Night Vision Symptoms and Progression of Age-related Macular Degeneration in the Complications of Age-related Macular Degeneration Prevention Trial
Presented in part at the meetings of the Association for Research and Vision in Ophthalmology in Fort Lauderdale, Florida, on May 1, 2005, and the Fourth US Symposium on Ocular Epidemiology on January 31, 2007.
Received 20 February 2008; received in revised form 12 May 2008; accepted 13 May 2008. published online 31 July 2008.
Objective
To describe baseline night vision symptoms and their association with ≥3-lines loss in visual acuity (VA), choroidal neovascularization (CNV), and geographic atrophy (GA).
Design
Cohort study within a multicenter randomized clinical trial.
Participants
A total of 1052 participants with ≥10 large (>125 μ) drusen and VA ≥20/40 in each eye.
Methods
At baseline, participants self-administered a 10-item Night Vision Questionnaire (NVQ-10). VA testing was performed at baseline, 6 months, and annually. One eye of each participant was randomly assigned to laser treatment, and the contralateral eye was assigned to observation. During follow-up, trained readers identified CNV on the basis of fluorescein angiograms and end point GA, defined as >1 disc area of new GA, based on color photographs. Evaluation was performed by repeated-measures logistic regression for NVQ-10 score as a risk factor for ≥3-lines loss in VA and by survival analysis for CNV and GA, with and without adjustment for participant and ocular characteristics. Evaluations were based on observed eyes and treated eyes, considered separately and combined.
Main Outcome Measures
A ≥3-lines loss in VA, development of CNV and end point GA.
Results
At baseline, NVQ-10 scores ranged from 3 to 100 with a mean of 70 (100 corresponds to no night vision symptoms). Compared with participants with the best night vision (fourth quartile of scores), participants with the worst night vision (first quartile of scores) were at increased risk of ≥3-lines loss in VA in both observed and treated eyes; odds ratios (95% confidence interval) were 2.85 (1.85–4.39) and 2.00 (1.27–3.14), respectively. The relative risk for the first quartile versus the fourth quartile for development of GA was 4.18 (1.80–9.68) in observed eyes and 2.59 (1.13–5.95) in treated eyes. The relative risk for CNV incidence was 1.99 (1.12–3.54) in observed eyes and 1.33 (0.81–2.19) in treated eyes. These relationships were maintained after adjustment for baseline participant and ocular characteristics.
Conclusions
Participants who perceived the most problems in their night vision at baseline had an increased risk of ≥3-lines loss in VA, CNV, and GA. These associations are independent of established risk factors.
Financial Disclosure(s)
The authors have no proprietary or commercial interest in any materials discussed in this article.
Available online: July 31, 2008.
1Department of Ophthalmology, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
2Charlotte Eye, Ear, Nose and Throat Associates, Charlotte, North Carolina
Correspondence: Gui-shuang Ying, PhD, University of Pennsylvania, 3535 Market Street, Suite 700, Philadelphia, PA 19104-3309
Manuscript no. 2008-231.
Financial Disclosure(s): The Writing Committee has no conflict of interest with regard to the material presented in the article.
Supported by grants EY012211, EY012261, and EY012279 from the National Eye Institute, National Institutes of Health, and Department of Health and Human Services.
⁎ A listing of the Complications of Age-related Macular Degeneration Prevention Trial Research Group is in Appendix 1 (available at http://aaojournal.org).
ABSTRACT