Detection of Early Loss of Color Vision in Age-Related Macular Degeneration - With Emphasis on Drusen and Reticular Pseudodrusen.

Purpose: To evaluate chromatic sensitivity in patients with age-related macular degeneration (AMD) characterized by drusen and reticular pseudodrusen. To investigate whether the severity of color vision loss can distinguish between various stages of AMD and hence be used as an index of progression toward advanced AMD. Methods: Chromatic sensitivity was measured by using the Color Assessment and Diagnosis (CAD) test in asymptomatic individuals with early and intermediate AMD and compared to normative data. All study participants had logMAR visual acuity of 0.3 or better. The CAD thresholds measured in eyes with and without reticular pseudodrusen were also compared and related to central macular thickness (CMT). Student's t-test P values < 0.05 were considered significant. Results: All early- and intermediate-AMD eyes (n = 90) had chromatic sensitivity loss in either RG (red/green) or YB (yellow/blue), or both (P < 0.0001) as compared to age-matched normal subjects. The eyes exhibited a range of CAD thresholds affecting both color mechanisms, but YB color thresholds were in general higher than RG thresholds (P < 0.001). Intermediate-AMD patients exhibited large intersubject variability. In general, eyes with reticular pseudodrusen and eyes with CMT < 200 µm had significantly higher CAD thresholds. Conclusions: The anatomic integrity of cone photoreceptors remains relatively unaffected in early and intermediate stages of AMD. The processing of cone signals in the retina can, however, be heavily disrupted with subsequent loss of both YB and RG chromatic sensitivity. The greatest losses were observed in eyes with reticular pseudodrusen.

Visual acuity outcomes in ranibizumab-treated neovascular age-related macular degeneration; stratified by baseline vision.

BACKGROUND: Ranibizumab (Lucentis, Novartis, Basel, Switzerland) is currently indicated for use in neovascular age-related macular degeneration (NVAMD). This study assessed the real-life outcomes based on baseline visual acuity when treated with intravitreal ranibizumab on a three + pro re nata (PRN) dosing schedule for NVAMD. DESIGN: This retrospective chart-review was conducted at King's College Hospital. The patients were stratified into three groups based on baseline Early treatment diabetic retinopathy study (ETDRS) letters: 27 with poor visual acuity (24-34 letters), 33 with intermediate visual acuity (35-54 letters) and 27 with good visual acuity (≥=55 letters). METHODS: All patients received a three + PRN dosing schedule of ranibizumab injections (0.5 mg per 0.05 mL) based on changes in visual acuity and macular thickness on optical coherence tomography (OCT) and all patients completed 12-month follow up. MAIN OUTCOME MEASURES: The mean change in visual acuity at 12 months in the three groups. RESULTS: Mean gain in ETDRS letters at 12 months was +14.00 (P < 0.0001), +7.10 (P = 0.012) and +2.85 (P = 0.19), and mean number of injections was 5.30, 6.12 and 5.70 in the poor, intermediate and good baseline vision group, respectively, over the 12- month follow-up period. CONCLUSIONS: Poor baseline visual acuity (24-34 ETDRS letters) is a predictor of maximum gain in visual acuity. However, eyes with better baseline visual acuity (55 letters) had a better final visual acuity.

Visual outcome of ranibizumab therapy for neovascular age related macular degeneration in the black population: a report of five cases.

INTRODUCTION: Neovascular age related macular degeneration (AMD) is relatively uncommon in the black population. We report the 12-month outcome of ranibizumab therapy in five black patients with choroidal neovascular membrane (CNV) secondary to AMD. MATERIAL AND METHODS: Retrospective analysis of a prospective audit database maintained for all patients on ranibizumab therapy in a retinal specialist unit that caters to a multi-ethnic cohort in London, United Kingdom. RESULTS: At 12 months, all the 5 patients maintained stable vision (loss of less than 15 ETDRS letters). However, none of them gained more than 15 ETDRS letters. All eyes showed early subretinal fibrosis while 2 patients showed extended areas of retinal pigment atrophy. CONCLUSION: Our case studies indicate that ranibizumab stabilizes the vision in black patients with CNV secondary to AMD but they tend to develop early subretinal fibrosis and retinal pigment atrophy.