Aim To investigate if active learning of contrast sensitivity (CS) in bilateral age-related macular degeneration (AMD) correlates better than visual acuity (VA) with vision-related quality of life (VRQoL) using factor analysis-calibrated National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25).
Methods Prospective cross-sectional observational study in 93 patients (186 eyes) with bilateral AMD. CS was measured in one eye at a time with the quantitative CS function (qCSF) method (Adaptive Sensory Technology). Same-day VRQoL was assessed with factor analysis-calibrated NEI VFQ-25 visual function and socioemotional scales. Mixed-effects multiple linear regression analyses evaluated the associations of the qCSF outcomes and VA with the NEI VFQ-25 scales. A subgroup analysis on patients with AMD with VA more than 20/25 in both eyes was performed.
Results Compared with VA, CS outcomes were associated with larger effect on both visual function scale (standardised beta coefficients (β*) for area under the logarithm of CSF (AULCSF) curve and CS thresholds at 1.5, 3 and 6 cycles per degree (cpd): β*=0.50, 0.48, 0.52, 0.46, all p<0.001, respectively, vs β*=−0.45 for VA, all p<0.001) and socioemotional scale (β* for AULCSF and CS threshold at 6 cpd: β*=0.44, 0.44 vs β*=−0.42 for VA, all p<0.001). In patients with AMD with VA more than 20/25 in both eyes (N=20), both VFQ-25 scales and all CS outcomes were significantly reduced.
Conclusions qCSF-measured CS strongly correlates with patient-reported VRQoL in bilateral AMD, even stronger than VA does. This study further validates qCSF-measured CS as a promising functional endpoint for future clinical trials in AMD.
Data availability statement
Data are available upon reasonable request.
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Contributors Concept and design—FV, LK, DV, JWM and JBM. Data collection—FV, AB, PZ, TK and HEW. Data analysis—FV and YZ. Data interpretation—FV, LK, DV, JWM and JBM. Drafting the initial manuscript—FV. Critical revision of the manuscript—FV, AB, PZ, TK, HEW, LK, DV, JWM and JBM. Guarantors: FV, JBM
Funding Lions International Fund (grant 530125 and 530869).
Disclaimer The funding organisation had no role in the design or conduct of this research.
Competing interests No conflicting relationship exists for any author. FV, AB, PZ, TK, HEW and DV declare no disclosures. LK has received research support from the National Eye Institute, Department of Defense and CureVac; and has a financial arrangement with Pykus Therapeutics. JWM is a consultant for Heidelberg Engineering, Sunovion, KalVista Pharmaceuticals and ONL Therapeutics; holds a patent through and has received financial support from ONL Therapeutics, Valeant Pharmaceuticals/Massachusetts Eye and Ear; and has received financial support from Lowy Medical Research Institute, Mactel Study (no PI salary) and NEI R01 EY030088-01A1, stock options in Aptinynx, ONL Therapeutics and Ciendias Bio, and equity in company related to vaccine development. JBM is a consultant for Alcon, Allergan, Carl Zeiss, Sunovion and Genentech.
Provenance and peer review Not commissioned; externally peer reviewed.