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Peter Bex, Michael Dorr, Kameran Lashkari, Luis A Lesmes, Zhong-Lin Lu, Emily K Wiecek; Home-Based Self-Assessment of the Contrast Sensitivity Function in Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2016;57(12):632.
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© ARVO (1962-2015); The Authors (2016-present)
Detection of the onset or progression of vision loss from blinding eye diseases such as age-related macular degeneration (AMD) requires precise assessment with sensitive endpoints. Home testing has the potential to improve the frequency and convenience of testing and thereby improve screening, healthcare provision and clinical trial design. Standard vision tests, such as acuity and Amsler grids that could be self-administered in the home lack the precision needed for effective telemedicine. We evaluate the potential of a self-administered test of the contrast sensitivity function (CSF).
The binocular CSFs of 21 AMD patients were measured using the quick CSF (Lesmes et al JoV 2010), self-administered on a tablet computer (Dorr et al IOVS 2013). The quick CSF algorithm adaptively changed the peak spatial frequency and contrast of a sequence of 50 band-pass filtered letter trials, to converge on the observer’s CSF. The observer’s 10AFC task after each stimulus was to report the identity of the letter on a touch-response screen. On the first and last day of the study, testing was supervised in the clinic, then every day over a period lasting at least 2 weeks, testing was unsupervised in the patient’s home. After each test, encrypted data were automatically uploaded to a secure server.
Consistent with our previous studies, patients with AMD showed reliable CSF deficits compared with age-matched controls. Unsupervised CSFs measured in the home were not significantly different from those measured under supervision in the clinic. The mean test-retest repeatability (standard deviation of the area under the log CSF) of home tests was 0.108 log10 units (range 0.044 – 0.26), which is better than the repeatability of most clinic-based, supervised vision tests in those with retinal disease.
The quick CSF test can be reliably self-administered outside the clinic without supervision and may therefore form part of an effective program for monitoring people who have or are at risk of eye disease. It could be a precise and sensitive endpoint for detecting changes in visual function caused by the presence or progression of vision loss in AMD. The ability to increase the frequency of testing without imposing additional burden on patients has the potential to increase the statistical power and dramatically reduce the sample size and duration of clinical trials.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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