Center for Eye Research Australia, The University of Melbourne, The Royal Victorian, Eye and Ear Hospital (RVEEH), Victoria, Australia.
Invest Ophthalmol Vis Sci. 2011 Dec 9;52(13):9457-69. doi: 10.1167/iovs.10-7043.
To evaluate the potential of psychophysical assessments of retinal function to provide diagnostic biomarkers of early age-related macular degeneration (AMD).
Unilateral visual function was assessed in 221 participants (72.86 ± 9.94 years; 67% women) with early AMD (visual acuity better than 20/60) and 109 controls (73.07 ± 10.32 years; 65% women). Psychophysical assessment included steady state thresholds (4- and 14-Hz flicker and red and blue color) and dynamic tests (photostress recovery [PSR] and dark adaptation [DA]). All test parameters were compared in terms of their diagnostic capacity (sensitivity and specificity), reproducibility, and clinical applicability (test duration and participant's perception of test difficulty). AMD status was determined by digital photography, according to the International Classification and Grading System.
All functional measurements were significantly worse, on average, in the AMD group than in the control group (P < 0.001). Static and dynamic parameters showed weak correlations (range, 0.003-0.225). Rod recovery in DA and cone recovery in PSR had the best diagnostic capacity (area under curve [AUC], receiver operating characteristic [ROC] analysis, 0.93 ± 0.016 and 0.85 ± 0.021, respectively). Considering diagnostic capacity together with test reproducibility and clinical applicability, the 14-Hz flicker gave the best outcome, followed by PSR. Combination of these two tests detected 71% of abnormal early AMD cases.
All the visual function tests had good diagnostic capacity. Combination of the 14-Hz flicker thresholds and dynamics of the PSR test provided optimal quantitative assessment of retinal function in early AMD, suggesting that this set is a potentially useful clinical tool for following progression of early AMD and assessing the efficacy of interventions.
评估视网膜功能的心理物理评估在提供与年龄相关的黄斑变性（AMD）早期相关的诊断生物标志物方面的潜力。
评估了 221 名患有早期 AMD（视力优于 20/60）的参与者（72.86±9.94 岁；67%为女性）和 109 名对照组（73.07±10.32 岁；65%为女性）的单侧视觉功能。心理物理评估包括稳态阈值（4-和 14-赫兹闪烁和红蓝色）和动态测试（光应激恢复[PSR]和暗适应[DA]）。根据国际分类和分级系统，通过数字摄影确定所有测试参数的诊断能力（敏感性和特异性）、可重复性和临床适用性（测试持续时间和参与者对测试难度的感知）。
平均而言，AMD 组的所有功能测量均明显差于对照组（P<0.001）。静态和动态参数之间的相关性较弱（范围为 0.003-0.225）。在 DA 中的杆状细胞恢复和 PSR 中的锥状细胞恢复具有最佳的诊断能力（曲线下面积[AUC]，ROC 分析分别为 0.93±0.016 和 0.85±0.021）。考虑到诊断能力，以及测试的可重复性和临床适用性，14-赫兹闪烁的效果最佳，其次是 PSR。这两种测试的组合检测到 71%的异常早期 AMD 病例。
所有视觉功能测试均具有良好的诊断能力。14-赫兹闪烁阈值和 PSR 测试动态的组合提供了早期 AMD 视网膜功能的最佳定量评估，这表明该组测试可能是一种有用的临床工具，可用于跟踪早期 AMD 的进展并评估干预措施的效果。
