Some patients with age-related changes at the level of Bruch's membrane and good visual acuity report poor vision in dim light, fading vision in bright light, and a central scotoma noticeable in the dark. Ophthalmic examination, scotopic thresholds, and dark adaptation kinetics were recorded in 12 eyes of 12 patients with such symptoms. All had macular drusen which were hypofluorescent on fluorescein angiography in nine subjects, and six had evidence of prolonged choroidal filling on fluorescein angiography. Scotopic thresholds were depressed in six patients who all experienced a central scotoma in the dark or poor night vision. The kinetics of dark adaptation were abnormal in all 10 patients in whom reliable measurements were possible. The findings suggest that visual symptoms reflect abnormality of both scotopic sensitivity and the time course of dark adaptation in patients with age-related Bruch's membrane change.
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