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      Detection of Macular Function Changes in Early (AREDS 2) and Intermediate (AREDS 3) Age-Related Macular Degeneration

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          Abstract

          Background/Aim: To evaluate if retinal sensitivity values obtained with a dedicated (screening) device can be used to functionally identify early and intermediate age-related macular degeneration (ARMD). Methods: A fully automatic fundus perimeter combined with an image-stabilized scanning laser ophthalmoscope was used in 200 ARMD patients (319 eyes) in 5 study sites. The age-matched control group consisted of 200 normals. Sensitivity point values (S values), mean retinal sensitivity, number of points below 24 dB (K value, cutoff for normal values) and fixation stability were recorded. Results: Of 319 eyes, 164 were classified as early (AREDS 2) and 155 as intermediate (AREDS 3) ARMD. Mean retinal sensitivity was significantly reduced in ARMD patients versus normals (p < 0.001). K values were different between normals and ARMD patients (p < 0.001). Fixation stability did not differ between early and intermediate ARMD patients. Conclusions: Macular sensitivity is reduced in patients with early and intermediate ARMD when compared to age-matched normals. These changes may be detected with a screening device.

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          How big is the burden of visual loss caused by age related macular degeneration in the United Kingdom?

          To predict the burden of blindness, partial sight, and visual impairment (binocular visual acuity 6/18 or less) due to late stage age related macular degeneration (AMD) in the ageing population of the United Kingdom. A systematic review, followed by a request for data, was used to establish a pooled prevalence of AMD and corresponding visual loss. Prevalence figures were applied to the UK population. Using UK population trends, the future burden of AMD over the coming decade was established. Pooled data from six studies showed that the prevalence of visual loss caused by AMD increased exponentially from the age of 70-85 years of age, with 3.5% (95% CI 3.0 to 4.1) having visual impairment beyond the age of 75 years. The authors estimate that there are currently 214 000 (95% CI 151 000 to 310 000) with visual impairment caused by AMD (suitable for registration). This number is expected to increase to 239 000 (95% CI 168 000 to 346 000) by the year 2011. Currently there are 172 000 (95% CI 106 000 to 279 000) and 245 000 (95% CI 163 000 to 364 000) with geographical and neovascular AMD, respectively. Estimates of visual impairment agree with official statistics for the number registered partially sighted or blind, caused by AMD, and are well below other figures often cited. Although these estimates are associated with wide confidence intervals (CI) and a number of caveats, they represent the best available data, which can be used to guide health and social care provision for older people in the UK setting. Implications for low vision services are outlined.
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            Microperimetry and fundus autofluorescence in patients with early age-related macular degeneration.

            Early age-related macular degeneration (AMD) has been correlated with different functional alterations, but the exact relationship between fundus lesions and overlying sensitivity is not well known. The aim of this study was to compare fundus-related sensitivity (microperimetry) and fundus autofluorescence (FAF) of the macular area with drusen and pigment abnormalities in early AMD.
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              The determinants of participation in activities of daily living in people with impaired vision.

              To investigate the determinants of participation in daily activities in people with impaired vision using the Impact of Vision Impairment (IVI) instrument. Cross-sectional study. We recruited 319 participants with no vision rehabilitation history, distance visual acuity (VA) <6/12 (better eye), the ability to converse in English, and 18 years or older. Participants completed the 32-item IVI questionnaire and provided demographic, personal, cultural, and environmental details on vision-related functioning. Visual acuity data were either abstracted from the participants' files or assessed by qualified personnel. Participants also completed the SF-12 to evaluate physical (PCS-12) and mental health (MCS-12). The areas of greatest restriction of participation were associated with reading, outdoor mobility, participation in leisure activities, and shopping. In stepwise linear regression presenting VA, the PCS-12 and MCS-12 explained the variance in leisure and work (60 participants or 19%), consumer and social interaction (92 participants or 30%), household and personal care (76 participants or 24%), mobility (92 participants or 30%), emotional reaction to visual loss and (106 participants or 33%), and total IVI score (114 participants or 36%). Having age-related macular degeneration contributed marginally to the IVI domains and total score (P <.05-.01), except for the emotional domain. Belonging to a social group explained 3% and 2% of the variance in the consumer and social interaction and emotional domains, respectively (P <.05). Distance VA and physical and mental health explained more than a third of the variance of the total score, suggesting that an intervention aimed at improving quality of life may include strategies to improve not only vision-related rehabilitation but also mental and physical health.
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                Author and article information

                Journal
                OPH
                Ophthalmologica
                10.1159/issn.0030-3755
                Ophthalmologica
                S. Karger AG
                0030-3755
                1423-0267
                2011
                March 2011
                09 December 2010
                : 225
                : 3
                : 155-160
                Affiliations
                aFondazione G.B. Bietti, IRCCS, Roma, and bThe International Microperimetry Reading Centre, Padova, Italy; cDepartment of Ophthalmology, LSU Eye Center, New Orleans, La., dAdjunct Faculty, Pennsylvania College of Optometry Private Practice, Virginia Beach, Va., and eEyeCare 20/20, Slidell, La., USA; fInstitute of Vision and Optics, University of Crete, Heraklion, Greece
                Author notes
                *Stela Vujosevic, MD, Fondazione G.B. Bietti, IRCCS, Rome, Via Livenza 3, IT–00198 Rome (Italy), E-Mail stelavu@hotmail.com
                Article
                320340 Ophthalmologica 2011;225:155–160
                10.1159/000320340
                21150232
                a7b57977-b841-49e9-9e16-3956855fa53a
                © 2010 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                : 22 April 2010
                : 16 August 2010
                Page count
                Figures: 2, Tables: 2, Pages: 6
                Categories
                EURETINA – Original Paper

                Vision sciences,Ophthalmology & Optometry,Pathology
                Retinal sensitivity,Functional screening,Visual function,Retinal fixation,Age-related macular degeneration,Fundus perimeter

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