title: Parafoveal letter recognition at reduced contrast in normal aging and in patients with risk factors for AMD.
abstract: BACKGROUND
  Patients with early age-related maculopathy (ARM) do not necessarily show obvious morphological signs or functional impairment. Many have good visual acuity, yet complain of decreased visual performance. The aim of this study was to investigate the aging effects on performance of parafoveal letter recognition at reduced contrast, and defects caused by early ARM and normal fellow eyes of patients with unilateral age-related macular degeneration (nfAMD).
  
  
  METHODS
  Testing of the central visual field (8 degrees radius) was performed by the Macular Mapping Test (MMT) using recognition of letters in 40 parafoveal target locations at four contrast levels (5, 10, 25 and 100%). Effects of aging were investigated in 64 healthy subjects aged 23 to 76 years (CTRL). In addition, 39 eyes (minimum visual acuity of 0.63;20/30) from 39 patients with either no visible signs of ARM, while the fellow eye had advanced age-related macular degeneration (nfAMD; n = 12), or early signs of ARM (eARM; n = 27) were examined. Performance was expressed summarily as a "field score" (FS).
  
  
  RESULTS
  Performance in the MMT begins to decline linearly with age in normal subjects from the age of 50 and 54 years on, at 5% and 10% contrast respectively. The differentiation between patients and CTRLs was enhanced if FS at 5% was analyzed along with FS at 10% contrast. In 8/12 patients from group nfAMD and in 18/27 from group eARM, the FS was statistically significantly lower than in the CTRL group in at least one of the lower contrast levels.
  
  
  CONCLUSIONS
  Using parafoveal test locations, a recognition task and diminished contrast increases the chance of early detection of functional defects due to eARM or nfAMD and can differentiate them from those due to aging alone.
authors.affiliation: Centre for Ophthalmology, University of Tübingen, Tübingen, Germany.
authors.forename: Gesa Astrid
authors.initials: GA
authors.lastname: Hahn
authors.forename: Andre
authors.initials: A
authors.lastname: Messias
authors.forename: Manfred
authors.initials: M
authors.lastname: Mackeben
authors.forename: Klaus
authors.initials: K
authors.lastname: Dietz
authors.forename: Karin
authors.initials: K
authors.lastname: Horwath
authors.forename: Lea
authors.initials: L
authors.lastname: Hyvärinen
authors.forename: Markku
authors.initials: M
authors.lastname: Leinonen
authors.forename: Susanne
authors.initials: S
authors.lastname: Trauzettel-Klosinski