Delays in rod-mediated dark adaptation in early age-related maculopathy

doi:10.1016/S0161-6420(01)00580-2

Ophthalmology

Volume 108, Issue 7, July 2001, Pages 1196-1202

https://doi.org/10.1016/S0161-6420(01)00580-2 Get rights and content

Abstract

Objective

To determine whether there are disturbances in the rod-mediated kinetics of dark adaptation in early age-related maculopathy (ARM).

Design

Comparative, observational case series.

Participants

Twenty older adults with early ARM as defined by one or more large (>63 μm) drusen, focal hyperpigmentation, or both, but no choroidal neovascularization or geographic atrophy, and 16 adults in the same age range with none of these fundus features. All participants had 20/25 visual acuity or better in the tested eye.

Methods

Dark adaptation functions were measured using a modified Humphrey Field Analyzer (Zeiss Humphrey Systems, Dublin, CA) to assess the rate of rod-mediated sensitivity recovery at 12° on the vertical meridian in the inferior visual field after exposure to the equivalent of a 98% bleach. Baseline (prebleach) scotopic sensitivity, visual acuity, contrast sensitivity, and photopic sensitivity were also measured.

Main outcome measures

Rod–cone break; second and third components of rod-mediated dark adaptation; time to baseline sensitivity; and baseline (prebleach) scotopic sensitivity.

Results

Although their visual acuity was at least 20/25, patients with early ARM on average exhibited deficits in almost all rod-mediated parameters of dark adaptation as compared with age-similar healthy participants. For example, the rod–cone break was delayed approximately 10 minutes in early ARM patients as compared with healthy participants. Age-related maculopathy patients were more likely to fall outside the normal reference range for variables representing dark adaptation kinetics than for steady-state visual functions such as scotopic sensitivity. For example, 85% of ARM patients fell outside the normal reference range in at least one dark adaptation kinetic parameter, whereas only 25% of ARM patients fell outside the normal reference range for steady-state scotopic sensitivity.

Conclusions

Rod-mediated kinetic parameters of dark adaptation, which reflect the sensitivity recovery of the visual cycle, are disrupted early in ARM pathogenesis.

Section snippets

Patients and methods

Patients with ARM were recruited based on consecutive chart review of patients seen over a 6-month period in the Retina and Vitreous Service of the Department of Ophthalmology, University of Alabama at Birmingham. Inclusion criteria were as follows: (1) at least 60 years of age; (2) 20/25 visual acuity or better (best-corrected distance) in the eye to be tested psychophysically, as measured by the Early Treatment Diabetic Retinopathy Study (ETDRS) chart31; and(3) a diagnosis of ARM in the test

Results

All variables were normally distributed, so parametric statistics were used. There were no missing data on any variable. Group differences between the ARM patients and healthy participants on key variables were assessed using one-way analysis of variance (two-tailed, α = 0.05; Stat-View, SAS, Cary, NC). As indicated in Table 2, although the ARM group (mean age, 75 years) was on average older than the healthy reference group (mean age, 72 years), the two age distributions were not statistically

Discussion

These results clearly indicate that the kinetics of rod-mediated dark adaptation are typically impaired in patients with early ARM, as compared with older adults who have normal-appearing maculas, and are consistent with other studies using different methodology.9, 21 For example, the rod–cone break is delayed in early ARM patients by approximately 10 minutes, on average, as compared with healthy participants; this delay nearly doubles the time before the beginning of the rod-dominated limb of

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We evaluate the impact of test target location in assessing rod-mediated dark adaptation (RMDA) along the transition from normal aging to intermediate age-related macular degeneration (AMD). We consider whether RMDA slows because the test locations are near mechanisms leading to or resulting from high-risk extracellular deposits. Soft drusen cluster under the fovea and extend to the inner ring of the ETDRS grid where rods are sparse. Subretinal drusenoid deposits (SDDs) appear first in the outer superior subfield of the ETDRS grid where rod photoreceptors are maximal and spread toward the fovea without covering it.
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To investigate the suitability of 6 rod- or cone-mediated dark adaptation (DA) parameters as outcome measures for clinical trials in age-related macular degeneration (AMD), including their retest reliability, association with age and disease severity, and measurable longitudinal change over time.
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^☆: Supported by the National Institute of Aging (grant no.: R01 AG04212), Bethesda, Maryland; the National Eye Institute (grant no.: P30 EY03039), Bethesda, Maryland; Research to Prevent Blindness, Inc., New York, New York; and the Alabama Eye Institute, Birmingham, Alabama. Cynthia Owsley is a RPB Senior Scientific Investigator.

¹: The authors have no commercial interests in any device or product mentioned in this paper.

View full text

Delays in rod-mediated dark adaptation in early age-related maculopathy☆

Abstract

Objective

Design

Participants

Methods

Main outcome measures

Results

Conclusions

Section snippets

Patients and methods

Results

Discussion

Age-related macular degeneration

Surv Ophthalmol

Age-related macular disease

Br J Ophthalmol

Age-related macular degenerationreview of pathogenesis

Eur J Ophthalmol

Prevalence of age-related maculopathy. The Beaver Dam Eye Study

Ophthalmology

The prevalence of age-related maculopathy in the Rotterdam study

Ophthalmology

Prevalence of age-related maculopathy in Australia. The Blue Mountains Eye Study

Ophthalmology

Photoreceptor loss in age-related macular degeneration

Invest Ophthalmol Vis Sci

Spare the rods, save the cones in aging and age-related maculopathy

Invest Ophthalmol Vis Sci

Symptomatic abnormalities of dark adaptation in patients with age-related Bruch’s membrane change

Br J Ophthalmol

Psychophysical evidence for rod vulnerability in age-related macular degeneration

Invest Ophthalmol Vis Sci

Bruch’s membrane change with age

Br J Ophthalmol

Age-related changes in the ultrastructure of Bruch’s membrane

Am J Ophthalmol

Morphometric analysis of Bruch’s membrane, the choriocapillaries and the choroid in aging

Invest Ophthalmol Vis Sci

Age-related variation in the hydraulic conductivity of Bruch’s membrane

Invest Ophthalmol Vis Sci

Hydrodynamics of ageing Bruch’s membraneimplications for macular disease

Exp Eye Res

Towards a molecular description of human dark adaptation

J Physiol

Molecular basis of dark adaptation in rod photoreceptors

Eye

Rod plateaux during dark adaptation in Sorsby’s fundus dystrophy and vitamin A deficiency

Invest Ophthalmol Vis Sci

Night blindness in Sorsby’s fundus dystrophy reversed by vitamin A

Nat Genet

Dark adaptation and the acuity/luminance response in senile macular degeneration (SMD)

Am J Optom Physiol Opt

Dark adaptation in age-related maculopathy

Ophthalmic Physiol Opt

Relative effects of aging and age-related macular degeneration on peripheral visual function

Optom Vis Sci

Sensitivities in older eyes with good acuityeyes whose fellow eye has exudative AMD

Invest Ophthalmol Vis Sci

Cone adaptation in age-related maculopathy

Am J Optom Physiol Opt

Glare recovery and age related maculopathy

Clin Vis Sci

Slow photostress recovery and disease severity in age-related macular degeneration

Retina