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Parafoveal letter recognition at reduced contrast in normal aging and in patients with risk factors for AMD

  • Retinal Disorders
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Abstract

Background

Patients with early age-related maculopathy (ARM) do not necessarily show obvious morphological signs or functional impairment. Many have good visual acuity, yet complain of decreased visual performance. The aim of this study was to investigate the aging effects on performance of parafoveal letter recognition at reduced contrast, and defects caused by early ARM and normal fellow eyes of patients with unilateral age-related macular degeneration (nfAMD).

Methods

Testing of the central visual field (8° radius) was performed by the Macular Mapping Test (MMT) using recognition of letters in 40 parafoveal target locations at four contrast levels (5, 10, 25 and 100%). Effects of aging were investigated in 64 healthy subjects aged 23 to 76 years (CTRL). In addition, 39 eyes (minimum visual acuity of 0.63;20/30) from 39 patients with either no visible signs of ARM, while the fellow eye had advanced age-related macular degeneration (nfAMD; n = 12), or early signs of ARM (eARM; n = 27) were examined. Performance was expressed summarily as a “field score” (FS).

Results

Performance in the MMT begins to decline linearly with age in normal subjects from the age of 50 and 54 years on, at 5% and 10% contrast respectively. The differentiation between patients and CTRLs was enhanced if FS at 5% was analyzed along with FS at 10% contrast. In 8/12 patients from group nfAMD and in 18/27 from group eARM, the FS was statistically significantly lower than in the CTRL group in at least one of the lower contrast levels.

Conclusion

Using parafoveal test locations, a recognition task and diminished contrast increases the chance of early detection of functional defects due to eARM or nfAMD and can differentiate them from those due to aging alone.

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References

  1. Vingerling JR, Dielemans I, Hofman A, Grobbee DE, Hijmering M, Kramer CF et al (1995) The prevalence of age-related maculopathy in the Rotterdam Study. Ophthalmology 102:205–210

    PubMed  CAS  Google Scholar 

  2. Klein R, Klein BE, Linton KL (1992) Prevalence of age-related maculopathy. The Beaver Dam Eye Study. Ophthalmology 99:933–943

    PubMed  CAS  Google Scholar 

  3. Bird AC, Bressler NM, Bressler SB, Chisholm IH, Coscas G, Davis MD et al (1995) An international classification and grading system for age-related maculopathy and age-related macular degeneration. The International ARM Epidemiological Study Group. Surv Ophthalmol 39:367–374, doi:10.1016/S0039–6257(05)80092-X

    Article  PubMed  CAS  Google Scholar 

  4. van der Schaft TL, Mooy CM, de Bruijn WC, Oron FG, Mulder PG, de Jong PT (1992) Histologic features of the early stages of age-related macular degeneration. A statistical analysis. Ophthalmology 99:278–286

    PubMed  Google Scholar 

  5. Sarks SH, Arnold JJ, Killingsworth MC, Sarks JP (1999) Early drusen formation in the normal and aging eye and their relation to age related maculopathy: a clinicopathological study. Br J Ophthalmol 83:358–368

    PubMed  CAS  Google Scholar 

  6. Pauleikhoff D, Harper CA, Marshall J, Bird AC (1990) Aging changes in Bruch’s membrane. A histochemical and morphologic study. Ophthalmology 97:171–178

    PubMed  CAS  Google Scholar 

  7. Bird AC (1992) Bruch’s membrane change with age. Br J Ophthalmol 76:166–168, doi:10.1136/bjo.76.3.166

    Article  PubMed  CAS  Google Scholar 

  8. Curcio CA, Millican CL, Bailey T, Kruth HS (2001) Accumulation of cholesterol with age in human Bruch’s membrane. Invest Ophthalmol Vis Sci 42:265–274

    PubMed  CAS  Google Scholar 

  9. Johnson M, Dabholkar A, Huang JD, Presley JB, Chimento MF, Curcio CA (2007) Comparison of morphology of human macular and peripheral Bruch’s membrane in older eyes. Curr Eye Res 32:791–799, doi:10.1080/02713680701550660

    Article  PubMed  Google Scholar 

  10. Steinmetz RL, Haimovici R, Jubb C, Fitzke FW, Bird AC (1993) Symptomatic abnormalities of dark adaptation in patients with age-related Bruch’s membrane change. Br J Ophthalmol 77:549–554, doi:10.1136/bjo.77.9.549

    Article  PubMed  CAS  Google Scholar 

  11. Klaver CC, Assink JJ, van LR, Wolfs RC, Vingerling JR, Stijnen T, Hofman A, de Jong PT (2001) Incidence and progression rates of age-related maculopathy: the Rotterdam Study. Invest Ophthalmol Vis Sci 42:2237–2241

    PubMed  CAS  Google Scholar 

  12. Klein R, Klein BE, Tomany SC, Meuer SM, Huang GH (2002) Ten-year incidence and progression of age-related maculopathy: The Beaver Dam eye study. Ophthalmology 109:1767–1779, doi:10.1016/S0161–6420(02)01146–6

    Article  PubMed  Google Scholar 

  13. Wang JJ, Foran S, Smith W, Mitchell P (2003) Risk of age-related macular degeneration in eyes with macular drusen or hyperpigmentation: the Blue Mountains Eye Study cohort. Arch Ophthalmol 121:658–663, doi:10.1001/archopht.121.5.658

    Article  PubMed  Google Scholar 

  14. van Leeuwen R, Klaver CC, Vingerling JR, Hofman A, de Jong PT (2003) The risk and natural course of age-related maculopathy: follow-up at 6 1/2 years in the Rotterdam study. Arch Ophthalmol 121:519–526, doi:10.1001/archopht.121.4.519

    Article  PubMed  Google Scholar 

  15. Chang B, Yannuzzi LA, Ladas ID, Guyer DR, Slakter JS, Sorenson JA (1995) Choroidal neovascularization in second eyes of patients with unilateral exudative age-related macular degeneration. Ophthalmology 102:1380–1386

    PubMed  CAS  Google Scholar 

  16. Pauleikhoff D, Radermacher M, Spital G, Muller C, Brumm G, Lommatzsch A et al (2002) Visual prognosis of second eyes in patients with unilateral late exudative age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 240:539–542, doi:10.1007/s00417–002–0507–6

    Article  PubMed  Google Scholar 

  17. Roy M, Kaiser-Kupfer M (1990) Second eye involvement in age-related macular degeneration: a four-year prospective study. Eye 4(Pt 6):813–818

    PubMed  Google Scholar 

  18. Soubrane G, Haddad WM, Coscas G (2002) Age-related macular degeneration. Presse Med 31:1282–1287

    PubMed  Google Scholar 

  19. Fletcher DC, Schuchard RA (1997) Preferred retinal loci relationship to macular scotomas in a low-vision population. Ophthalmology 104:632–638

    PubMed  CAS  Google Scholar 

  20. Messias A, Reinhard J, Velasco e Cruz AA, Dietz K, MacKeben M, Trauzettel-Klosinski S (2007) Eccentric fixation in Stargardt’s disease assessed by Tubingen perimetry. Invest Ophthalmol Vis Sci 48:5815–5822, doi:10.1167/iovs.06–0367

    Article  PubMed  Google Scholar 

  21. Sunness JS, Rubin GS, Applegate CA, Bressler NM, Marsh MJ, Hawkins BS et al (1997) Visual function abnormalities and prognosis in eyes with age-related geographic atrophy of the macula and good visual acuity. Ophthalmology 104:1677–1691

    PubMed  CAS  Google Scholar 

  22. Owsley C, McGwin G Jr, Jackson GR, Kallies K, Clark M (2007) Cone- and rod-mediated dark adaptation impairment in age-related maculopathy. Ophthalmology 114:1728–1735, doi:10.1016/j.ophtha.2006.12.023

    Article  PubMed  Google Scholar 

  23. Sunness JS, Massof RW, Johnson MA, Bressler NM, Bressler SB, Fine SL (1989) Diminished foveal sensitivity may predict the development of advanced age-related macular degeneration. Ophthalmology 96:375–381

    PubMed  CAS  Google Scholar 

  24. Hogg RE, Chakravarthy U (2006) Visual function and dysfunction in early and late age-related maculopathy. Prog Retin Eye Res 25:249–276, doi:10.1016/j.preteyeres.2005.11.002

    Article  PubMed  CAS  Google Scholar 

  25. Lovie-Kitchin J, Feigl B (2005) Assessment of age-related maculopathy using subjective vision tests. Clin Exp Optom 88:292–303

    PubMed  Google Scholar 

  26. Cheng AS, Vingrys AJ (1993) Visual losses in early age-related maculopathy. Optom Vis Sci 70:89–96, doi:10.1097/00006324–199302000–00001

    Article  PubMed  CAS  Google Scholar 

  27. Eisenbarth W, MacKeben M, Poggel DA, Strasburger H (2008) Characteristics of dynamic processing in the visual field of patients with age-related maculopathy. Graefes Arch Clin Exp Ophthalmol 246:27–37, doi:10.1007/s00417–007–0641–2

    Article  PubMed  Google Scholar 

  28. Midena E, Vujosevic S, Convento E, Manfre A, Cavarzeran F, Pilotto E (2007) Microperimetry and fundus autofluorescence in patients with early age-related macular degeneration. Br J Ophthalmol 91:1499–1503, doi:10.1136/bjo.2007.119685

    Article  PubMed  Google Scholar 

  29. Parisi V, Perillo L, Tedeschi M, Scassa C, Gallinaro G, Capaldo N et al (2007) Macular function in eyes with early age-related macular degeneration with or without contralateral late age-related macular degeneration. Retina 27:879–890, doi:10.1097/01.iae.0000256039.59142.22

    Article  PubMed  Google Scholar 

  30. Scilley K, Jackson GR, Cideciyan AV, Maguire MG, Jacobson SG, Owsley C (2002) Early age-related maculopathy and self-reported visual difficulty in daily life. Ophthalmology 109:1235–1242, doi:10.1016/S0161–6420(02)01060–6

    Article  PubMed  Google Scholar 

  31. MacKeben M, Colenbrander A, Stuen C (2000) Topographic measurements of low contrast letter recognition as a tool for diagnosis and vision rehabilitation. In: C Stuen et al (ed) Vision Rehabilitation. Swets & Zeitlinger, Lisse, pp 158–160

    Google Scholar 

  32. MacKeben M, Colenbrander A, Gofen A (1999) Use your PC to quickly map remaining vision after foveal vision loss. In: Wild JM, Wall M (eds) Perimetry Update 1998/1999. Kugler, Amsterdam, pp 307–316

    Google Scholar 

  33. Trauzettel-Klosinski S, Biermann P, Hahn G, Weismann M (2003) Assessment of parafoveal function in maculopathy: a comparison between the Macular Mapping Test and kinetic Manual Perimetry. Graefes Arch Clin Exp Ophthalmol 241:988–995, doi:10.1007/s00417–003–0757-y

    Article  PubMed  Google Scholar 

  34. Randall HG, Brown DJ, Sloan LL (1966) Peripheral visual acuity. Arch Ophthalmol 75:500–504

    PubMed  CAS  Google Scholar 

  35. Strasburger H, Harvey LO Jr, Rentschler I (1991) Contrast thresholds for identification of numeric characters in direct and eccentric view. Percept Psychophys 49:495–508

    PubMed  CAS  Google Scholar 

  36. Chung ST, Legge GE, Tjan BS (2002) Spatial-frequency characteristics of letter identification in central and peripheral vision. Vision Res 42:2137–2152, doi:10.1016/S0042–6989(02)00092–5

    Article  PubMed  Google Scholar 

  37. Fleiss JL (1973) Statistical Methods for Rates and Proportions. Wiley, New York

    Google Scholar 

  38. Schneck ME, Haegerstrom-Portnoy G, Lott LA, Brabyn JA, Gildengorin G (2004) Low contrast vision function predicts subsequent acuity loss in an aged population: the SKI study. Vision Res 44:2317–2325, doi:10.1016/j.visres.2004.04.018

    Article  PubMed  Google Scholar 

  39. Sjöstrand J (1979) Contrast sensitivity in macular disease using a small-field and a large-field TV-system. Acta Ophthalmol (Copenh) 57:832–846

    Article  Google Scholar 

  40. Bellmann C, Unnebrink K, Rubin GS, Miller D, Holz FG (2003) Visual acuity and contrast sensitivity in patients with neovascular age-related macular degeneration. Results from the Radiation Therapy for Age-Related Macular Degeneration (RAD-) Study. Graefes Arch Clin Exp Ophthalmol 241:968–974, doi:10.1007/s00417–003–0689–6

    Article  PubMed  Google Scholar 

  41. Stangos N, Voutas S, Topouzis F, Karampatakis V (1995) Contrast sensitivity evaluation in eyes predisposed to age-related macular degeneration and presenting normal visual acuity. Ophthalmologica 209:194–198

    Article  PubMed  CAS  Google Scholar 

  42. Hyvarinen L, Laurinen P, Rovamo J (1982) Contrast sensitivity in macular and optic nerve degeneration. Fortschr Ophthalmol 79:166–168

    PubMed  CAS  Google Scholar 

  43. Curcio CA, Medeiros NE, Millican CL (1996) Photoreceptor loss in age-related macular degeneration. Invest Ophthalmol Vis Sci 37:1236–1249

    PubMed  CAS  Google Scholar 

  44. Curcio CA, Owsley C, Jackson GR (2000) Spare the rods, save the cones in aging and age-related maculopathy. Invest Ophthalmol Vis Sci 41:2015–2018

    PubMed  CAS  Google Scholar 

  45. Owsley C, Jackson GR, White M, Feist R, Edwards D (2001) Delays in rod-mediated dark adaptation in early age-related maculopathy. Ophthalmology 108:1196–1202, doi:10.1016/S0161–6420(01)00580–2

    Article  PubMed  CAS  Google Scholar 

  46. Swann PG, Lovie-Kitchin JE (1990) Age-related maculopathy. I: A review of its morphology and effects on visual function. Ophthalmic Physiol Opt 10:149–158, doi:10.1111/j.1475–1313.1990.tb00969.x

    Article  PubMed  CAS  Google Scholar 

  47. Tolentino MJ, Miller S, Gaudio AR, Sandberg MA (1994) Visual field deficits in early age-related macular degeneration. Vision Res 34:409–413, doi:10.1016/0042–6989(94)90099-X

    Article  PubMed  CAS  Google Scholar 

  48. Anderson RS, Evans DW, Thibos LN (1996) Effect of window size on detection acuity and resolution acuity for sinusoidal gratings in central and peripheral vision. J Opt Soc Am A Opt Image Sci Vis 13:697–706

    Article  PubMed  CAS  Google Scholar 

  49. Foley JM, Legge GE (1981) Contrast detection and near-threshold discrimination in human vision. Vision Res 21:1041–1053, doi:10.1016/0042–6989(81)90009–2

    Article  PubMed  CAS  Google Scholar 

  50. Strasburger H, Rentschler I (1996) Contrast-dependent dissociation of visual recognition and detection fields. Eur J Neurosci 8:1787–1791, doi:10.1111/j.1460–9568.1996.tb01322.x

    Article  PubMed  CAS  Google Scholar 

  51. Owsley C, Sekuler R, Siemsen D (1983) Contrast sensitivity throughout adulthood. Vision Res 23:689–699, doi:10.1016/0042–6989(83)90210–9

    Article  PubMed  CAS  Google Scholar 

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Acknowledgement

This study was supported by the European Commission (QLK-CT-2002–00214, AMD-Read). The authors would like to thank Werner Inhoffen MD, PhD, and Malte Weismann, MD, from the University of Tübingen for their help with recruiting patients, and Claudia Gehrlich for support with patient examinations.

Author information

Authors and Affiliations

  1. Centre for Ophthalmology, University of Tübingen, Tübingen, Germany

    Gesa Astrid Hahn, Andre Messias, Karin Horwath & Susanne Trauzettel-Klosinski

  2. Department of Ophthalmology, Otorhinolaringology and Head & Neck Surgery, University of São Paulo, Ribeirão Preto, Brazil

    Andre Messias

  3. The Smith-Kettlewell Eye Research Institute, San Francisco, USA

    Manfred MacKeben

  4. Department of Medical Biometry, University of Tübingen, Tübingen, Germany

    Klaus Dietz

  5. Faculty of Behavioural Sciences, University of Helsinki, Helsinki, Finland

    Lea Hyvärinen

  6. Department of Ophthalmology, Turku University Hospital, Turku, Finland

    Markku Leinonen

  7. Centre for Ophthalmology, University of Tübingen, Schleichstr. 12–16, Tübingen, D72076, Germany

    Susanne Trauzettel-Klosinski

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  1. Gesa Astrid Hahn
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  2. Andre Messias
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Correspondence to Susanne Trauzettel-Klosinski.

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Gesa Astrid Hahn and Andre Messias share first authorship

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Hahn, G.A., Messias, A., MacKeben, M. et al. Parafoveal letter recognition at reduced contrast in normal aging and in patients with risk factors for AMD. Graefes Arch Clin Exp Ophthalmol 247, 43–51 (2009). https://doi.org/10.1007/s00417-008-0919-z

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  • DOI: https://doi.org/10.1007/s00417-008-0919-z

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