Increased Visual Acuity Will Not Necessarily Equal an Increased Reading Ability in Patients with Subfoveal Neovascular Macular Degeneration

Fredrik P. Källmark, Anders Kvanta, Gustaf Öqvist, Rune Brautaset

.

DOI: 10.4236/ijcm.2011.24068                

Abstract

Reading ability in the elderly means independence, and quality of life. In age-related macular degeneration (AMD), the main deficit is the loss of reading ability. The neovascular form is the leading cause of vision loss in the developed world among people over 50 years of age. With ranibizumab (Lucentis) a drug treatment has become available, but, despite good outcome of visual acuity, patients often report that their reading ability has been affected. We aimed therefor to study reading performance with Tobii Eye Tracker in patients, treated with intravitrial Lucentis. Twenty patients, 15 female and 5 male (range 74 - 98 year), were recruited from St. Erik Eye Hospital. All had, before and after treatment, their reading speed, comprehension, fixations, saccadic eye movements measured while reading two texts with an equal readability rating. For all eye movement parameters, except the number of regressions per word, there was no statistically significant difference when comparing the results from before and after treatment. However, a statistically significant increase in the number of regressions per word after treatment as well as increased visual acuity and comprehension, were found. Reading is fundamental in our society and should be tested in order to fully understand a patient’s complaints; however, an increased VA will not necessarily equal an increased reading ability. The results also show that the Tobii system is suitable for evaluation of reading performance in a clinical setting, and can together with other tests, give valuable information about the patients complains and the outcome of a treatment.

Keywords

Reading Ability, Age-Related Macular Degeneration, Lucentis, Tobii Eye Tracker

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	N. M. Bressler, “Age-Related Macular Degeneration Is the Leading Cause of Blindness,” Journal of the American Medical Association, Vol. 291, No. 15, 2004, pp. 1900-1901.
[2]	N. Congdon, B. O’Colmain and C. C. Klaver, “Causes and Prevalence of Visual Impairment among Adults in the United States,” Archives of Ophthalmology, Vol. 122, No. 4, 2004, pp. 477-485. doi:10.1001/archopht.122.4.477
[3]	VIP Study Group and TAP Study Group, “Verteprofin Therapy of Subfoveal Choroidal Neovascularization in Age-Related Macular Degeneration. Meta-analysis of 2-Year Results in Three Randomized Clinical Trials: Treatment of Age-Related Macular Degeneration with Photodynamic Therapy and Verteporfin in Photodynamic Therapy Study Report No. 4,” Retina, Vol. 24, 2004, pp. 1-11.
[4]	J. M. Rakic, V. Lambert, L. Devy, et al., “Placental Growth Factor, a Member of the VEGF Family, Contributes to the Development of Choroidal Neovascularization,” Investigative Ophthalmology & Visual Science, Vol. 44, No. 7, 2003, pp. 3186-3193. doi:10.1167/iovs.02-1092
[5]	Verteporfin Roundtable 2000 and 2001 Participants, “Treatment of Age-related Macular Degeneration with Photodynamic Therapy (TAP) Study Group Principal Investigators; Verteporfin in Photodynamic Therapy (VIP) Study Group Principal Investigators. Guidelines for using verteporfin (Visudyne) in Photodynamic Therapy to Treat Choroidalneovascularization Due to Age-Related Macular Degeneration and Other Causes,” Retina, Vol. 22, 2002, pp. 6-18.
[6]	A. Otani, H. Takagi and H. Oh, “Vascular Endothelial Growth Factor Family and Receptor Expression in Human Choroidal Neovascular Membranes,” Microvascular Research, Vol. 64, No. 1, 2002, pp. 162-169. doi:10.1006/mvre.2002.2407
[7]	TAP Study Group, “Photodynamic Therapy of Subfoveoal Choroidal Neovascularization in Age-Related Macular Degeneration with Verteporfin. One-year Results of 2 Randomized Clinical Trials-TAP Report No. 1,” Archives of Ophthalmology, Vol. 117, 1999, pp. 1329-1345.
[8]	TAP Study Group, “Photodynamic Therapy of Subfoveal Choroidal Neovascularization in Age-Related Macular Degeneration with Verteporfin: Two-Year Results of Two Randomized Clinical Trials-TAP Report No. 2,” Archives of Ophthalmology, Vol. 119, 2001, pp. 198-207.
[9]	P. F. Lopez, B. D. Sippy and H. M. Lambert, “Transdifferentiated Retinal Pigment Epithelial Cells Are Immunoreactive for Vascular Endothelial Growth Factor in Surgically Excised Age-Related Macular Degenertion- Related Choroidal Neovascular Membranes,” Investigative Ophthalmology & Visual Science, Vol. 3, No. 5, 1996, pp. 855-868.
[10]	R. N. Frank, R. H. Amin and D. Eliott, “Basic Fibroblast Growth Factor and Vascular Endothelial Growth Factor Are Present in Epiretinal and Choroidal Neovascular Membranes,” American Journal of Ophthalmology, Vol. 122, 1996, pp. 393-403.
[11]	A. Kvanta, P.V. Algvere, L. Berglin and S. Seregard, “Subfoveal Fibrovascular Membranes in Age-Related Macular Degeneration Express Vascular Endothelial Growth Factor,” Investigative Ophthalmology & Visual Science, 1996, Vol. 37, No. 9, pp. 1929-1934.
[12]	P. J. Rosenfeld, D. M. Brown, J. S. Heier, D. S. Boyer, P. K. Kaiser, C. Y. Chung, R. Y. Kim and MARINA Study Group, “Ranibizumab for Neovascular Age-Related Macular Degeneration,” The New England Journal of Medicine, Vol. 355, No. 14, 2006, pp. 1419-1431. doi:10.1056/NEJMoa054481
[13]	C. D. Regillo, D. M. Brown, P. Abraham, H. Yue, T. Ianchulev, S. Schneider and N. Shams, “Randomized, Double-Masked, Sham-Controlled Trial of Ranibizumab for Neovascular Age-Related Macular Degeneration: PIER Study year 1,” American Journal of Ophthalmology, Vol. 145, No. 2, 2008, pp. 239-248. doi:10.1016/j.ajo.2007.10.004
[14]	D. M. Brown, P. K. Kaiser, M. Michels, G. Sourbrane, J. S. Heier, R. Y. Kim, J. P. Sy, S. Schneider and ANCHOR Study Group, “Ranibizumab versus Verteporfin for Neovascular Age-Related Macular Degeneration,” The New England Journal of Medicine, Vol. 355, No. 14, 2006, pp. 1432-1444. doi:10.1056/NEJMoa062655
[15]	P. S. Rothenbuehler, D. Waeber, K. C. Brinkmann, S. Wolf and E. K. Wolf-Schnurrbusch, “Effects of Ranibizumab in Patients with Subfoveal Choroidal Neovascularization Attributable to Age-related Macular Degeneration,” American Journal of Ophthalmology, Vol. 147, No. 5, 2009, pp. 831-817. doi:10.1016/j.ajo.2008.12.005
[16]	S. Richter-Mueksch, M. Stur, E. Stifter and W. Radner, “Differences in Reading Performance of Patients with Drusen Maculopathy and Subretinal Fibrosis after CNV,” Graefe’s Archive for Clinical and Experimental Ophthalmology, Vol. 244, No. 2, 2006, pp. 154-162. doi:10.1007/s00417-005-0063-y
[17]	R. Ram-Tsur, M. Faust, A. Caspi, C. R. Gordon and A. Z. Zivotivsky, “Evidence for Ocular Motor Deficits in Developmental Dyslexia: Application of the Double-Step Paradigm,” Investigative Ophthalmology & Visual Science, Vol. 47, No. 10, 2006, pp. 4401-4409. doi:10.1167/iovs.05-1657
[18]	D. A. Robinson, “A Method of Measuring Eye Movement Using A Scleral Search Coil in a Magnetic Field,” IEEE Transaction on Biomedical Engineering, Vol. 10, 1963, pp. 137-145.
[19]	C. von Hofsten and K. Rosander, “The Development of Gaze Control and Predictive Tracking in Young Infants,” Vision Research, Vol. 36, No. 1, 1996, pp. 81-96. doi:10.1016/0042-6989(95)00054-4
[20]	Tobii Technology, Inc., “Cognitive Psychology, Ophthal- mology and Neurophysiology,” http://www.tobii.com/System/images/icons/file_pdf_16.g
[21]	F. P. K?llmark, G. ?qvist and R. Brautaset, “Evaluation of Reading Performance in Clinical Settings Using the Tobii 1750 Eye Tracker,” Scandinavian Journal of Optometry and Visual Science, Manuscript Submitted 2008.
[22]	S. M. Sass, G. E. Legge and H. W. Lee, “Low-Vision Reading Speed: Influences of Linguistic Inference and Aging,” Optometry & Vision Science, Vol. 83, No. 3, 2006, pp. 166-177.
[23]	C. Bj?rnsson, “L?sbarhet,” Bokf?rlaget Liber, Stockholm, 1968.
[24]	F. P. K?llmark and J. Ygge, “Fixation Pattern in Healthy Subjects during Microperimetry with the Scanning Laser Ophthalmoscope,” Medical Science Monitor, Vol. 14, No. 6, 2008, pp. 311-315.
[25]	C. G. Kiss, W. Geitzenauer, C. Simader, G. Gregori, U. Schmidt-Erfurth, “Evaluation of Ranibizumab-Induced Changes of High-Resolution Optical Coherence Tomographic Retinal Morphology and Their Impact on Visual Function,” Investigative Ophthalmology & Visual Science, Vol. 50, No. 50, 2009, pp. 2376-2383.
[26]	N. M. Bressler, T. S. Chang, J. T. Fine, C. M. Dolan and J. Ward “Improved Vision-Related Function after Ranibizumab vs. Photodynamic Therapy: A Randomized Clinical Trial,” Archives of Ophthalmology, Vol. 127, No. 1, 2009, pp. 13-21. doi:10.1001/archophthalmol.2008.562
[27]	R. P. Carver, “Reading Rate: A Comprehensive Review of Research and Theory,” Academic Press Ltd., London 1990.
[28]	G. R. Watson, V. Wright and W. De Paune, “The Efficacy of Comprehension Training and Reading Praetice for Print Readers with Macular Loss,” Journal of Visual Impairment & Blindness, Vol. 86, No. 1, 1992, pp. 37-43.
[29]	K. Ciuffreda and B. Tannen, “Eyemovements Basics for the Clinician,” Moseby Year Book Inc., St. Louis, 1995, pp. 162-163.