Parimi Vamsi, Elsner Ann E, Papay Joel A, Clark Christopher A, Miura Masahiro, Gast Thomas J
School of Optometry, Indiana University, Bloomington, Indiana, USA.
Aeon Imaging, LLC, Bloomington, Indiana, USA.
Ophthalmic Physiol Opt. 2025 Mar;45(2):480-493. doi: 10.1111/opo.13422. Epub 2024 Dec 26.
Visual acuity (VA) is a primary outcome measure that defines the success of clinical interventions for retinal diseases such as age-related macular degeneration (AMD) or diabetic macular oedema (DME). These conditions can lead to the presence of subretinal fluid, causing substantial photoreceptor layer elevation. Hyperopic defocus then occurs, affecting the VA measurements. In this study, we simulated the induced hyperopic shift for real-world values of photoreceptor layer elevation and measured the effect on VA measurements.
To simulate the hyperopic shift, we used a four-surface eye model. To measure the effect of defocus on VA, normally sighted adults (N = 44, mean [SD] age = 32 [13.0] year, range: 21-71 year) performed four test conditions, that is, defocus of 0.00, +0.75, +1.50 and +2.25 D. For each subject, mean VA and SD obtained from a cumulative normal fit to the VA data provided the coefficient of variation (CV) and 95% confidence interval (CI).
Refractive error induced by photoreceptor layer elevation was maximum for hyperopic error conditions, followed by emmetropic and myopic refractive error conditions. The 76% threshold VA worsened with increasing defocus conditions. The 95% CI was significantly larger for +0.75, +1.50 and +2.25 D defocus compared to no defocus (p = 0.04, 0.02 and 0.01, respectively). The CI for the +2.25 D defocus condition was larger (3-10 letters) compared with no defocus (3-6 letters).
Photoreceptor layer elevation causes a hyperopic shift sufficient for clinically meaningful changes: worse VA and more variable measurements.
视力（VA）是一项主要结局指标，用于定义针对诸如年龄相关性黄斑变性（AMD）或糖尿病性黄斑水肿（DME）等视网膜疾病的临床干预是否成功。这些病症可导致视网膜下液的出现，引起感光层显著抬高。继而发生远视性离焦，影响视力测量。在本研究中，我们针对感光层抬高的实际值模拟了诱导性远视偏移，并测量了其对视力测量的影响。
为模拟远视偏移，我们使用了四表面眼模型。为测量离焦对视力的影响，正常视力的成年人（N = 44，平均[标准差]年龄 = 32 [13.0]岁，范围：21 - 71岁）进行了四种测试条件，即0.00、+0.75、+1.50和 +2.25 D的离焦。对于每个受试者，从对视力数据的累积正态拟合中获得的平均视力和标准差提供了变异系数（CV）和95%置信区间（CI）。
对于远视性误差条件，由感光层抬高引起的屈光不正最大，其次是正视和近视性屈光不正条件。随着离焦条件增加，76%阈值视力恶化。与无离焦相比，+0.75、+1.50和 +2.25 D离焦时的95% CI显著更大（分别为p = 0.04、0.02和0.01）。与无离焦（3 - 6字母）相比，+2.25 D离焦条件下的CI更大（3 - 10字母）。
感光层抬高会引起足以产生临床意义变化的远视偏移：视力变差且测量值更具变异性。
