title: Blue on yellow perimetry with scanning laser ophthalmoscopy in patients with age related macular disease.
abstract: OBJECTIVE
  The loss of short wavelength sensitive (SWS) cone mechanism sensitivity is related to severe vision loss in patients with age related maculopathy (ARM). A case-control study of patients with ARM and age matched controls was performed, using blue on yellow static perimetry.
  
  
  METHODS
  A bright yellow background at 594 nm isolated the responses of short wavelength cone mechanisms to 458 nm targets. A scanning laser ophthalmoscope produced stimuli and provided real time, simultaneous fundus illumination. The macula was probed with 16 Goldmann IV targets, 1-10 degrees from fixation, using a staircase method.
  
  
  RESULTS
  24 patients with non-exudative ARM were matched to 24 subjects with normal fundus appearance. SWS cone pathway sensitivity for macular targets was significantly reduced in the patients with ARM compared to normals--15.45 (SD 4.56) dB v 17.22 (0.28) dB, respectively (p<0.0005). There was not only a diffuse loss of sensitivity in ARM patients, but also a localised loss of sensitivity over drusen (p<0.025). Neither the mean age, 69 (8) years, nor the mean visual acuity differed between groups, logMAR 0.09 (0.10) v 0.05 (0.06) for ARM patients v normals, respectively. Patients with soft drusen had lower sensitivity than those with hard drusen (p<0.05).
  
  
  CONCLUSIONS
  A loss of SWS cone pathway sensitivity occurred in most patients with early ARM, despite good visual acuity, demonstrating a loss of visual function that cannot be attributed to ageing changes. The loss of sensitivity, despite good visual acuity, included both a diffuse loss and localised losses.
authors.affiliation: Schepens Eye Research Institute, Harvard Medical School, Boston, MA 02114, USA. andreas.remky@post.rwth-aachen.de
authors.forename: A
authors.initials: A
authors.lastname: Remky
authors.forename: A E
authors.initials: AE
authors.lastname: Elsner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology; D016022:Case-Control Studies; D002648:Child; D003117:Color Vision Defects / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D007834:Lasers; D008268:Macular Degeneration / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D008297:Male; D008875:Middle Aged; D009887:Ophthalmoscopy / Q000379:methods; D017949:Retinal Cone Photoreceptor Cells / Q000503:physiopathology*; D014792:Visual Acuity; D058609:Visual Field Tests / Q000379:methods*