Abstract
Abstract: :
Purpose: To determine if reading performance, visual acuity, contrast sensitivity, and size of SLO determined macular scotomas was affected by PDT with VisudyneR. Methods: 13 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) tests performed prior to PDT and 3 months post 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. Results: Patient median age was 81 years with 12.6 mean years of education. Lesion size range was 1400 – 3700, mean 2400 microns. 3 month post treatment results showed visual acuity I 23%, S 31% and W 46%; contrast I 15%, S 38% and W 46%; central dense scotomas I 23%, S 46% and W 31%; central relative scotomas I 31%, S 15% and W 54%; continuous text maximum reading rate I 23%, S 31% and W 46%; random word reading rate I 31%, S 46% and W 23%; and random word error rate I 46%, S 31% and W 23%. The Kappa test showed agreement in I S W categories for random word reading rate with reading accuracy (0.77), contrast with relative scotoma (0.64), random word error rate with relative scotoma (0.44) and continuous text rate with contrast (0.39). Random word reading rate and accuracy means improved with treatment. Of note, 3 patients more than tripled their reading speed and cut their error rates by more than 75%. Conclusions: This study showed that at 3 months post PDT with VisudyneR more patients had stabilization or improvement in acuity, contrast, reading performance and dense scotomas than had a decrease in these functions. Only in relative scotomas did more patients show a decline rather than stabilization or improvement, but for many activities of daily living like reading, relative scotomas can be overcome with good illumination. Random word reading rate and accuracy showed dramatic improvement in several patients. These visual function results may represent a significant benefit of PDT for reading and other real world activities of daily living. Data collection will continue. Supported by a grant from Novartis Ophthalmics
Keywords: photodynamic therapy • reading • age–related macular degeneration