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Gregory R Jackson, John G Edwards; Concordance of dark adaptation impairment between eyes in patients with AMD. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3959. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Dark adaptation impairment is an early sensitive marker of dry AMD. A common clinical question is whether measuring dark adaptation in one eye is sufficient for detecting impaired dark adaptation in patients with AMD. If sensitivity remains high, monocular testing may be useful for high volume testing of patients at risk of AMD.
A multicenter clinical study was conducted at three sites. Two groups of subjects were enrolled: normal and AMD. Classification was based upon grading of fundus photographs by a masked, experienced grader. Dark adaptation was measured with the AdaptDx (MacuLogix, Hummelstown, PA). For each subject, dark adaptation was separately measured in each eye. A demonstration test was used to prevent a learning effect. An enforced rest break of 10 minutes between tests was used to prevent fatigue. Dark adaptation was classified as impaired or normal based upon a pre-specified cut point. The study was IRB approved, adhered to the principles of the Declaration of Helsinki and was HIPPA compliant.
The sample consisted of 144 subjects (21 normal and 123 AMD). Across all subjects, dark adaptation findings were identical between both eyes for 92% (133/144) of subjects (p < 0.0001). For patients with AMD, the concordance was 93% (114/123; p < 0.0001). The concordance was 90% (19/21) for subjects with normal retinal health (p < 0.03). Using a randomly selected eye, the sensitivity of monocular testing to detect dark adaptation impairment in the AMD group was 84% (103/123, p < 0.0004).
By randomly testing one eye, impaired dark adaptation was found in 84% of all AMD patients. These findings suggest that using modern rapid dark adaptation measurement may be useful for high volume testing for AMD in clinical practice.
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