005) and in Group 3 (P , 0.05, for all), but only at 1.75° in Group 1 (P = 0.018). Statistically significant (P , 0.05) improvements in letter contrast sensitivity were seen at all spatial frequencies (except 1.2 cycles per degree) in Group 3, and at low spatial frequencies in Groups 1 and 2. Conclusion: Augmentation of the macular pigment optical density across its spatial profile and enhancements in contrast sensitivity were best achieved after supplementation with a formulation containing high doses of meso-zeaxanthin in combination with lutein and zeaxanthin