Macular Function in Early and Intermediate Age-related Macular Degeneration: Correlation with the Simplified Thea Risk Assessment Scale (STARS).

Purpose: Early detection of retinal dysfunction in age-related macular degeneration (AMD) may be important for both prevention and treatment. The aim of this study was to evaluate in early and intermediate AMD the correlation of macular function, assessed by the focal electroretinogram (fERG), with the Simplified Thea Risk Assessment Scale (STARS), a simple 13-item self-administered questionnaire. Methods: We recorded a fERG (18°, 41 Hz) in 84 patients with AMD (40 male and 44 female, age 55-87 years, visual acuity 20/40-20/20), who had undergone a 5-year clinical ophthalmic and general follow-up. Sixty-six patients had early and 17 patients intermediate AMD. Fifty healthy subjects, in a comparable age range, served as controls. The fERG amplitude (in microVolts) was the main outcome variable. STARS was calculated for each patient. Results: Compared with controls, fERG amplitudes were significantly reduced, on average, in both early and intermediate patients with AMD (P < 0.01). In both groups, fERG amplitudes tended to decrease with age and to increase with visual acuity and were negatively correlated with STARS (early r = -0.6, P < 0.01; intermediate, r = -0.50, P < 0.05). fERG losses were greatest in patients with a STARS score of greater than 20. Conclusions: In early and intermediate AMD, STARS robustly predicted central retinal function, as assessed by fERG, supporting the combined use of both parameters to estimate the clinical risk of visual function loss. Translational Relevance: The STARS may predict macular function in AMD and could be used in the daily clinical practice to estimate the risk of visual function loss in early disease stages.

Influence of short-term antioxidant supplementation on macular function in age-related maculopathy: a pilot study including electrophysiologic assessment.

PURPOSE: To evaluate the influence of short-term antioxidant supplementation on retinal function in age-related maculopathy (ARM) patients by recording focal electroretinograms (FERGs). DESIGN: Nonrandomized, comparative clinical trial. PARTICIPANTS: Thirty patients with early ARM and visual acuity >/=20/30, divided into two groups, similar for age and disease severity: antioxidant group (ARM-A, n = 17) and no treatment group (ARM-NT, n = 13). Eight age-matched normal subjects divided into antioxidant (N-A, n = 4) or no treatment (N-NT, n = 4) groups. METHODS: ARM-A patients and N-A patients had oral supplementation of lutein, 15 mg; vitamin E, 20 mg; and nicotinamide, 18 mg, daily for 180 days, whereas ARM-NT patients and N-NT patients had no dietary supplementation during the same period. Eight of the 17 ARM-A patients took supplementation for an additional 180-day period. In all patients and normal subjects, FERG assessment was performed at the study entry (baseline) and after 180 days. Further testing was performed at 360 days for the eight ARM-A patients taking supplements and for one ARM-A patient who had discontinued supplementation after 180 days. FERGs were recorded in response to a 41-Hz sinusoidally modulated uniform field (93.5% modulation depth) presented to the macular region (18 degrees ) on a light-adapting background. In a subgroup of patients (11 ARM-A and 5 ARM-NT), whose responses had suitable signal-to-noise ratios, FERGs were also recorded at different stimulus modulation depths between 8.25% and 93.5%. MAIN OUTCOME AND MEASURES: Amplitude (in micro V) and phase (in degrees) of the FERG fundamental harmonic component. FERG modulation thresholds, estimated from the value of log modulation depth yielding a criterion response. RESULTS: At 180 days, FERGs of ARM-A patients and N-A patients were increased in amplitude (mean change, 0.11 and 0.15 log micro V, respectively, P

Age, a predictive factor for the reduction in the mean transmitral pressure gradient after percutaneous balloon mitral valvotomy.

BACKGROUND: The aim of this study was to evaluate the changes in mitral valve area and mean transmitral pressure gradient before and after percutaneous balloon mitral valvotomy and at 2 years of follow-up. We hypothesized that the patient's age would be an important determinant for the success of balloon valvotomy. METHODS: We studied 24 patients with mitral stenosis (6 men and 18 women with an average age of 58 years, range 39 to 80 years), who underwent percutaneous balloon mitral valvotomy. Two-dimensional and Doppler echocardiographic examinations were taken before, immediately after and at a mean follow-up of 24 months (range 12 to 73 months). The correlation between the changes in the mitral valve area or mean transmitral pressure gradient and age was assessed with rank correlation and with stepwise multiple linear regression analysis correcting for sex, days of follow-up, heart rate score, pulmonary hypertension, mitral regurgitation and Wilkins score at follow-up. RESULTS: Changes in the mitral valve area did not correlate with age. The reduction in mean transmitral pressure gradient at follow-up was associated with age with a 20.6% less reduction in mean transmitral pressure gradient (95% confidence interval 3.5-40.4%, p < 0.021) for every other year of the patients' age. When comparing changes in mean transmitral pressure gradient before and after percutaneous balloon mitral valvotomy, the strength and consistency of the association with age appeared similar (mean transmitral pressure gradient -0.9 +/- 3.0 vs -2.8 +/- 3.4 mmHg). CONCLUSIONS: Age is a predictive factor for the reduction in mean transmitral pressure gradient after percutaneous balloon mitral valvotomy. This suggests that a better outcome is to be expected in younger patients, independently of the list of factors taken into consideration in our study.