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Ulrike W. Scheschy, Ramzi G. Sayegh, Christian Simader, Florian Sulzbacher, Matthias Bolz, Katharina Kefer, Stefan Eisenkoelbl, Christopher G. Kiss, Ursula Schmidt-Erfurth; ETDRS Visual Acuity Outcomes in Comparison With Two Automatic Systems in Patients With Macular Diseases in a Follow-up Study. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1897.
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© ARVO (1962-2015); The Authors (2016-present)
Visual acuity testing is the most sensitive functional test method in patients with macular diseases. The purpose of that study was to compare three VA test methods among each other in patients with geographic atrophy (GA), in patients with choroirdal neovascularisation (CNV), with diabetic macular edema (DME) and in an age matched physiological control group.
75 eyes of 43 patients were examined 3 times with an interval of 3 month using the three VA test-methods in random order and after optimal refraction. Among the 75 eyes, 20 eyes had GA, 20 eyes had CNV, 20 eyes had DME and 15 eyes did not show any retinal pathology. As test instruments the early treatment diabetic retinopathy study (ETDRS) charts, the EVA (electronic visual acuity) computer and the AR were used. EVA is tested using a held hand device and a laptop, which shows one optotype after another in different sizes. Viewing distance remains according to protocol always 3 meters. VA test results were compared to each other at each visit and for each macular disease separately.
In patients with GA no statistically significant changes in BCVA between the three methods could be detected. In patients with CNV and DME significant changes (p<0.05) in BCVA could be detected for ETDRS VA and EVA in comparison to the AR at each visit. Interestingly in the physiological control group highly significant differences between the 3 VA test methods could be recognized.
This study showed that patients with severly impared visual acuity as in GA can be monitored with all three methods, though mean visual acuity in absolute letters was better for ETDRS VA and EVA in comparison to VA in the AR and seems therefore more adequate if the exact visual function is to be found. In eyes with DME and CNV either an ETDRS or EVA VA test seems mandatory for follow up, as they differed significantly with AR VA. Concerning the control group, sensible differences could be detected for VA in the three systems and there seems to be a learning curve in the follow up that seems not to appear in patients with macular diseases.
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