Patient awareness of binocular central scotoma in age-related macular degeneration.
Patient awareness of binocular central scotoma in age-related macular degeneration.
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DOI：
10.1097/opx.0b013e318264cc77
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发表时间：
2012-09-01
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影响因子：
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通讯作者：
Renninger, Laura W
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文献类型：
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作者：
Fletcher, Donald C;Schuchard, Ronald A;Renninger, Laura W
目得：评估年龄相关性黄斑变性（AMD）患者是否意识到双眼中心视野缺损。153名连续的AMD患者在他们最初的低视力康复评估中，在他们就诊开始时立即被询问（1）他们是否能够看到视野中的任何盲点或缺陷，以及（2）他们是否有任何证据或经历使他们相信他们的视野有缺陷。然后，通过使用加州中央视野测试的双眼中央视野测试评估他们的视力，使用史密斯-凯特尔韦尔阅读测试（SK阅读）和MN阅读表评估双眼阅读性能，并使用ETDRS表在1米处测量视敏度。平均直径的暗点与边界附近fixation.Results：视力中位数为20/253（范围20/40手的运动）。88%的患者存在双眼暗点（66%有密集暗点）。在患有双眼暗点的患者中，56%的人完全没有意识到自己的存在，即使是直径高达30°的密集暗点; 1.5%的人在清醒时可以短暂地看到视野中的缺陷; 44%的人与他们身上的东西“消失”有关。那些没有意识到与那些有一些意识到他们的暗点的暗点直径的中位数和范围是相当的。意识到暗点与年龄、视力、暗点大小、密度或发病时间无显著关系。意识到暗点与SK读数错误较少相关（p < 0.01）。结论：低视力临床医生不能依赖患者报告存在显著暗点;因此，必须进行适当的测试。暗点的存在降低了阅读准确性，但对暗点的一些意识有提高准确性的趋势。旨在提高患者对暗点的认识的康复计划的价值可能得到这一证据的支持。
PURPOSE: To assess whether age-related macular degeneration (AMD) patients are aware of binocular central visual field defects.METHODS: One hundred fifty-three consecutive AMD patients in their initial low-vision rehabilitation evaluation were immediately asked at the beginning of their visit (1) whether they were able to see any blind spots or defects in their field of vision and (2) whether they had any evidence or experiences that led them to believe that they had defects in their field of vision. They then had their vision assessed by binocular central visual field testing using the California Central Visual Field Test, binocular reading performance evaluated using the Smith-Kettlewell Reading Test (SK Read) and MN Read charts, and visual acuity measured using the ETDRS chart at 1 meter. Mean diameters of the scotomas with borders near fixation were noted.RESULTS: Visual acuity median was 20/253 (range 20/40 to hand movements). Binocular scotomas were present in 88% of patients (66% had dense scotoma). Of patients with binocular scotomas, 56% were totally unaware of their presence, even with dense scotomas measuring up to 30° in diameter; 1.5% could fleetingly see a defect in their visual field on waking; and 44% related experiences of things "disappearing" on them. The median and range of scotoma diameters for those unaware vs. those with some awareness of their scotomas were comparable. There was no significant relationship of awareness of the scotoma with age, acuity, scotoma size, density, or duration of onset. Awareness of scotoma was associated with fewer errors on the SK Read (p < 0.01).CONCLUSIONS: Low vision clinicians cannot depend on patients to report the presence of significant scotomas; thus, appropriate testing must be performed. Presence of scotomas decreased reading accuracy, but some awareness of the scotomas had a tendency to improve accuracy. The value of rehabilitation programs aimed at increasing patient awareness of their scotomas may be supported by this evidence.