Impaired Mesopic Visual Acuity in Eyes with Early Age-Related Macular Degeneration

Purpose.: To determine photopic and mesopic distance high-contrast visual acuity (HC-VA) and low-contrast visual acuity (LC-VA) in eyes with early age-related macular degeneration (AMD). Methods.: Measurements were made in 22 subjects with early AMD and 28 healthy control subjects. Inclusion criteria included a photopic HC-VA of 20/25 or better. Distance VA was measured using HC (96%) and LC (10%) Bailey-Lovie logMAR letter charts under photopic (85 cd/m2) and mesopic (0.1–0.2 cd/m2) luminance conditions. Results.: Mean mesopic distance HC-VA and LC-VA were significantly worse (0.1 logMAR and 0.28 logMAR, respectively) in the early AMD group than in the control group. Under mesopic conditions, the mean difference between LC-VA and HC-VA was significantly greater in the early AMD (0.45 logMAR) than the control group (0.27 logMAR). Mean differences between mesopic versus photopic HC-VA and mesopic versus photopic LC-VA were significantly greater in the early AMD than the control group (0.13 and 0.32 logMAR of difference between the means, respectively). Sensitivity and specificity were significantly greater for mesopic LC-VA than for mesopic HC-VA (Receiver Operating Characteristics, area under the curve [AUC], 0.94 ± 0.030 and 0.76 ± 0.067, respectively). AUC values for photopic HC-VA and LC-VA were below 0.70. Conclusions.: Visual acuity testing under low luminance conditions emerged as an optimal quantitative measure of retinal function in early AMD.

Visual suppression in intermittent exotropia during binocular alignment.

PURPOSE To investigate the cortical mechanisms that prevent diplopia in intermittent exotropia (X(T)) during binocular alignment (orthotropia). METHODS The authors studied 12 X(T) patients aged 5 to 22 years. Seventy-five percent had functional stereo vision with stereoacuity similar to that of 12 age-matched controls (0.2-3.7 min arc). Identical face images were presented to the two eyes for 400 ms. In one eye, the face was presented at the fovea; in the other, offset along the horizontal axis with up to 12° eccentricity. The task was to indicate whether one or two faces were perceived. RESULTS All X(T) patients showed normal diplopia when the nonfoveal face was presented to nasal hemiretina, though with a slightly larger fusional range than age-matched controls. However, 10 of 12 patients never experienced diplopia when the nonfoveal face was presented to temporal hemiretina (i.e., when the stimulus simulated exodeviation). Patients showed considerable variability when the single image was perceived. Some patients suppressed the temporal stimulus regardless of which eye viewed it, whereas others suppressed a particular eye even when it viewed the foveal stimulus. In two patients, the simulated exodeviation might have triggered a shift from normal to anomalous retinal correspondence. CONCLUSIONS Antidiplopic mechanisms in X(T) can be reliably triggered by purely retinal information during orthotropia, but the nature of these mechanisms varies between patients.