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Autofluorescence in a patient with geographic atrophy (GA) (left), Microperimetry (right), and Histogram of Macular sensitivity and Fixation stability (below) from the same patient. To comprehensively evaluate visual function in eyes with geographic atrophy (GA) as compared to normal eyes. Both CS and LLD are reliable measurements that detect abnormal visual function and help to determine the risk of VA loss in GA patients.17,48,49. endobj Cocce KJ, Stinnett SS, Luhmann UFO, et al. Interestingly, a recent study demonstrated that visual rehabilitation via microperimetry may be effective in improving fixation stability, reading speed, and visual acuity after one week of training, but no improvement in retinal sensitivity was noted after training.50 Some studies reveal detail on changes in retinal sensitivity in the pathogenesis of GA. Although the GA group showed an important reduction in the reading speed measurements compared with CG, both were able to read a similar size of letter with maximum speed. Abbreviations: Max, maximum; GA, geographic atrophy. Determinants of health related quality of life and health state utility in patients with age related macular degeneration: the association of contrast sensitivity and visual acuity, Contrast sensitivity as an outcome measure in patients with subfoveal choroidal neovascularisation due to age-related macular degeneration. In macular diseases such as AMD with GA, it is critical to correlate the anatomic findings with visual function.11 Though visual acuity has been used as the primary metric to assess visual function, it has been demonstrated that it is inadequate to comprehensively assess visual impairment10 and thus, underrepresents functional deficits.12 Other measures such as the contrast sensitivity function (CSF),1316 reading speed,1619 and low luminance visual acuity (LLVA), have been introduced to predict future VA loss.9,17,19 Several studies have also demonstrated the importance of microperimetry,9,11,20-23 measurement of extrafoveal fixation/preferred retinal locus (PRL),2427 and fixation stability in the assessment of retinal sensitivity and macular function.28. Bandello F, Sacconi R, Querques L, Corbelli E, Cicinelli MV, Querques G. Recent advances in the management of dry age-related macular degeneration: a review. Similar to our results, differences between self-reported visual performance and reading speed have been reported previously.48 The results showed that reading speed cannot be assumed to be the attribute on which readers base their perceived reading performance. Error bars represent 95% confidence interval. The continuous variables were expressed as the mean standard deviation (SD), whereas the categorical variables were expressed as the frequency and percentage. Multimodal imaging with fundus autofluorescence (FAF) and spectral-domain optical coherence tomography (SD-OCT) have proven to be useful in monitoring GA.5,8,30 The combination of multimodal imaging with psychophysical tests and quality of life questionnaires may allow for a more comprehensive evaluation of the progression of GA.31,32 Nonetheless, there is no consensus on the anatomic and functional evaluation of GA that takes into account the patientreported outcome (PRO). Another limitation of our study was the small cohort of patients; a larger cohort would allow us to obtain more robust results and divide GA into different groups based on FAF patterns. The comparison of the results of the visual function tests between groups are shown in Table 2 and the NEI VFQ-25 scores in Table 3. The results suggest the importance of the reading letter size in patients with GA. Microperimetry and reading speed are useful tools to better assess visual impairment in patients with GA. Age-related Macular Degeneration (AMD) is considered the most frequent cause of severe, irreversible central vision loss and is one of the leading causes of blindness in developed countries.1,2 More than 21 million people older than 60 years in the world have AMD2 and will increase in the coming years due to population aging.3 8.7% of the elderly population has AMD and is projected to largely increase by 2020 (196 million people) and reach 288 million by 2040.3. GA has anatomic and functional effects. In addition to the 25 questions, 6 more questions related to near vision (A3, A4, A5) and distance vision (A6, A7, A8) were added, making a total of 31 questions. Only the sentences read in 20 seconds at most were recorded as valid. Association Between Visual Function Tests and NEI VFQ-25 in GA Patients. Visual rehabilitation via microperimetry in patients with geographic atrophy: a pilot study. T5&:Z~d zkU6 }rn-Jda7I|J!g|>_{L9pt$MCh)uV)@1.N@s w3Tiz ? FOIA This result highlights that patients with GA are able to read small single letters but are more efficient reading with a larger size of letter (CPS). Fixation patterns and reading rates in eyes with central scotomas from advanced atrophic age-related macular degeneration and stargardt disease. Q ,~?E Ct J EzK}l*|^T In our study, there were 6 questions about reading whereas the VCM1 has 15 reading questions. ]cQ`Lqli ydP~'y9F?0>7460~ Z,e@Q%~HB?CB>U5/0x`5P. There is central fixation but relatively unstable fixation (below). PMC legacy view Fleckenstein M, Mitchell P, Freund KB, et al. As the aging population continues to grow, geographic atrophy, the advanced form of dry AMD, looms large as a major cause of severe, central vision loss. The association between the visual function tests and questionnaire scores were explored by performing a stepwise forward multiple regression analysis with the visual function tests results as potential explanatory variables. 4 0 obj Poor reading speed is a predictive marker of future deterioration in BCVA in patients with GA.17,19 Interestingly, critical point size (CPS) was similar in both groups - GA CPS = 0.9 logRAD (20/160) and CG CPS = 0.8 logRAD (20/125) (p = 0.214). Visual function and subjective quality of life compared in subjects with acquired macular disease. Difficulties in reading tasks are the most common complaints in patients with GA due to the critical importance of reading in varied daily activities. Sivaprasad S, Tschosik E, Kapre A, et al. Given the lack of treatment options to prevent GA, it is especially important to monitor closely for progression of GA and comprehensively evaluate visual function.38 The ultimate goal will be early intervention once an effective treatment is established. Age and gender variations in age-related macular degeneration prevalence in populations of european ancestry: a meta-analysis. The 95% BCEA value, expressed as an ellipse area in square degrees, contained 95% of the fixation points used by the patient throughout the test. The consensus view on the combination of different metrics such as visual acuity, contrast sensitivity, reading speed, microperimetry, and psychometric questionnaires to assess visual impairment, has not been elucidated.3234,39 Correlating visual function and multimodal imaging such as autofluorescence and SD-OCT is critically important in the clinical management of patients with dry AMD.8,31,40-43 We sought to comprehensively evaluate visual function in GA versus normal controls to better inform the evaluation of GA. Bansback N, Czoski-Murray C, Carlton J, et al. The new PMC design is here! Accessibility The composite score in the GA group was 46.7 (mean VA letter score 71, 20/40). Careers, Correspondence: Gowtham Jonna Tel +1512 454 5851, Email g_jonna@hotmail.com. CPS is defined as the minimum character that one can read with fast speed. Moderate and strong correlations in the GA group were found between maximum reading speed (r = 0.787) (p0.01), CS spatial frequency 3 cpd (r = 0.441) (p0.05), CS spatial frequency 6 cpd (r = 0.524) (p0.01), fixation P1 (r = 0.379) (p0.05), macular sensitivity (r = 0.484) (p0.05) and atrophic area (r = 0.689) (p0.01), and the VFQ-25 composite score. Visual function metrics in early and intermediate dry age-related macular degeneration for use as clinical trial endpoints. Patient Baseline Demographics and Ocular Characteristics. Sunness JS, Rubin GS, Applegate CA, et al. http://creativecommons.org/licenses/by-nc/3.0/. In the near activities score, most variation was noted in the maximum reading speed (R2 = 0.478, p 0.01) followed by atrophy area (R2 =0.594, p 0.05). Reliability and construct validity of the NEI VFQ-25 in a subset of patients with geographic atrophy from the phase 2 mahalo study. Relatively unstable fixation was defined as P1 percentage with greater than 75% of the fixation points inside the 4 diameter circle, and unstable fixation as less than 75% of the fixation points inside the 4 diameter circle. 1Ophthalmology Department, Retina Research Center, Austin, Texas, USA, 2Optometry Department, University of Valencia, Valencia, Spain, 3Ophthalmology Department, Qvision, Hospital Vithas Virgen Del Mar, Almeria, Spain, 4Ophthalmology Department, La Fe University Hospital, Valencia, Spain, 5Surgery Department, University of Valencia, Valencia, Spain, 6Ophthalmology Department, Oftalvist, IMED Hospital, Valencia, Spain. Received 2020 Jan 16; Accepted 2020 Apr 30. )gq'>: FE:.gPkYW@~AhE U>AWiS;1R~X]bH!Oepk i=%Sh>IB+cD"MzOI{ # ;^] The site is secure. Prediction of age-related macular degeneration in the general population: the three continent AMD consortium, Amd-the retinal disease with an unprecised etiopathogenesis: in search of effective therapeutics. Mara Andreu-Fenoll, Ophthalmology Department, La Fe University Hospital, Valencia, Spain - Provided and cared for study patients. Similar reading vision results (mean = 0.8 0.2 logRAD) were found in patients with GA.47 The mean near visual acuity in GA was 0.29 0.02 logMAR or 20/40 measured at 40 cm, which was better than the mean CPS of 20/160 measured at 32 cm. /Type /Stream McClure ME, Hart PM, Jackson AJ, Stevenson SM, Chakravarthy U. Sunness JS, Rubin GS, Broman A, Applegate CA, Bressler NM, Hawkins BS. On the right, the black points correspond to no sensitivity and the red points correspond to decreased sensitivity on the macular sensitivity map. Furthermore, it has been suggested that these visual function measures be monitored more closely in patients with GA.17 As GA progresses, changes become evident in several visual functions before deterioration in BCVA occurs. Table 5 shows the only correlation found in the CG between NVA and distance activities score. This may be due to less specific reading questions in the NEI VFQ-25 than those used in the VCM1. ?GYr;|!BkCHY~ JD!,}-/r~Owwt}3sK/O,x6R BTVwfU93b;;_By+;6P{C~X}#.Y~AY,Bh\O(kywbCWD$MD D*! "|H}cnW}"4*#) dD%(] U^+)e7DJW. >> Macular dystrophies mimicking age-related macular degeneration, Improving the age-related macular degeneration construct: a new classification system, The journey of geographic atrophy through past, present, and future, Low-luminance visual acuity and microperimetry in age-related macular degeneration, Reading newsprint but not headlines: pitfalls in measuring visual acuity and color vision in patients with bullseye maculopathy and other macular scotomas, Introduction to microperimetry and its use in analysis of geographic atrophy in age-related macular degeneration. Ooto S, Suzuki M, Vongkulsiri S, Sato T, Spaide RF. Sixty-three eyes from 63 patients 50 years old were recruited for this observational study; 31 were identified as normal macular health eyes and 32 with GA. Demographics and study eye characteristics of the patients are shown in Table 1. /Length 229249 << Patients with foveal-sparing GA may have scotomata encircling the fovea or in the parafoveal area but with fovea-involving GA, central scotomata may lead to eccentric fixation and PRL. Institute for Retina Research, Austin, Texas, United States - Provided material support. A total of 63 eyes from 63 patients were included in the analysis. The measurement of reading speed was done with the Radner Reading Test measured as logarithm of the reading acuity determination (logRAD), formed of short sentence optotypes (14 words) with standardized word length, word location, lexical and syntactical difficulty. In a previous trial, significant correlations between visual function tests and the vision-related quality of life test, vision core measure (VCM1), were identified in subjects with acquired macular disease.48 Recently, The Phase 2 MAHALO study reported correlations between NEI VFQ composite score and near and distance activities score, maximum binocular reading speed, and FRI index score in patients with GA.34 The highest correlation found was between the composite score and reading speed. Though variable, the mean enlargement rate of GA from the largest clinical trials to date is approximately 2 mm2 per year but there remains no currently approved, efficacious treatment option.29 For this reason, it is very important to continue to refine the tools for monitoring GA progression. This study was approved by the Committee of the Sanitary Research Institute La Fe. Abbreviations: CG, control group; GA, geographic atrophy; NVA, near visual acuity; BCVA, best corrected visual acuity; LLVA, low luminance visual acuity; LLD, low luminance deficit; CPS, critical point size; CS, contrast sensitivity; BCEA, bivariate contour ellipse area; CST, central subfield thickness; Max, maximum; SD-OCT, spectral-domain optical coherence tomography. Preliminary analysis showed the relationship to be monotonic, as assessed by visual inspection of a scatter plot. No relevant financial or commercial relationship exists for any author. Multimodal imaging with spectral-domain optical coherence tomography (SD-OCT) and fundus autofluorescence (FAF) were obtained using the Heidelberg Spectralis HRA-OCT (Heidelberg Engineering, Heidelberg, Germany). The test is made up of circular sheets on a grey background with sinusoidal waves in 5 frequency levels and 8 contrast levels. This final version differs from the previous version in that it includes an extra driving item from the appendix of supplementary questions as a part of the base set of items. The current study did not divide GA into central and non-central atrophy groups. OI Owen CG, Rudnicka AR, Smeeth L, Evans JR, Wormald RPL, Fletcher AE. about navigating our updated article layout. Buitendijk GHS, Rochtchina E, Myers C, et al. When all patients were analyzed together as a group, all visual function tests showed correlation except central subfield thickness (CST) and CPS; results are illustrated in Table 6. The https:// ensures that you are connecting to the Sunness JS, Applegate CA, Haselwood D, Rubin GS. The FRI Index score is correlated with GA lesion size and VFQ-25 score.37 However, it does not measure aspects of visual function and vision-related quality of life as they are measured with VFQ-25 test.34 The purpose of this study was to analyze the association between the different tests of visual function and the scores of the NEI VFQ-25 in subjects with GA as compared to normal controls to better elucidate the broad-ranging effects of GA based on the PRO. (Adobe) The CSF allows us to measure visual impairment in eyes with GA.1316 Patients with good VA may have poor CS, and it will be reflected in driving and reading difficulties, recognizing faces, and in dim-lit conditions.39 This study demonstrated a significant reduction of CS in patients with GA compared to healthy eyes (p 0.01) (Table 2 and Figure 2). We observed worse LLVA and BCVA in GA as compared to normal controls (p0.01) (Table 2). Contrast sensitivity in patients with geographic atrophy (GA) and control group (CG). There were strong and moderate correlations in CG and GA groups together, for NEI VFQ-25 composite score, near and distance activities score with all visual function tests, except for the CST and CPS (Table 6). National Library of Medicine Standard LLVA was measured using a log 2.0 neutral density filter Kodak Wratten (Kodak, Rochester, NY) that reduces the luminance 100 times. FAF and microperimetry from one representative GA patient is illustrated in Figure 3. This study was focused solely on GA and the most recent visual function tests used to evaluate progression and visual impairment in patients with GA: microperimetry, SD-OCT, FAF and the NEI VFQ-25, the gold standard quality of life test for AMD patients. They had better VA likely because 75% of the patients had foveal-sparing GA in our study. government site. Development of the 25-item national eye institute visual function questionnaire, Functional reading independence (FRI) index: a new patient-reported outcome measure for patients with geographic atrophy, Preventing the growth of geographic atrophy: an important therapeutic target in age-related macular degeneration, The effect of non-neovascular age-related macular degeneration on face recognition performance. Association Between Visual Function Tests and NEI VFQ-25 in CG and GA Patients. Exclusion criteria were: previous diagnosis of inherited retinal disease/retinal or macular dystrophy, retinal detachment, uveitis, glaucoma, non-glaucomatous optic neuropathy, epiretinal membrane, diabetes mellitus, or any other condition disease that, in the view of the investigators, could confound the study results. This work is published and licensed by Dove Medical Press Limited. Stable fixation was defined as P1 percentage with greater than 75% of the fixation points inside the 2 diameter circle. %PDF-1.7 GA, the late-stage of AMD, is increasing exponentially with population aging4 and is becoming a larger public health problem.5 GA is characterized by loss of the retinal pigment epithelium (RPE) in the parafoveal area (pericentric macula).68 With disease progression, atrophic areas grow and coalesce leading to foveal RPE atrophy and moderate to severe vision loss.9 Patients with foveal-sparing (FS) GA may have good central vision but have many difficulties reading or recognizing faces due to parafoveal scotomata and because they cannot fit into the non-atrophic foveal area.9,10 The progression of GA results in a deterioration of visual function and a reduction in quality of life. Inclusion criteria for participants with GA were: age greater than or equal to 50 years with the ability to provide consent to participate, Snellen Visual Acuity of 20/200 (0.1 logMAR) or better, GA secondary to AMD, and no prior or active choroidal neovascularization (CNV). In the distance activities score, the most variable were maximum reading speed (R2 = 0.335, p 0.01), atrophy area (R2 =0.527, p 0.01), and macular sensitivity (R2 = 0.602, p 0.05). 8 0 obj The control group composite score was 89.6 (20/16), which is comparable to other studies.35,52. Notes: *p0.05 (Spearman correlation); p0.01 (Spearman correlation). Luminita T, Gonzlez E, Markowitz SN, Steinbach MJ. Anatomic function was evaluated with spectral-domain optical coherence tomography (SD-OCT) and fundus autofluorescence (FAF). Our results demonstrated that a reading letter size between 20/125 and 20/160 may be optimal for all patients healthy eyes as well as those with geographic atrophy regardless of area of involvement. The progression of geographic atrophy secondary to age-related macular degeneration. MB]#F+Q.w^EnAE+52n#+WeQ6W|k&C @xAx}.p_Ct/G|p) ]dqa%\vs#j Mh>mx+!PMh%P?xaxaS$3E3(YokMiaxaxo@axaxa5($D@* fK (O_z4xaxaxaxao^BORS$(!9p:GAFiMBQ+nGB{C8+{39o__C'C=Q'gRA=x:~0=hP/9:|v.3FcsV `.r$OOg?__L 0JgP9Br\rm 9lF8 1og'|)I4~(p/]A&TZZA'qgZ\5?nZ4 Even though VA is reduced and some magnification is required, too much magnification will lead to some parts of the words within the atrophic area.46 We demonstrated the drop-off of the reading rate with letter size for eyes with GA compared to healthy eyes (p0.01) (Figure 1 and Table 2). The .gov means its official. Systemic complement inhibition with eculizumab for geographic atrophy in age-related macular degeneration. There was a notable difference in age between groups, as healthy patients who met the requirements and completed all tests, were younger than patients with GA. The results of the CSF were not significant in the regression analysis; however we have demonstrated a strong correlation between the CSF and near activities in the GA group (Table 4). Abbreviations: GA, geographic atrophy; NVA, near visual acuity; BCVA, best corrected visual acuity; LLVA, low luminance visual acuity; LLD, low luminance deficit; CPS, critical point size; CS, contrast sensitivity; BCEA, bivariate contour ellipse area; CST, central subfield thickness; Max, maximum; SD-OCT, spectral-domain optical coherence tomography. The average LLD was a reduction of 6 lines in patients with GA. LLVA and LLD are efficient measures to assess central cone-mediated function under conditions of reduced luminance.44 Deficits in LLVA are associated with higher rates of GA lesion progression.45. Rudnicka AR, Jarrar Z, Wormald R, Cook DG, Fletcher A, Owen CG. Saksens NTM, Fleckenstein M, Schmitz-Valckenberg S, et al. Mangione CM, Lee PP, Gutierrez PR, Spritzer K, Berry S, Hays RD. In conclusion, advanced AMD with GA causes a dramatic decrease of visual function and quality of life as a result of disease progression. Preliminary analysis showed that both variables were not normally distributed as assessed by ShapiroWilk test and p-value 0.05. There is a lack of correlation between CST and the NEI VFQ-25 in both groups likely due to fovea sparing of GA until very advanced and due to generalized variability in CST. Suer IJ, Kokame GT, Yu E, Ward J, Dolan C, Bressler N. Responsiveness of NEI VFQ-25 to changes in visual acuity in neovascular AMD: validation studies from two phase 3 clinical trials. and transmitted securely. Federal government websites often end in .gov or .mil. Bethesda, MD 20894, Web Policies Although our patients had better VA, the rest of the visual function measures showed worse results. Some magnification is required but too much magnification causes difficulty with reading. Reading speed in patients with geographic atrophy (GA) and control group (CG) Maximum reading speed (0.9 logRAD for GA and 0.8 logRAD for CG) corresponds to the critical point size (CPS). 5 0 obj Sunness JS, Gonzalez-Baron J, Applegate CA, et al. Ten degrees of visual field (space between sampling points < 1 degree) were assessed with 4 fixed sensitivity levels (0 dB, 5 dB, 15 dB, 25 dB). tpRK>Gp\{R#GCK'a6v2-(a=w~P@^ Visual function and quality of life are reduced in patients with GA. Our study has several limitations. This was an observational study that did not prospectively and longitudinally evaluate the progressive decrease in the visual function. (Identity) Nstor Garca-Marn, Ophthalmology Department, La Fe University Hospital, Valencia, Spain - Provided and cared for study patients. Abbreviations: CG, control group; NVA, nbar visual acuity; BCVA, best corrected visual acuity; LLVA, low luminance visual acuity; LLD, low luminance deficit; CPS, critical point size; CS, contrast sensitivity; BCEA, bivariate contour ellipse area; CST, central subfield thickness; Max, maximum; SD-OCT, spectral-domain optical coherence tomography. The research followed the tenets of the Declaration of Helsinki. p0.01 (Pearson Chi Square). Hazel CA, Petre KL, Armstrong RA, Benson MT, Frost NA. =u'3_ awr: bkW]zJz] OD6/0|A-^@!P/4 @;a=p?`` 4Q Learn more The decreased visual function is reflected in a poor quality of life in patients with GA. Reading speed, contrast sensitivity, fixation, and macular sensitivity are strongly associated with vision-related quality of life. Before The results showed a strong relationship between the different scores and atrophy area. It is sometimes associated with depression due to the progressive loss of vision. In addition to reading speed, macular sensitivity showed an important relationship with composite and distance activities scores; if we add macular sensitivity to the model, it would explain an additional 4.8% of the variation (p 0.05) in the composite score and 8.3% of the variation (p 0.05) in the distance activities score. Inclusion criteria for control subjects were the same for age, but with Snellen VA of 20/20 and no signs of AMD. The highest positive correlation was found between the maximum reading speed and the composite score r = 0.787 (p0.01), and the negative highest correlation was between the atrophy area and the composite score r = 0.689 (p0.01). Notes: *p0.05; p0.01; Composite Score NEI VFQ-25, near and distance activities scores are the dependent (y) variables, visual function tests are the independent (x) variables. Reading speed tests results explained most of the variance in the NEI VFQ-25 composite score and near activities score, accounting for more than 48% (p 0.01) of the variance in each of these scores (Table 7). Age was not included as a factor in the analysis due to the fact that it did not correlate with any of the variables. Patients with GA may have a large area of atrophy but they would have less difficulty reading words if the words are of the CPS. endobj At baseline mean age was 78.53 8.11 years for the GA group, and 65.42 7.86 years for the macular health group. the european eye study (EUREYE). The full terms of this license are available at, geographic atrophy, age-related macular degeneration, reading speed, visual function, quality of life. x `U?>s}oyy['d'y,@H$,AqCVXM qkJjjH;sN@e;gs33%#!ij!+E}}u)C\69"#$K"g}f7f+;l5]_"${ a"B? Is the NEI-VFQ-25 a useful tool in identifying visual impairment in an elderly population? sharing sensitive information, make sure youre on a federal Only significant relationships are shown. Near visual acuity (NVA) was measured with the test SOSH Low Vision Chart (Pennsylvania College of Optometry, Pennsylvania) at 40 centimeters in photopic conditions (111.45 5.83 cd/m2 Tektronix J17 LumaColor (Tektronix, Beaverton, Oregon, U.S.A.)), the reading add used was +2.50D. The highest correlation was found between the macular sensitivity and distance activities score r = 0.827 (p 0.01) followed by composite score r = 0.818 (p 0.01). Schmitz-Valckenberg S, Bltmann S, Dreyhaupt J, Bindewald A, Holz FG, Rohrschneider K. Fundus autofluorescence and fundus perimetry in the junctional zone of geographic atrophy in patients with age-related macular degeneration, The preferred retinal locus in macular disease, Functional and cortical adaptations to central vision loss, Preferred retinal loci relationship to macular scotomas in a low-vision population, Concept of a functional retinal locus in age-related macular degeneration. Finger RP, Fleckenstein M, Holz FG, Scholl HPN. Enlargement of atrophy and visual acuity loss in the geographic atrophy form of age-related macular degeneration, Contrast sensitivity and functional vision. Fixation characteristics of patients with macular degeneration recorded with the MP-1 microperimeter, Efficacy and safety of lampalizumab for geographic atrophy due to age-related macular degeneration: chroma and spectri Phase 3 randomized clinical trials. Macular integrity and fixation stability were evaluated with the Macular Integrity Assessment (MAIA, CenterVue, Padova, Italy). This study demonstrated a decrease on the composite score in addition to a significant reduction in all subscales tested in the GA group compared with the control group (p 0.01) (Table 3). HHS Vulnerability Disclosure, Help Our study highlights expected deterioration in visual function with GA. With a larger area of GA, there is a greater reduction in reading speed, contrast sensitivity, macular sensitivity, and fixation stability, resulting in a poor score in the NEI VFQ-25, despite good central VA in many. Visual function abnormalities and prognosis in eyes with age-related geographic atrophy of the macula and good visual acuity, Changes in retinal sensitivity in geographic atrophy progression as measured by microperimetry, Use of fundus perimetry (microperimetry) to quantify macular sensitivity. will also be available for a limited time. 8600 Rockville Pike Quality of life and vision were assessed with the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25). 93JsFsbeCB~ZPy!,Ft 5g-n4))t 75cRK8]s{.7%mWcas/zzMPUoPUuo$5 !W>t)R",i: rI-Hf%8fEZzvr bk"Wv+CUY;3Ao2u/n_PUh0}Y7+ O`EcXD*k;RYU=UI]P}~jn!2wKAN2+f |*K,7cb.R"|ON hGH$KU DFsJWwWz1j;srDtTvOiT#&^t{s;i&m#1TW,%s"E"u'].st!>l%-#-%P. The patient should be able to distinguish the direction of the sinusoidal waves and the answers were recorded as a curve; the CSF curve of each patient was obtained. Quality of life in age-related macular degeneration: a review of available vision-specific psychometric tools, Quality of life in patients with age-related macular degeneration: impact of the condition and benefits of treatment. Foveal-sparing scotomas in advanced dry age-related macular degeneration, Autologous translocation of the choroid and retinal pigment epithelium in patients with geographic atrophy. Finally, all patients completed the NEI VFQ-25 Version 2000. Some parameters differed from the definition used by the Age Related Eye Disease Study (AREDS) for GA. ==`, z~\/H Qan {q.~5Wyvw-Ym sf9n5US*'G+'LHO ''>d44jR! nS3H {T36O]3

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