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Manfred MacKeben, Donald C. Fletcher, Anne E. Fung, Michael J. Jumper, Steve R. Sanislo; Effects Of Ranibizumab Injections On Functional Vision In Advanced Amd. Invest. Ophthalmol. Vis. Sci. 2012;53(14):4395.
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To use functional vision in multiple ways that are relevant for daily living to assess effects of ranibizumab on patients with advanced AMD.
In the investigator-sponsored "Lucentis in Advanced MAcular degeneration" (LAMA) study, 18 patients with active advanced exudative AMD and visual acuity (v.a.) of 20/400 or worse were treated with ranibizumab monthly for 3 or 6 months and then as needed. Functional vision was assessed by testing reading performance, contrast sensitivity, 6 timed instrumental activities of daily living (TIADL), and micro-perimetry by scanning laser ophthalmoscope (SLO). Tests were conducted at baseline and at 3, 6, and 12 months into treatment.Functional vision was assessed by testing reading performance, contrast sensitivity, 6 timed instrumental activities of daily living (TIADL), and micro-perimetry by scanning laser ophthalmoscope (SLO). Tests were conducted at baseline and at 3, 6, and 12 months into treatment.
We measured the fastest reading speed (RS) achievable at any size in characters per minute (CPM) using the MNread and SKread tests. Two out of 17 patients could never read MNread text at any size (max. 8.0 M). RS in 10 out of 15 improved, and 5 got worse. Improvements were 28 - 344 CPM (average 148 CPM).7/17 patients could not read the SKread chart at all. 9 improved in reading speed, one got worse. Improvement lay between 125 and 17 CPM (average 33 CPM). 7 also showed improved reading accuracy.All patients recognized at least a few letters on the Pelli-Robson chart. 9 showed improvement, one got worse. Improvement was 17 - 125 CPM (average 33 CPM).TIADL: Most patients could not find a phone number (one did), or the amount owed on an invoice. We measured the sum of seconds required to solve ALL tasks. 120 elapsed seconds was counted as "not possible", so that NO ability = 720s. Performance (720 - measured values) starting levels varied from 95s - 498 s. Performance in 11 patients improved (30s -360 s), and worsened in 5 patients (by 88s to 176 s).Micro-perimetry was performed using 52 test points in a 10-2 like stimulus pattern. 14/15 patients showed improvement of light detection. Improvements ranged from 3 to 34 points (average 16.1 points).
Patients with profound low v.a. can be tested, and accurate v.a. scores can be obtained. Functional vision can also be assessed by other methods besides v.a. Even in patients with advanced AMD, injecting ranibizumab can be beneficial. Progress of AMD can be halted, and visually guided performance can also be improved.
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