title: Functional loss in age-related Bruch's membrane change with choroidal perfusion defect.
abstract: During a prospective study of age-related macular degeneration, evidence of diffuse Bruch's membrane disease was sought using fluorescein angiographic evidence of a prolonged choroidal filling phase. Dark-adapted static perimetry was done on eight eyes with this angiographic sign and on six eyes with a similar number of drusen but no manifest choroidal perfusion abnormality. Scotopic threshold was measured using the Humphrey automated perimeter and fine matrix mapping. In eyes without delayed choroidal perfusion, no discrete areas of increased threshold were found compared with the background sensitivity. By contrast, in seven of the eight eyes with fluorescein angiographic evidence of prolonged choroidal filling, discrete areas of scotopic threshold elevation (up to 3.4 log units) were recorded; these corresponded closely to regions of choroidal perfusion abnormality. It was postulated that diffuse deposits of abnormal material might account for both the perfusion abnormality and functional loss by acting as a diffusion barrier between the choriocapillaris and the retinal pigment epithelium.
authors.affiliation: Department of Clinical Ophthalmology, Institute of Ophthalmology, London, England.
authors.forename: J C
authors.initials: JC
authors.lastname: Chen
authors.forename: F W
authors.initials: FW
authors.lastname: Fitzke
authors.forename: D
authors.initials: D
authors.lastname: Pauleikhoff
authors.forename: A C
authors.initials: AC
authors.lastname: Bird
mesh_terms: D000368:Aged; D000375:Aging / Q000502:physiology; D016570:Bruch Membrane / Q000503:physiopathology*; D002829:Choroid / Q000098:blood supply*; D015862:Choroid Diseases / Q000503:physiopathology; D003623:Dark Adaptation; D005260:Female; D005451:Fluorescein Angiography; D005654:Fundus Oculi; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008268:Macular Degeneration / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012684:Sensory Thresholds; D014792:Visual Acuity; D058609:Visual Field Tests