Visual function in patients with choroidal neovascularization resulting from age-related macular degeneration: the importance of looking beyond visual acuity.
OBJECTIVE
A detailed understanding of overall quality of vision may help primary care physicians, optometrists, and general ophthalmologists to improve the care of patients with choroidal neovascularization (CNV) resulting from age-related macular degeneration (AMD).


METHODS
Published literature was reviewed using Medline searches and the authors' knowledge of the field.


RESULTS
Both visual acuity and contrast sensitivity are strongly associated with the ability to perform vision-related activities of daily living. CNV resulting from AMD often leads to scotoma, which is also strongly associated with the ability to perform everyday activities such as reading and driving. Contrast sensitivity and visual field extent may be better predictors of many abilities than visual acuity. Laser photocoagulation, verteporfin therapy, and pegaptanib sodium have been proven to reduce the risk of visual acuity loss in patients with CNV resulting from AMD. Laser photocoagulation frequently causes scotoma, but data on its effects on other aspects of overall quality of vision are scarce. Verteporfin therapy has been shown to also reduce the risk of contrast sensitivity loss and has been associated with stabilization or reduction of scotoma size. Treatment effects beyond visual acuity have not been investigated for pegaptanib. Detailed assessment of overall quality of vision also aids the design of vision rehabilitation programs tailored to the needs of individual patients.


CONCLUSIONS
Understanding the impact of vision loss on patients with CNV resulting from AMD and assessing treatment benefits requires assessment of overall quality of vision. Primary care physicians and optometrists have an important role in ensuring that patients receive the best possible care, which can be aided by prompt referral to an ophthalmologist or retina specialist and collaboration with low-vision specialists and optometrists who together can make detailed assessments of overall quality of vision, implement appropriate treatment, and design effective rehabilitation strategies.
Department of Ophthalmology, Smith Kettlewell Eye Research Institute, San Francisco, California, USA. floridafletch@msn.com
Donald C
DC
Fletcher
Ronald A
RA
Schuchard
D020256:Choroidal Neovascularization / Q000209:etiology / Q000503:physiopathology*; D015350:Contrast Sensitivity / Q000502:physiology*; D018450:Disease Progression; D006801:Humans; D008268:Macular Degeneration / Q000150:complications* / Q000503:physiopathology; D011379:Prognosis; D014792:Visual Acuity / Q000502:physiology*; D014794:Visual Fields / Q000502:physiology*