Reading, Vision Function and Disease Progression in Early AMD

描述(由申请人提供)： 项目摘要老年性黄斑变性(AMD)是美国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影响中央视觉功能，阅读困难是AMD患者最常见的主诉之一。大多数关于AMD阅读的研究都集中在患有晚期疾病的人身上，他们已经有了严重的中央视力损失。然而，研究表明，在标准视力丧失之前，阅读和其他非标准功能视力测量在疾病发生的早期就会受到影响。本项目旨在研究视觉、运动和认知因素对早期AMD老年个体阅读成绩的影响。这项研究还试图确定是否可以使用阅读成绩和其他非标准视觉功能指标来预测哪些参与者会继续患上这种疾病的晚期形式。目前的临床指标(如眼底表现)很少指导具有AMD早期症状的特定患者进展为晚期疾病和伴随的中心视力丧失的风险。需要更好、更准确的方法来识别那些面临风险的人。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，并且几乎不需要时间来管理，这可以提高预测AMD进展的能力。以前的研究有力地表明，将这种简单的测试与现有的识别眼底风险因素的临床方案相结合，可以提高 临床医生预测成功的机会显著增加。为了检查这些问题，早期AMD患者将参加由视力、运动和认知测试组成的测试部分，以及广泛的阅读评估。这些措施也将在没有视网膜疾病和晚期AMD的对照组中进行比较。参与者还将接受视网膜专家的全面眼科检查。研究参与者将随着时间的推移进行跟踪，分析将确定对晚期疾病进展的最佳预测因素。了解阅读问题的原因将使我们能够识别早期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：随着可以在疾病早期阶段应用的新兴AMD治疗方法的出现，拥有适当和实用的工具来确定哪些患者应该接受治疗将是绝对至关重要的。这是关键，因为所有的药物都有成本和副作用。其次，提供简单的预测工具将大大简化 并通过减少统计能力所需的受试者数量和进行研究的时间长度来简化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.