Early age-related maculopathy and self-reported visual difficulty in daily life
Early age-related maculopathy and self-reported visual difficulty in daily life
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DOI：
10.1016/s0161-6420(02)01060-6
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发表时间：
2002-07-01
期刊：
影响因子：
13.7
通讯作者：
Owsley, C
中科院分区：
文献类型：
--
作者：
Scilley, K;Jackson, GR;Owsley, C
目的：确定早期年龄相关性黄斑病变（ARM）是否与日常活动中的视力困难相关，超出正常视网膜老化的预期困难;确定暗视敏感度和视力是否与这些老年人的视力困难相关。研究设计：比较性横断面问卷调查研究。92名至少一只眼睛患有早期ARM的老年人，其定义为一个或多个大的（>63 μ m）玻璃疣和/或局灶性色素沉着过度，但没有脉络膜新生血管形成或地图状萎缩，视力为20/60或更好，以及由55名相同年龄段的老年人组成的参考组，没有这些眼底特征，每只眼睛的视力为20/35或更好。方法。视力和暗视敏感度和一般健康问卷进行了测试。使用日常视觉活动量表（ADVS）评估日常任务中自我报告的视觉困难，并以0（极度困难）至100（无困难）的量表表示。拍摄眼底照片并进行分级，以表征ARM的存在和严重程度，从而确定合格性。结果如下：出于分析目的，将早期ARM组分为对侧眼（FE）为20/60或更好的患者和FE低于20/60的患者。与正常视网膜健康组（中位数，97-100）相比，FE低于20/60（中位数，58-83）的早期ARM组的ADVS子量表评分显著较低。即使对于FE 20/60或更好的早期ARM患者，5个分量表中有4个分数低于参考组（中位数，81-97），尽管在某些情况下略低于参考组。对于两个ARM亚组，夜间驾驶子量表的所有子量表的得分最低。早期ARM FE 20/60或更好的人更有可能报告夜间驾驶困难（比值比[OR]，4.3; 95%置信区间[Cl]，1.6-11.4），近视力（OR，5.0; 95% CI，1.9-12.9）和眩光残疾（OR，2.7; 95% CI，1.1-6.3）子量表与正常视网膜健康者进行比较，调整年龄、性别、医学合并症和透镜密度。对于FE差于20/60的早期ARM患者，广泛报告了所有子量表的困难（OR范围为4.7-52.9）。暗视敏感性差与夜间驾驶子量表的困难高度相关（OR，6.6; 95% CI，1.2-35.5），但与任何其他子量表无关。双眼视力低于20/25与所有ADVS分量表上的困难显著相关;当这种视力损害仅存在于一只眼睛中时，在某些分量表上仍然显著存在相关性，尽管它们较弱。处于ARM早期阶段的人，即使他们的另一只眼睛具有相对较好的敏锐度，也更有可能在夜间驾驶，近视任务，与视网膜健康的人相比，暗视功能障碍是早期ARM的功能标志，与报告的夜间驾驶问题有关。即使只有一只眼睛出现敏锐度受损，患者也会报告日间驾驶和远近视力任务的困难。Ophthalmology 2002，-109：1235-1242（C）2002，美国眼科学会。
Purpose: To determine whether early age-related maculopathy (ARM) is associated with visual difficulty in daily activities beyond the difficulty that would be expected based on normal retinal aging; to determine whether scotopic sensitivity and visual acuity are associated with visual difficulties in these older adults.Study Design: Comparative, cross-sectional questionnaire study.Subjects: Ninety-two older adults with early ARM in at least one eye as defined by one or more large (>63 mum) drusen and/or focal hyperpigmentation but no choroidal neovascularization or geographic atrophy, acuity of 20/60 or better, and a reference group of 55 older adults in the same age range without these fundus features and acuity of 20/35 or better in each eye.Method. Tests of visual acuity and scotopic sensitivity and a general health questionnaire were carried out. The Activities of Daily Vision Scale (ADVS) was administered to assess self-reported visual difficulties in everyday tasks and expressed on a scale of 0 (extreme difficulty) to 100 (no difficulty). Fundus photographs were taken and graded to characterize the presence and severity of ARM to determine eligibility. Results: For purposes of analysis, the early ARM group was divided into those whose fellow eye (FE) was 20/60 or better and those whose FE was worse than 20/60. ADVS subscale scores were substantially lower in the early ARM group with FE worse than 20/60 (medians, 58-83) compared with the normal retinal health group (medians, 97-100). Even for those with early ARM with FE 20/60 or better, four of five subscale scores were lower (medians, 81-97), albeit slightly in some cases, than those of the reference group. For both ARM subgroups, the night driving subscale had the lowest scores of all subscales. Persons with early ARM with FE 20/60 or better were more likely to report difficulty on the night driving (odds ratio [OR], 4.3; 95% confidence interval [Cl], 1.6-11.4), near vision (OR, 5.0; 95% Cl, 1.9-12.9), and glare disability (OR, 2.7; 95% Cl, 1.1-6.3) subscales compared with those in normal retinal health, adjusting for age, gender, medical comorbidities, and lens density. For early ARM patients with FE worse than 20/60, there was widespread reporting of difficulty on all subscales (ORs ranging from 4.7-52.9). Poor scotopic sensitivity was highly associated with difficulty on the night driving subscale (OR, 6.6; 95% Cl, 1.2-35.5) but not with any other subscale. Acuity worse than 20/25 in both eyes was significantly associated with difficulty on all ADVS subscales; when this acuity impairment was present in one eye only, associations were still significantly present on some subscales, although they were weaker.Conclusions: Persons in the early phases of ARM, even when their fellow eye has relatively good acuity, are more likely to experience difficulty in night driving, near vision tasks, and glare disability compared with those in good retinal health. Scotopic dysfunction, a functional marker of early ARM, is linked to reported night driving problems. Even when acuity impairment occurs in one eye only, patients report difficulties with day driving and near and far vision tasks. Ophthalmology 2002,-109:1235-1242 (C) 2002 by the American Academy of Ophthalmology.