Pondorfer, Susanne Gunda: Identification of functional markers for detecting vision loss in early and intermediate age-related macular degeneration. - Bonn, 2020. - Dissertation, Rheinische Friedrich-Wilhelms-Universität Bonn.
Online-Ausgabe in bonndoc: https://nbn-resolving.org/urn:nbn:de:hbz:5-58925
@phdthesis{handle:20.500.11811/8436,
urn: https://nbn-resolving.org/urn:nbn:de:hbz:5-58925,
author = {{Susanne Gunda Pondorfer}},
title = {Identification of functional markers for detecting vision loss in early and intermediate age-related macular degeneration},
school = {Rheinische Friedrich-Wilhelms-Universität Bonn},
year = 2020,
month = jul,

note = {Patients in the early and intermediate stages of age-related macular degeneration (AMD) often perform well in conventional visual function tests under high luminance and high contrast, whereas testing under dim light and low contrasts shows functional impairment. The functional deficit under reduced luminance and/or contrast has been well documented in patients with early and intermediate AMD (iAMD) using a number of different functional assessments such as low luminance visual acuity (LLVA), visual acuity (VA) measurements with the Moorfield Vanishing Optotypes Chart (MAC), contrast sensitivity tests and fundus-controlled perimetry. However, to date it is unclear which functional tests are most impacted in patients with early and iAMD and which tests are able to discriminate between different stages of AMD. As AMD affects vision-related quality of life (VRQoL) already in the earliest stages of the disease, it is important to investigate the relationship between visual function tests and VRQoL. Further, the relationship between visual function tests under low luminance and low contrast and measurements of retinal structure associated with AMD progression, such as drusen volume, has not been well characterized so far. Against this background we first determined the intrasession test-retest reliability of mesopic and dark-adapted fundus-controlled perimetry in patients with intermediate AMD and found good pointwise sensitivity test-retest among both testing types and in both groups (coefficient of repeatability of 4.4, 4.52, 3.96, and 4.56 dB, respectively). In order to assess which visual function measures are most strongly associated with VRQoL, we conducted a cross-sectional study and subjects were interviewed with the Impact of Vision Impairment (IVI) questionnaire. We found that patients with late AMD had significant lower IVI scores on all three subscales compared with iAMD and early AMD (p < 0.011). In the overall cohort, IVI subscales were associated with best corrected visual acuity (BCVA), LLVA, MAC-VA and contrast sensitivity (all p < 0.001), whereas a subgroup analysis, including only patients with early and iAMD, revealed that the IVI reading and mobility subscale was significantly associated with MAC-VA (p < 0.013). Moreover, we assessed which visual function measures are most strongly associated with overall retinal drusen volume in AMD. Drusen volume was automatically determined based on optical coherence tomography using a convolutional neural network (CNN) based approach. Mean drusen volume and MAC-VA significantly differed between all AMD stages and controls (p < 0.001). After controlling for AMD stage, age and the presence of reticular pseudodrusen MAC-VA, mesopic and dark-adapted microperimetry were still significantly associated with drusen volume (p = 0.008, p = 0.023 and p = 0.022, respectively). Our results suggest that MAC-VA as well as mesopic and dark-adapted microperimetry might indicate structural changes related to drusen volume in early stages of AMD and are useful, patient-relevant measures of visual impairment in AMD.},
url = {http://hdl.handle.net/20.500.11811/8436}
}

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