A functional predictive test for age-related macular degeneration

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Age-related macular degeneration (AMD) is the leading cause of blindness in our community. It is a progressive, late onset disease affecting central vision. Signs of disease are present in 15% of the population over 50 years with severe visual loss affecting increasing numbers in each subsequent decade. By 90 years 25% of people will have lost significant vision. There is no prevention, and treatment options are limited and have little impact on the rates of blindness. AMD causes enormous personal costs and places a massive burden on health resources. The high prevalence, anticipated increase in the ageing population and the limited treatment options, highlight the urgency with which research is required. The early clinical signs of AMD are yellow deposits called drusen, in the central retina (macula) and alteration in retinal pigmentation. As AMD progresses the macula is damaged either through atrophy (holes) or by growth of blood vessels. Currently, clinically accessible information about drusen and pigmentary changes are used to grade the severity of disease and predict the risk of progression to vision loss. This at risk group is recruited into prevention and intervention studies looking for new interventions. Such scoring of clinical characteristics currently underpins all clinical trials and epidemiological research in AMD. However this scheme is not without limitations, and results in an inexact correlation between clinical appearance and risk of blindness. We believe that a test of retinal function, (ability to see in the dark, to detect a faint light), will provide a better correlation for identifying patients at high risk of vision loss. We aim to test various aspects of retinal function (in both the light and dark and for moving and stationary objects) in subjects with early clinical signs of AMD, to identify parameters that will be more sensitive and specific predictors of risk of progression to visually devastating complications of AMD.