Normal- and Low-Luminance Automated Quantitative Contrast Sensitivity Assessment in Eyes With Age-Related Macular Degeneration.

PURPOSE: To assess the effectiveness of an active learning approach to measuring the contrast sensitivity function (CSF) in patients with various degrees of dry age-related macular degeneration (AMD) under multiple luminance conditions. DESIGN: Cross-sectional study. METHODS: Patients with AMD (26 intermediate AMD, 19 AMD with subretinal drusenoid deposits [SDD], 20 geographic atrophy [GA]) and 23 age-matched controls were tested with the Manifold Contrast Vision Meter (Adaptive Sensory Technology) and the qCSF algorithm, which applies active learning to estimate a model of the CSF's global shape. Testing was performed under conditions of standard and low luminance. For each AMD severity, the area under log CSF (AULCSF) and contrast sensitivities at individual spatial frequencies were calculated for analysis. Low-luminance deficits (LLDs) for visual acuity (VA) and AULCSF were calculated as the difference between standard and low luminance values. RESULTS: Progressive decreases in AULCSF were observed as disease severity increased. For standard luminance, pairwise comparisons revealed significant differences between control/intermediate AMD (P < .0005), control/SDD (P < .0005), control/GA (P < .0005), and intermediate AMD/GA (P < .005). Similarly, for low luminance, pairwise comparisons revealed significant differences between the controls and each disease group (all P < .0005), in addition to significant differences between intermediate AMD/SDD (P < .005), and intermediate AMD/GA (P < .005). No correlations were found between LLD VA and LLD AULCSF in any AMD groups. CONCLUSIONS: Contrast sensitivity measured via qCSF under both standard- and low-luminance conditions correlates with advancing stages of dry AMD. The interaction between luminance and contrast sensitivity appears to reflect a different aspect of visual function than the interaction between luminance and VA.

Scotopic Microperimetric Assessment of Rod Function in Stargardt Disease (SMART) Study: Design and Baseline Characteristics (Report No. 1).

PURPOSE: To describe the study design and characteristics at first visit of participants in the longitudinal Scotopic Microperimetric Assessment of Rod Function in Stargardt Disease (SMART) study. METHODS: Scotopic microperimetry (sMP) was performed in one designated study eye in a subset of participants with molecularly proven ABCA4-associated Stargardt disease (STGD1) enrolled in a multicenter natural history study (ProgStar). Study visits were every 6 months over a period ranging from 6 to 24 months, and also included fundus autofluorescence (FAF). RESULTS: SMART enrolled 118 participants (118 eyes). At the first visit of SMART, the mean sensitivity in mesopic microperimetry was 11.48 (±5.05; range 0.00-19.88) dB and in sMP 11.25 (±5.26; 0-19.25) dB. For FAF, all eyes had a lesion of decreased autofluorescence (mean lesion size 3.62 [±3.48; 0.10-21.46] mm2), and a total of 76 eyes (65.5%) had a lesion of definitely decreased autofluorescence with a mean lesion size of 3.46 (±3.60; 0.21-21.46) mm2. CONCLUSIONS: Rod function is impaired in STGD1 and can be assessed by sMP. Testing rod function may serve as a potential outcome measure for future clinical treatment trials. This is evaluated in the SMART study.

An Assessment of the Contrast Sensitivity in Patients with Ametropic and Anisometropic Amblyopia in Achieving the Corrected Visual Acuity of 1.0.

Both visual acuity (VA) and contrast sensitivity (CS) are important parameters for measuring visual function. In this research, we investigated the CS of patients with ametropic or anisometropic amblyopia, whose corrected visual acuity (CVA) recovered to 1.0. Fifty-five cases with amblyopia and 22 control cases with a normal visual acuity of 1.0 were enrolled. The CS of the patients whose ametropic amblyopia had recovered to a CVA of 1.0 at 18 cpd spatial frequency was still lower than that of the normal control group under both photopic and scotopic conditions (P = 0.001, 0.025), but there were no significant differences at low- and middle-spatial frequencies. The CS of amblyopic eyes of the patients with anisometropic amblyopia was lower than that of the normal control group at the 18 cpd spatial frequency under photopic conditions (P = 0.005), and at the 6 cpd, 12 cpd, and 18 cpd spatial frequencies under scotopic conditions (P = 0.008, <0.001, 0.004, respectively). The CS between the amblyopic eyes and the sound eyes of patients with anisometropic amblyopia presented significant differences at the 6 cpd, 12 cpd, and 18 cpd spatial frequencies under scotopic conditions (P = 0.025, 0.045, 0.019, respectively). We suggest that amblyopia treatment should involve not only the correction of VA but also the improvement of CS.

Bioelectrical function and structural assessment of the retina in patients with early stages of Parkinson's disease (PD).

PURPOSE: To determine bioelectrical function and structural changes of the retina in patients with early stages of Parkinson's disease (PD). MATERIALS AND METHODS: Thirty-eight eyes of 20 patients with early idiopathic PD and 38 eyes of 20 healthy age- and sex-matched controls were ophthalmologically examined, including assessment of distance best-corrected visual acuity (DBCVA), slit lamp examination of the anterior and posterior segment of the eye, evaluation of the eye structures: paramacular retinal thickness (RT) and retinal nerve fiber layer (RNFL) thickness with the aid of OCT, and the bioelectrical function by full-field electroretinogram (ERG). Additionally, PD patients were interviewed as to the presence of dopamine-dependent visual functions abnormalities. RESULTS: In patients with early PD, statistically significant changes in comparison with the control group were observed in ERG. They contained a reduction in mean amplitudes of the scotopic a-wave (rod-cone response), the scotopic oscillatory potentials (OPs)--OP2 and OP3, the photopic b-wave, and a reduction in the overall index (OP1 + OP2 + OP3) and a prolongation of mean peak times of the scotopic OP1, OP2, OP3, OP4 (p < 0.05). A questionnaire concerning abnormalities of dopamine-dependent visual functions revealed that PD patients with abnormal peak times of OP1, OP2, and OP3 reported non-specific visual disturbances more frequently in comparison with PD patients with normal peak times of OPs. Other analyzed parameters of ERG, DBCVA, RT, and RNFL did not significantly differ between patients with PD and the control group. CONCLUSION: In patients with early PD, bioelectrical dysfunction of the retina was observed in the ERG test, probably as a result of dopamine deficiency in the retina. The results of our study indicate that ERG may also be a useful tool for understanding the reason for non-specific visual disturbances occurring in PD patients.

Assessment of inner retina dysfunction and progressive ganglion cell loss in a mouse model of glaucoma.

The DBA/2J mouse is a model of ocular hypertension and retinal ganglion cell (RGC) degeneration, the main features of which are iris pigment dispersion (IPD) and iris stromal atrophy (ISA). These animals also experience glaucomatous changes, including an increase in intraocular pressure (IOP) beginning at about 9-12 months of age and sectorial RGC death in the retina. The aim of this study was to determine the onset of functional changes exhibited by DBA/2J mice in the inner retina. This was performed by means of electroretinographic recordings (scotopic threshold response, STR) and their correlation with morphological changes (loss of RGCs). To this end, we recorded the scotopic threshold response in control C57BL/6J and in DBA/2J mice at different ages. The RGCs, in both DBA/2J and C57BL/6J animals, were identified at 15 months of age by retrograde tracing with an analogue of fluorogold, hydroxystilbamidine methanesulfonate (OHSt), applied on the superior colliculi. Whole mount retinas were processed to quantify the population of RGCs identified by fluorogold tracing and Brn3a immunodetection, and were counted using image analysis software; an isodensity contour plot was generated for each retina. DBA/2J mice showed a significant reduction in the positive STR (pSTR) amplitudes at 12 months of age, as compared to control C57BL/6J mice of the same age. The pSTR mean amplitude decreased to approximately 27.82% of the values recorded in control mice (p = 0.0058). STR responses decreased in both strains as a result of the natural process of aging, but the decrease was more pronounced in DBA/2J mice. Furthermore, quantification of the total number of RGCs identified by OHSt and Brn3a expression showed a reduced population of RGCs in DBA/2J mice as compared to control mice. Regression analysis revealed significant correlations between the decrease in pSTR and a non-homogeneous reduction in the number of RGCs throughout the retina. Our results indicate the existence of a correlation between retinal function impairment and RGC loss. This functional and morphological analysis allows a reliable assessment of the progression of the disease.

Assessment of night vision problems in patients with congenital stationary night blindness.

Congenital Stationary Night Blindness (CSNB) is a retinal disorder caused by a signal transmission defect between photoreceptors and bipolar cells. CSNB can be subdivided in CSNB2 (rod signal transmission reduced) and CSNB1 (rod signal transmission absent). The present study is the first in which night vision problems are assessed in CSNB patients in a systematic way, with the purpose of improving rehabilitation for these patients. We assessed the night vision problems of 13 CSNB2 patients and 9 CSNB1 patients by means of a questionnaire on low luminance situations. We furthermore investigated their dark adapted visual functions by the Goldmann Weekers dark adaptation curve, a dark adapted static visual field, and a two-dimensional version of the "Light Lab". In the latter test, a digital image of a living room with objects was projected on a screen. While increasing the luminance of the image, we asked the patients to report on detection and recognition of objects. The questionnaire showed that the CSNB2 patients hardly experienced any night vision problems, while all CSNB1 patients experienced some problems although they generally did not describe them as severe. The three scotopic tests showed minimally to moderately decreased dark adapted visual functions in the CSNB2 patients, with differences between patients. In contrast, the dark adapted visual functions of the CSNB1 patients were more severely affected, but showed almost no differences between patients. The results from the "2D Light Lab" showed that all CSNB1 patients were blind at low intensities (equal to starlight), but quickly regained vision at higher intensities (full moonlight). Just above their dark adapted thresholds both CSNB1 and CSNB2 patients had normal visual fields. From the results we conclude that night vision problems in CSNB, in contrast to what the name suggests, are not conspicuous and generally not disabling.

Visual quality assessment in patients with orange-tinted blue light-filtering and clear ultraviolet light-filtering intraocular lenses.

PURPOSE: To evaluate potential differences in the quality of vision after implantation of a blue light-filtering intraocular lens (IOL) and an ultraviolet (UV) light-filtering IOL. SETTING: Department of Ophthalmology, Ruhr-University, Bochum, Germany. DESIGN: Prospective randomized cohort study. METHODS: Patients with age-related cataract had bilateral standardized small-incision Kelman phacoemulsification-based cataract surgery with implantation of a blue light-filtering IOL (Oculaid PC 440Y Orange Series) in 1 eye and a UV light-filtering IOL (Oculaid PC 430 Elite Series) in the other eye. Outcome measures included scotopic and photopic corrected distance visual acuity (CDVA) and photopic uncorrected distance visual acuity (UDVA), color discrimination, and contrast sensitivity with and without glare. A questionnaire was used to assess patient satisfaction. Postoperative follow-up visits were scheduled at 1, 3, and 6 months. RESULTS: Twenty-two patients (44 eyes) completed the study. There were no statistically significant differences in UDVA, CDVA, or contrast sensitivity with or without glare between the 2 IOL groups. Color discrimination was significantly decreased in eyes with blue light-filtering IOLs compared with UV light-filtering IOLs, except along the red-green axis (P=.118). No subjective differences in color or light perception were found. CONCLUSIONS: Both IOL types provided similar postoperative visual function except color perception, which was slightly better in eyes with a clear IOL. Although differences were not clinically significant, information about potential disturbances in color vision might be provided before implanting an orange blue light-filtering IOL. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.