Reading, Vision Function and Disease Progression in Early AMD

描述（由申请人提供）： 在美国，黄斑变性（AMD）是导致65岁及以上人群视力丧失的主要原因。 由于这种疾病的晚期形式影响中央视觉功能，因此阅读困难是AMD患者最常见的主诉之一。 大多数关于AMD患者阅读的研究都集中在晚期疾病患者身上，他们已经有了明显的中央视力损失。 然而，研究表明，阅读和其他非标准的功能性视力测量在疾病的早期受到影响，在标准视力丧失之前。 本研究旨在探讨早期AMD患者的视觉、运动和认知因素对阅读表现的影响。 这项研究还试图确定阅读表现和其他非标准的视觉功能测量是否可以用来预测哪些参与者将继续发展为疾病的晚期形式。 目前的临床指标（如眼底外观）几乎没有提供指导，一个给定的患者与AMD的早期迹象有多大的风险进展到先进的疾病和伴随的中心视力丧失。 需要更好、更准确的方法来识别那些有风险的人。 我们的方法是应用简单，廉价的视觉功能测试，需要最少的特殊设备，管理时间很少，可以提高预测AMD进展的能力。 以前的研究强烈表明，结合这些简单的测试，与现有的临床协议确定眼底危险因素，可以提高 临床医生成功预测的机会显著增加。 为了检查这些问题，患有早期AMD的个体将参加由视觉、运动和认知测试组成的测试课程，沿着广泛的阅读评估。 还将在无视网膜疾病和晚期AMD的对照组中比较这些指标。 参与者还将接受视网膜专家的全面眼科检查。 将对研究参与者进行一段时间的随访，分析将确定晚期疾病进展的最佳预测因子。 了解阅读问题的原因将使我们能够确定早期AMD患者缺乏的特定技能，这将有助于更好地了解疾病的过程，并提出适当的康复策略。 提高预测能力的意义是双重的：随着可以在疾病的最早阶段应用的新兴AMD治疗方法变得可用，拥有适当和实用的工具来确定哪些患者应该接受它们将是绝对重要的。 这是关键，因为所有药物都有成本和副作用。 其次，简单的预测工具的可用性将大大简化 并通过减少统计功效所需的受试者数量和研究必须进行的时间长度来简化AMD治疗的临床试验。

DESCRIPTION (provided by applicant): Project Summary Age-related macular degeneration (AMD) is the leading cause of vision loss among people aged 65 and older in the US. Since the advanced form of this disease affects central vision function, reading difficulties are one of the most common complaints of AMD patients. Most research on reading in AMD has focused on people with advanced disease, who already have significant central vision losses. However, research suggests that reading and other non-standard functional vision measures are afected earlier in the disease, prior to losses in standard visual acuity. This project aims to examine the contribution of visual, motor and cognitive factors to reading performance in elderly individuals with early AMD. This study also seeks to determine whether reading performance and other non-standard vision function measures can be used to predict which participants will go on to develop the advanced forms of the disease. Current clinical metrics (such as fundus appearance) provide little guidance on how much risk a given patient with early signs of AMD has of progressing to advanced disease and the accompanying central vision loss. Better, more accurate methods of identifying those at risk are needed. Our approach is to apply simple, inexpensive vision function tests, requiring minimal special equipment, and little time to administer, that can improve the ability to predict AMD progression. Previous research strongly suggests that some combination of such simple tests, in conjunction with existing clinical protocols identifying fundus risk factors, could boost the clinician's chances of prognostic success significantly. To examine these questions, individuals with early AMD will take part in test sessions consisting of vision, motor, and cognitive testing, along with an extensive reading assessment. These measures will also be compared in control groups with no retinal disease and with advanced AMD. Participants will also undergo a comprehensive eye exam by a retinal specialist. Study participants will be followed over time, and analyses will determine the best predictors of advanced disease progression. Understanding the causes of reading problems will allow us to identify the specific skills lacking in people with early AMD, which will aid in better understanding of the course of the disease, and suggest appropriate rehabilitative strategies. The significance of improving predictive ability is two-fold: As emerging AMD treatments that can be applied in the earliest stages of the disease become available, it will be absolutely vital to have appropriate and practical tools to identify which patients should receive them. This is key since all medications have costs and side effects. Second, availability of simple predictive tools will greatly simplify and streamline clinical trials of AMD treatments by reducing the number of subjects needed for statistical power and length of time over which the studies must be carried out.