TY - JOUR
T1 - Scanning laser ophthalmoscopic analysis of the pattern of visual loss in age-related geographic atrophy of the macula
AU - Sunness, J. S.
AU - Bressler, N. M.
AU - Maguire, M. G.
N1 - Funding Information:
From the Lions Vision Center (Dr. Sunness); Retinal Vascular Center (Drs. Sunness and Bressler); and Clinical Trials and Biometry Center (Drs. Bressler and Maguire), Wilmer Ophthalmological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland. This study was supported by research grant EY08552 from the National Eye Institute, National Institutes of Health; and by grants from the American Federation for Aging Research and the Macula Foundation, New York, New York. Reprint requests to Janet S. Sunness, M.D., Lions Vision Center, 550 N. Broadway, 6th Floor, Baltimore, MD 21205; fax: (410) 955-1829; E-mail address: janet@lions.med.jhu.edu.
Funding Information:
graphic atrophy, which is funded by the National Eye Institute, 60 patients were enrolled from July 1992 to May 1993. All enrolled patients had geographic atrophy in at least one eye. Geographic atrophy in this study was defined as at least one area of discrete retinal pigment epithelial atrophy of at least 500 μπι in diameter within one disk diameter of the fovea.
PY - 1995
Y1 - 1995
N2 - PURPOSE: We explored the clinical impression that geographic atrophy of the retinal pigment epithelium, a form of advanced age-related macular degeneration, is perceived by the patient as progressing gradually, even when fixation switches from foveal to extrafoveal. METHODS: We analyzed the responses of 60 patients with geographic atrophy to a questionnaire administered as part of a five-year study of the natural course of geographic atrophy, funded by the National Eye Institute. We performed scanning laser ophthalmoscope perimetry on all patients. We examined two additional patients with geographic atrophy who reported abrupt visual loss. RESULTS: No eye with geographic atrophy was reported by any patient to have had sudden visual loss. Although most patients with geographic atrophy show foveal fixation until the fovea is atrophic and then show extrafoveal fixation, scanning laser ophthalmoscope perimetry in three patients with geographic atrophy showed alternation between a foveal and an extrafoveal retinal locus for fixation. Two patients with geographic atrophy who complained of abrupt visual loss were found to have occult choroidal neovascularization, which evolved in one patient to classic choroidal neovascularization. The neovascularization was difficult to detect because of the presence of geographic atrophy and its associated ophthalmoscopic and fluorescein angiographic features. CONCLUSIONS: Visual loss in geographic atrophy is nearly always perceived by the patient as being gradual, even when considerable decreases m visual acuity occur and when foveal vision and fixation are lost. A possible explanation for this perception is that there is a transitional period during which a patient uses both a foveal and extrafoveal site for fixation. The complaint of abrupt visual loss in a patient with geographic atrophy should raise the suspicion of choroidal neovascularization, which may be occult and difficult to detect.
AB - PURPOSE: We explored the clinical impression that geographic atrophy of the retinal pigment epithelium, a form of advanced age-related macular degeneration, is perceived by the patient as progressing gradually, even when fixation switches from foveal to extrafoveal. METHODS: We analyzed the responses of 60 patients with geographic atrophy to a questionnaire administered as part of a five-year study of the natural course of geographic atrophy, funded by the National Eye Institute. We performed scanning laser ophthalmoscope perimetry on all patients. We examined two additional patients with geographic atrophy who reported abrupt visual loss. RESULTS: No eye with geographic atrophy was reported by any patient to have had sudden visual loss. Although most patients with geographic atrophy show foveal fixation until the fovea is atrophic and then show extrafoveal fixation, scanning laser ophthalmoscope perimetry in three patients with geographic atrophy showed alternation between a foveal and an extrafoveal retinal locus for fixation. Two patients with geographic atrophy who complained of abrupt visual loss were found to have occult choroidal neovascularization, which evolved in one patient to classic choroidal neovascularization. The neovascularization was difficult to detect because of the presence of geographic atrophy and its associated ophthalmoscopic and fluorescein angiographic features. CONCLUSIONS: Visual loss in geographic atrophy is nearly always perceived by the patient as being gradual, even when considerable decreases m visual acuity occur and when foveal vision and fixation are lost. A possible explanation for this perception is that there is a transitional period during which a patient uses both a foveal and extrafoveal site for fixation. The complaint of abrupt visual loss in a patient with geographic atrophy should raise the suspicion of choroidal neovascularization, which may be occult and difficult to detect.
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U2 - 10.1016/S0002-9394(14)73866-8
DO - 10.1016/S0002-9394(14)73866-8
M3 - Article
C2 - 7530408
AN - SCOPUS:0028801580
SN - 0002-9394
VL - 119
SP - 143
EP - 151
JO - American journal of ophthalmology
JF - American journal of ophthalmology
IS - 2
ER -