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C. DelCourt, J.-F. Dartigues, J. Colin, F. Malet, M. Le Goff, P. Barberger-Gateau, M.-B. Rougier, M.-N. Delyfer, J.-F. Korobelnik; Use of a Simple Reading Test for the Detection of Case of Late Age-Related Maculopathy in Large Epidemiological Studies. Invest. Ophthalmol. Vis. Sci. 2008;49(13):599.
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Inclusion of end-points on age-related maculopathy (ARM) in large epidemiological (in particular multicentre or national) studies is limited by the fact that specialized eye examination (including costly material) is required. We evaluate the use of a simple reading test for the detection of cases of late ARM.
The ALIENOR (Antioxydants, LIpides Essentiels, Nutrition et maladies OculaiRes) study consists in an eye examination, simultaneous to the third, ongoing, follow-up examination of a population-based cohort study on dementia. This examination includes a measure of far visual acuity using ETDRS charts and near visual acuity using the Parinaud test, a Jaeger-like reading test commonly used by French ophthalmologists. The results of this test ranges from 2 (normal vision) to 28 (very low vision). Visual acuity tests were performed for each eye, using current and optimal correction. The total expected number of subjects is 1000. Late ARM was classified on the basis of non-mydriatic digital photographs of the macula and was defined by the presence of neovascular ARM and/or geographic atrophy.
Among the first 408 subjects, the Parinaud test was available for 402 subjects (98 %) and among those, 366 (91 %) had gradable photographs in at least one eye. Parinaud scores with current and with optimal correction were highly correlated (r=0.99). The Parinaud score (maximum of the two eyes) was highly efficient in detecting cases of late ARM (in at least one eye), with an area under the ROC curve of 0.90. The maximum of the Youden index (y=0.75) was obtained for a cut-off at value 3. For those subjects with a Parinaud score greater than 3 in at least one eye, the sensitivity was 88.2 % and the specificity was 86.5 %. Results were much worse for far visual acuity : area under the ROC curve of 0.79, maximum of the Youden index (0.48) giving a sensitivity of 87.5 % and a specificity of 61.1 %.
The present study shows that it is possible to use a simple reading test with current correction, which can easily be performed at home or in non specialized examination centres, for the detection of cases of late ARM. Cases could thereafter be confirmed by contacting the ophthalmologist in charge of the patient, or by performing a retinal examination for the identified subjects.
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