Impact of graphical user interface screen features on computer task accuracy and speed in a cohort of patients with age-related macular degeneration

PURPOSE: To investigate the impact of graphical user interface screen features on computer task performance in patients with age-related macular degeneration (AMD). DESIGN: Interventional case series. METHODS: Eighteen patients with visual impairment due to AMD were recruited from the Bascom Palmer Eye Institute Low Vision Clinic. Each patient underwent evaluation of visual acuity using the Early Treatment Diabetic Retinopathy Study protocol, contrast sensitivity using a Pelli-Robson chart, binocular simultaneous visual field using the Esterman program on an automated perimeter, and color vision using Farnsworth D-15. Each subject then completed computer icon identification tasks while the following screen features of the graphical user interface were varied: size of icons displayed, icon set size (number of icons displayed), and background color. Each patient performed all 125 computer tasks with each of five icon sizes (9.2 mm, 14.6 mm, 23.2 mm, 36.8 mm, 58.3 mm), each of five icon set sizes (2, 3, 4, 5, 6), and each of five different background colors (black, white, red, green, blue) in a randomly ordered fashion. Relationships between computer task performance (accuracy and speed) and graphical user interface screen features were studied. RESULTS: Icon size and icon set size are significantly associated with computer task accuracy (P <.001), whereas background color is not a significant predictor of task accuracy (P =.63). The impact of icon size on accuracy is nonlinear, with the data indicating that no additional improvement in accuracy is associated with increasing the icon size beyond 23.2 mm. The impact of icon set size on accuracy is linear, with a smaller icon set size significantly associated with greater computer accuracy. A larger icon size is significantly associated with a shorter time to task completion (P =.001); this relationship is largely linearly related to icon size. There was no significant impact of background color (P =.11) or set size (P =.37) on time to task completion. CONCLUSIONS: Modifications of graphical user interface design may permit improved computer task performance among patients with visual impairment due to AMD.     

Effects of task lighting on visual function in age-related macular degeneration

The purpose was to investigate the effects of the spectral power distribution (SPD) and illuminance of task lighting on visual function in age-related macular degeneration (ARMD) compared to normal healthy eyes. Twenty-eight subjects with ARMD and 18 age-matched normal subjects were studied. The effects on visual function were determined for four common task light sources: standard pearl coat incandescent (SP), daylight blue incandescent (DL), warm white fluorescent (WW) and cool white fluorescent (CW). Apart from a small, statistically significant improvement in contrast sensitivity with DL compared to SP lighting (0.5 dB, p = 0.01), there were no significant effects of SPD on other visual functions and no differences in the effects for subjects with ARMD and those with normal vision. Thus, for task lighting typically used in low vision rehabilitation, the SPD would seem to be of minimal clinical importance to visual function. However, increasing the task illuminance had a greater effect on visual function, in particular for subjects with ARMD (p < 0.01). For an increase in illuminance from 300 to 3000 lux, the mean increase in contrast sensitivity and near visual acuity was 1.5 dB and 0.13 log MAR, respectively. Although this effect is not large, we suggest that it is clinically relevant and supports the provision of additional task illuminance as an important part of low vision rehabilitation for patients with ARMD.     

叶黄素干预对早期年龄相关性黄斑变性患者视功能的影响

目的：探讨叶黄素干预对早期年龄相关性黄斑变性(age-related macular degeneration,AMD)患者视功能的影响。

方法：采用随机双盲空白对照的方法,将200例早期AMD患者随机分为叶黄素干预组(20mg/d)和安慰剂对照组。分别于基线、12、24、36、48wk进行问卷调查、血清叶黄素密度及视功能检查。

结果：叶黄素干预组12、24、36、48wk的血清叶黄素密度比安慰剂对照组高(P<0.05),血清叶黄素密度较基线升高(P<0.05)。叶黄素干预组24、48wk的对比敏感度(contrast sensitivity,CS)的低(3c/d)、中(6c/d)频段,黄斑色素光学密度(macular pigment optical density,MPOD),最佳矫正视力(best-spectacle corrected visual acuity,BCVA)高于安慰剂对照组(P<0.05); CS的低、中频段高于基线(P<0.05),MPOD、BCVA与基线比较差异无统计学意义(P>0.05)。

结论：叶黄素干预可改善早期AMD患者的视功能。     

Repeatability of visual function measures in age-related macular degeneration

Purpose

To assess repeatability of visual function measures in patients with early, intermediate or late age-related macular degeneration (AMD) without active neovascular disease in the study eye, but active neovascular AMD in the fellow eye.

Methods

One hundred subjects from an ongoing trial were screened for this study in which their LogMAR acuity, contrast sensitivity and reading performance were assessed using standardised protocols by trained optometrists. The same measures were repeated one month later and repeatability of the visual functions assessed.

Results

Data from 83 subjects satisfied inclusion criteria for analysis. Coefficient of repeatability was 14.9 letters for LogMAR visual acuity , 7.2 letters for Pelli Robson contrast sensitivity, 0.72 for LogMAR reading acuity, 110.4 words/ min for reading speed and 0.67 for LogMAR critical print size. Intraclass correlation coefficients allowed comparison between measures and were found to be 0.96 for LogMAR visual acuity, 0.93 for contrast sensitivity, 0.75 for LogMAR reading acuity, 0.79 for reading speed and 0.74 for LogMAR critical print size. Coefficients of variation were 9.4 %, 10.7 %, 48.4 %, 28.4 % and 31.8 % respectively.

Conclusions

We found coefficients of repeatability that concurred with previous studies demonstrating variability of visual functions in patients with AMD. In addition, we found intraclass correlation coefficients to be better with visual acuity and contrast sensitivity than with measures of reading performance.     

Unusual visual evoked potentials in patients with age-related macular degeneration

Among a series of patients with age-related macular degeneration (ARMD), a few individuals could be identified showing larger amplitudes of pattern reversal visual evoked potentials (prVEP) after stimulation of a central 3 degrees field compared to stimulation of a 13 degrees field although in the majority of ARMD patients and in normals, VEP amplitudes increased with increasing field size. An analysis of prVEPs recorded after stimulation of different macular zones showed that the 3 degrees central area and the perifoveal zone contributed differently to the 13 degrees response or macular response. Perifoveal activity in this subgroup of ARMD patients seemed to mask the foveal contribution to the macular prVEP. The cortical magnification factor in ARMD may be higher than in normal controls. Small-field stimulation techniques are therefore also recommended in patients with central retinal pathology.     

Binocular function in patients with age-related macular degeneration: a review

Normally sighted observers typically benefit from binocular viewing when monocular sensitivities are equivalent. Age-related macular degeneration (AMD) not only destroys the foveal vision, however, but it also affects the 2 eyes unequally, providing grounds for impairment of binocular function. The aim of the present article is to provide a review of the current research on the effect of AMD on binocular vision. The main findings to date reveal that a high proportion of patients show characteristics of binocular contrast inhibition at low and medium spatial frequencies. Yet binocular acuity gain is not different from that of age-matched control participants without AMD. Additional findings show that rivalry processes are severely disrupted in patients with AMD. The effects of the disease on other binocular functions have yet to be explored. Knowledge of binocular function in AMD may one day help clinicians decide on the most appropriate management and rehabilitation techniques.     

Assessment of vision-related function in patients with age-related macular degeneration

OBJECTIVE: To investigate the validity of the visual function index (VF-14) in assessing visual function in patients with age-related macular degeneration (AMD). DESIGN: Prospective noncomparative observational case series. PARTICIPANTS: One hundred fifty-nine consecutive patients attending a sole practitioner's academic retina-only clinic from May 1998 through August 1998 and from May 1999 through August 1999. MAIN OUTCOME MEASURES: Correlations were calculated between the VF-14 scores and the medical outcomes study 36-item short form (SF-36), weighted comorbidity scale, visual acuity and clinical AMD severity (stage), and vision self-assessment scales. Documentation of the severity of macular degeneration was performed by a sole examiner. RESULTS: There was a moderately strong correlation between visual acuity and trouble with vision (r = 0.51), satisfaction with vision (r = -0.50), and overall quality of vision (r = -0.56). A strong correlation was noted between VF-14 score and patients' self-rating of amount of trouble with vision (r = -0.67), satisfaction with vision (r = 0.62), and overall quality of vision (r = 0.67). In comparison, correlations between SF-36 score and patients' self-rating of amount of trouble with vision, satisfaction with vision, and overall quality of vision ranged from r = 0.37 to r = -0.40. Linear regression analysis for the overall study population indicated that AMD severity was not an independently significant predictor of VF-14 score after adjusting for visual acuity. However, among patients with 20/20 vision in the better eye, AMD severity was an independently significant predictor of VF-14 score after adjusting for visual acuity in the worse eye. CONCLUSIONS: The VF-14 exhibits a considerable degree of validity as a measure of functional impairment in patients with AMD. Age-related macular degeneration severity was an independently significant predictor of VF-14 score in the group of patients with 20/20 vision in the better eye, but this did not hold true for the overall study population. Age-related macular degeneration is associated with substantial impairment in reported visual function.     

年龄相关性黄斑变性患者治疗后视功能及生活质量评价

目的：评估由雷珠单抗转为康柏西普治疗的年龄相关性黄斑变性(ARMD)患者治疗后视功能及生活质量情况。

方法：选取2016-01/2017-08我院收治的因雷珠单抗治疗疗效不佳转为康柏西普治疗的新生血管性ARMD患者20例29眼,比较行玻璃体腔注射康柏西普治疗前和治疗第4mo患者最佳矫正视力(BCVA)、对比敏感度(CS)、中央视网膜厚度(CRT)及生活质量评分情况。

结果：治疗第4mo,患者BCVA较治疗前改善,差异有统计学意义(P<0.05); OCT检测CRT较治疗前降低,差异有统计学意义(P<0.05); 各空间频率CS均较治疗前改善,差异均有统计学意义(P<0.05); NEI VFQ-25评分总分及各项目评分均较治疗前提高,差异均有统计学意义(P<0.05)

结论：玻璃体腔注射康柏西普治疗ARMD可明显改善患者的视功能和生活质量。     

Improvement of visual acuity over time in patients with bilateral geographic atrophy from age-related macular degeneration

PURPOSE: To study the improvement in visual acuity over time in patients with central scotomas. METHODS: In a prospective natural history study of geographic atrophy (GA) from age-related macular degeneration (ARMD) with annual follow-up, 36 patients with bilateral GA completed 3 years of follow-up. Protocol visual acuity (VA) measurements were performed. Scanning laser ophthalmoscopy (SLO) was performed, and the areas of GA were measured from fundus photographs. RESULTS: Six eyes of six patients with VA ranging from 20/80 to 20/500 had a VA improvement of two or more lines (mean, 3.2 lines). This was found only in the worse-seeing eyes of the patients and was contemporaneous with the deterioration in VA of the better-seeing eyes. Four of six eyes that improved in acuity had an improvement in the ability to find and hold the fixation target in an area of seeing retina, as assessed by SLO at follow-up, and a fifth eye changed from one fixation site that had little functional retina to another site. CONCLUSIONS: Spontaneous improvement in VA in eyes with bilateral GA and central scotomas may occur. It appears to be related to deterioration in VA of the better-seeing fellow eye and is associated with improvement of fixation in the worse-seeing eye. The worse-seeing eye of a patient with bilateral ARMD may have the potential for better vision than measured VA indicates. This finding may have implications for the choice of patients in treatment trials, for interpretation of long-term results, and for planning and assessment of low vision intervention.     

Impact of visual impairment on use of caregiving by individuals with age-related macular degeneration

BACKGROUND: To assess the patient-reported use of caregiving among individuals with age-related macular degeneration (AMD) and evaluate the impact of visual impairment level on this use. METHODS: A survey including the AMD Health and Impact Questionnaire and the Daily Living Tasks Dependent on Vision Questionnaire (DLTV) was mailed to members of the Macular Degeneration Partnership. The study was approved by an institutional review board, and respondents provided consent before participating. Responses were analyzed by estimated visual acuity determined by scores from the DLTV. Deidentified data were analyzed using SAS Version 8.2 (SAS Institute, Cary, NC). RESULTS: Of 803 respondents, 56% were male, and the mean age was 73 years. Use of paid and unpaid help significantly increased as visual acuity decreased. Using a national average for caregiver time, annual costs for caregiving ranged from 225 to 47,086 US dollar depending on visual acuity. CONCLUSION: There are substantial differences in caregiver support with increased AMD severity. Delaying progression of AMD could result in considerable cost savings.     

渗出型年龄相关性黄斑变性的形态学及视功能的研究

通过将渗出型年龄相关性黄斑变性(age-related macular degeneration,AMD)患者黄斑区OCT形态学检查及视觉电生理视功能检查相结合,探讨渗出型AMD的形态学改变与视功能改变之间的相互关系.方法 选取初次诊断为年龄相关性渗出型AMD的患者渗出组20例(30只眼)以及同年龄段正常对照组15名(30只眼),根据眼底及荧光造影检查将渗出组仅发生玻璃膜疣和脉络膜新生血管膜(CNV)的12只眼归为早期渗出组,并发视网膜下出血及渗出的18只眼归为渗出期组.对三组病人进行黄斑中心凹OCT检查及眼电生理检查.采用单因素方差分析检查结果.结果 (1)黄斑中心凹水平及垂直神经上皮层厚度:早期渗出组较正常组明显增厚(P＜0.05);渗出期组较正常组和早期渗出组明显增厚(P＜0.05).(2)眼电生理检查结果:暗适应ERG,OPS振荡电位以及P-VEP的检查结果表明,早期渗出组已出现了明显的视功能损害;渗出期组的视功能受损较早期渗出组严重.结论 渗出型AMD患者视功能的改变合并有视网膜神经上皮层的变厚,渗出期患者的黄斑区形态以及视网膜功能的改变比渗出早期更严重.     

Relationship between retinal morphological findings and visual function in age-related macular degeneration

Background

We aimed to study the retinal morphological findings associated with exudative age-related macular degeneration (AMD) and their association with visual prognosis.

Methods

We retrospectively reviewed the medical records of 96 consecutive patients (96 eyes) with exudative AMD. Retinal structural changes were examined using optical coherence tomography (OCT).

Results

Initial OCT examination showed cystoid macular edema in 18 eyes (18.8%), fibrin exudate in 56 eyes (58.3%), and hyperreflective foci within the neurosensory retina in 78 eyes (81.3%). Upon initial examination, an external limiting membrane (ELM) line was detected under the fovea in 64 eyes (66.7%). Using Pearson’s correlation analyses, final visual acuity (VA) was correlated with initial VA (r?=?0.61, p?r?=?0.34, p?r?=?0.41, p?r?=?0.40, p?r?=?0.55, p?r?=?0.48, p?r?=?0.23, p?=?0.054), and detection of a foveal ELM line (r?=?0.36, p?=?0.008).

Conclusions

In eyes with exudative AMD, final VA was most correlated with initial VA. In addition, the initial integrity of the foveal outer retina was partially correlated with the visual prognosis. The initial ELM condition was associated with good final VA, while the initial presence of hyperreflective foci in the foveal neurosensory retina was associated with poor final VA.     

评价枸橼酸西地那非片对早期AMD患者视功能的急性效应(英文)

目的:评估单剂量枸橼酸西地那非片对早期年龄相关性黄斑变性(AMD)男性患者视功能的急性效应。方法:早期年龄相关性黄斑变性男40例,年龄58～86(平均71)岁,前瞻性随机接受安慰剂或者枸橼酸西地那非片(Viagra;Pfizer Inc,New York,NY)100mg,单次口服。受试者双眼在接受药物之前及之后9h内特定的时间间期进行视力、Amsler方格表及辨色力检查。结果:与安慰剂相比,服用枸橼酸西地那非片后视功能检查均未有明显改变。视力和辨色力检查在基线水平上未见有统计意义或临床相关的改变,Amsler方格表检查未见临床相关的改变。服用枸橼酸西地那非片与短暂的轻度至中度头痛和面红有关。结论:单次口服100mg枸橼酸西地那非片,在早期年龄相关性黄斑变性男性样本人群中,耐受性良好,未对视觉产生显著急性效应。     

Macular function in eyes with early age-related macular degeneration with or without contralateral late age-related macular degeneration

PURPOSE: To evaluate psychophysical and electrophysiologic responses in eyes with early age-related macular degeneration (AMD) without a decrease in visual acuity and with or without late AMD in the fellow eye. METHODS: Fifteen patients (mean age: 67.9 +/- 7.20 years) with early AMD in both eyes (AMD1 group, 15 eyes) and 15 patients (mean age: 71.40 +/- 7.06 years) with early AMD in one eye and late AMD in the fellow eye (AMD2 group, 15 eyes) were enrolled. They were compared to 15 age-similar normal control subjects. LogMAR visual acuity (VA), macular sensitivity by MP-1 microperimetry, and multifocal electroretinograms (mfERG) were assessed in control, AMD1, and AMD2 eyes. mfERG response amplitude density (RAD, nV/deg2) of the N1-P1 component of first order binary kernels was measured. RESULTS: When compared to controls, AMD1 and AMD2 eyes showed a significant (analysis of variance, P < 0.01) decrease in MP-1 microperimetry assessed in the 0-2.5 and 2.5-5 degrees of the macula, significantly correlated (Pearson test, P < 0.01) to the corresponding significant decrease (P < 0.01) in mfERG N1-P1 RADs assessed in the 0-2.5 and 2.5-5 degrees. In AMD1 and AMD2 eyes, VA and mfERG N1-P1 RADs assessed in the 5-20 degrees were similar (P > 0.01) to controls. VA, MP-1, and mfERG values were not significantly different in AMD1 and AMD2 eyes. CONCLUSION: In eyes with early AMD there is a dysfunction of preganglionic elements in the central 0-5 retinal degrees detectable by mfERG or MP-1 microperimetry. This impairment is not further influenced by the presence of late AMD in the fellow eye.     

The use of microperimetry in assessing visual function in age-related macular degeneration

Microperimetry is a novel technique for assessing visual function that appears particularly suitable for age-related macular degeneration (AMD). Compared with standard automated perimetry, microperimetry offers several unique features. It simultaneously images the fundus, incorporates an eye-tracking system to correct the stimulus location for fixation loss, and identifies any preferred retinal loci. We identified 52 articles that met the inclusion criteria for a systematic review of microperimetry in the assessment of visual function in AMD. We discuss microperimetry and AMD in relation to disease severity, structural imaging outcomes, other measures of visual function, and evaluation of the efficacy of surgical and/or medical therapies in clinical trials. The evidence for the use of microperimetry in the functional assessment of AMD is encouraging. Disruptions of the ellipsoid zone band and retinal pigment epithelium are clearly associated with reduced differential light sensitivity despite the maintenance of good visual acuity. Reduced differential light sensitivity is also associated with outer segment thinning and retinal pigment epithelium thickening in early AMD and with both a thickening and a thinning of the whole retina in choroidal neovascularization. Microperimetry, however, lacks the robust diffuse and focal loss age-corrected probability analyses associated with standard automated perimetry, and the technique is currently limited by this omission.     

Fundus autofluorescence in patients with age-related macular degeneration and high risk of visual loss

PURPOSE: To describe fundus autofluorescence (AF) patterns and their change over time in patients with age-related macular degeneration (AMD) and high risk of visual loss participating in the drusen laser study (DLS). DESIGN: Randomized clinical trial. METHODS: The study population consisted of 29 patients (35 eyes) participating in the DLS, which is a prospective, randomized, controlled clinical trial of prophylactic laser therapy in patients with AMD and high risk of neovascular complications. The intervention consisted of 16 eyes having prophylactic laser and 19 receiving no treatment. The main outcome measures were changes in the distribution of drusen and AF. Patients were reviewed for a median follow-up or 24 months (range 12-36 months). RESULTS: At baseline, four patterns of fundus AF were recognized: focal increased AF (n = 18), reticular AF (n = 3), combined focal and reticular AF (n = 2), and homogeneous AF (n = 12). At last follow-up, fundus AF remained unchanged in 15 untreated (78%) and in seven treated (43%) eyes. In only one untreated eye, focal areas of increased AF returned to background levels and were no longer detectable at last follow-up, compared with six treated eyes. This difference was statistically significant (P =.03). Only large foveal soft drusen (drusenoid pigment epithelium detachments) consistently corresponded with focal changes in AF, whereas no obvious correspondence was found between small soft drusen located elsewhere and changes in AF. CONCLUSION: The lack of obvious correspondence between the distribution of drusen and of AF found in this study appears to indicate that drusen and AF represent independent measures of aging in the posterior pole.     

Multimodal evaluation of macular function in age-related macular degeneration

Objective

To evaluate macular function using multimodality in eyes with age-related macular degeneration (AMD) at various stages.

Methods

Macular function in 20 control eyes (20 subjects), 17 eyes (17 patients) with large drusen, 18 eyes (18 patients) with drusenoid pigment epithelial detachment (PED), and 19 eyes (19 patients) with neovascular AMD was examined using a Landolt chart for visual acuity; retinal sensitivity was measured by microperimetry; and focal macular electroretinography (fmERG) was performed. In all of these eyes, retinal morphology was examined using optical coherence tomography.

Results

Eyes with neovascular AMD showed morphologic changes in the neurosensory retina as well as marked deterioration of macular function in all parameters measured with a Landolt chart, fmERG, and microperimetry. Eyes with large drusen showed only minimal morphologic changes in the neurosensory retina. In this large drusen group, although retinal sensitivity at the central point was significantly decreased (P = 0.0063), the other parameters of macular function were well preserved. In eyes with drusenoid PED, the structure of the neurosensory retina was well preserved, while the foveal thickness was significantly increased (P = 0.013). The macular function of these eyes was significantly deteriorated, with the VA, amplitude of the a-wave and b-wave, and retinal sensitivity being markedly decreased. In addition, the area of PED correlated with the latency of the a-wave and b-wave and with the retinal sensitivity within the central 4° or 8° region.

Conclusion

Multimodal evaluation demonstrated a significant decrease in macular function in drusenoid PED and in neovascular AMD.     

Complement in age-related macular degeneration: a focus on function

Age-related macular degeneration (AMD) is an inflammatory disease, which causes visual impairment and blindness in older people. The proteins of the complement system are central to the development of this disease. Local and systemic inflammation in AMD are mediated by the deregulated action of the alternative pathway of the complement system. Variants in complement system genes alter an individual's risk of developing AMD. Recent studies have shown how some risk-associated genetic variants alter the function of the complement system. In this review, we describe the evolution of the complement system and bring together recent research to form a picture of how changes in complement system genes and proteins affect the function of the complement cascade, and how this affects the development of AMD. We discuss the application of this knowledge to prevention and possible future treatments of AMD.