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D.C. Fletcher, R.A. Schuchard; Variable Response of Visual Function Measures After PDT With Visudyne R . Invest. Ophthalmol. Vis. Sci. 2005;46(13):326.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To determine if reading performance, visual acuity, contrast sensitivity, and size of SLO determined macular scotomas were similarly affected by PDT with VisudyneR. Methods: 14 patients with subfoveal wet ARM had visual acuity (ETDRS), contrast sensitivity (Pelli–Robson), SLO macular perimetry (50,000 troland dense and 500 troland relative scotomas), continuous text reading (MN Read) and random word reading (Pepper/VSRT) tests performed prior to PDT and at 3 & 12 months post initial treatment. Standard PDT with VisudyneR treatment protocols were followed. Each visual function parameter was categorized as improved (I), stable (S) or worse (W) with a change in category defined as visual acuity – 5 letters, contrast – 3 letters, random word rate – 10 wpm, continuous text rate – 20 wpm, error rate – 10%, and SLO scotoma – 2 degrees squared or 10% (largest value). Results: Patient median age was 81 years. Pre morbid weekly reading time range was 3 – 55, mean 15 hours. Lesion size range was 1400 – 5000, mean 2521 microns. 12 month post treatment results showed visual acuity I 36%, S 7% and W 57%; contrast I 29%, S 43% and W 29%; central dense scotomas I 21%, S 29% and W 50%; central relative scotomas I 29%, S 29% and W 43%; continuous text maximum reading rate I 14%, S 43% and W 43%; VSRT reading rate I 43%, S 29% and W 29%; and VSRT error rate I 36%, S 50% and W 14%. 4/14 patients had improvement and 8/14 had improvement or stabilization on the majority of tests. The change in the 7 outcome tests did not show agreement with change in other tests with the exception of scotomas which had Kappa Values of Agreement with LogMAR .66, contrast .68, max reading rate .67, and VSRT .48. Conclusions: This study showed that at 12 months post PDT, 8/14 patients had stabilization or improvement in the majority of visual function tests. Changes in any one outcome measure was generally not predictive of changes in the other measures but central scotomas were a better predictor of changes than visual acuity. No one test can be used alone to assess outcomes. PDT may have a positive effect on decreasing deterioration rate on several visual function parameters and it may be wise to consider them all when assessing its value.
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