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Blue on yellow perimetry with scanning laser ophthalmoscopy in patients with age related macular disease
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  1. A Remky1,2,
  2. A E Elsner1
  1. 1Schepens Eye Research Institute, Harvard Medical School, 20 Staniford Street, Boston, MA 02114, USA
  2. 2Augenklinik der Med Fak der RWTH Aachen, Pauwelsstrasse 30, 52057 Aachen, Germany
  1. Correspondence to: Dr A Remky Augenklinik der Med Fak der RWTH Aachen, Pauwelsstrasse 30, 52057 Aachen, Germany; andreas.remkypost.rwth-aachen.de

Abstract

Background/aim: The loss of short wavelength sensitive (SWS) cone mechanism sensitivity is related to severe vision loss in patients with age related maculopathy (ARM). A case-control study of patients with ARM and age matched controls was performed, using blue on yellow static perimetry.

Methods: A bright yellow background at 594 nm isolated the responses of short wavelength cone mechanisms to 458 nm targets. A scanning laser ophthalmoscope produced stimuli and provided real time, simultaneous fundus illumination. The macula was probed with 16 Goldmann IV targets, 1–10 degrees from fixation, using a staircase method.

Results: 24 patients with non-exudative ARM were matched to 24 subjects with normal fundus appearance. SWS cone pathway sensitivity for macular targets was significantly reduced in the patients with ARM compared to normals—15.45 (SD 4.56) dB v 17.22 (0.28) dB, respectively (p<0.0005). There was not only a diffuse loss of sensitivity in ARM patients, but also a localised loss of sensitivity over drusen (p<0.025). Neither the mean age, 69 (8) years, nor the mean visual acuity differed between groups, logMAR 0.09 (0.10) v 0.05 (0.06) for ARM patients v normals, respectively. Patients with soft drusen had lower sensitivity than those with hard drusen (p <0.05).

Conclusion: A loss of SWS cone pathway sensitivity occurred in most patients with early ARM, despite good visual acuity, demonstrating a loss of visual function that cannot be attributed to ageing changes. The loss of sensitivity, despite good visual acuity, included both a diffuse loss and localised losses.

  • AMD, age related macular degeneration
  • ARM, age related maculopathy
  • RPE, retinal pigment epithelium
  • SLO, scanning laser ophthalmoscopy
  • SWS, short wavelength sensitive
  • VA, visual acuity
  • perimetry
  • scanning laser ophthalmoscopy
  • blue cones
  • age related macular degeneration
  • macula
  • AMD, age related macular degeneration
  • ARM, age related maculopathy
  • RPE, retinal pigment epithelium
  • SLO, scanning laser ophthalmoscopy
  • SWS, short wavelength sensitive
  • VA, visual acuity
  • perimetry
  • scanning laser ophthalmoscopy
  • blue cones
  • age related macular degeneration
  • macula

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Footnotes

  • This investigation was supported by Re 805/2-1 (Deutsche Forschungsgemeinschaft, Bonn, Germany) to AR and EY007624 (Bethesda, MD) to AE.